The global burden of women's cancers: a grand challenge in global health

Abstract

Every year, more than 2 million women worldwide are diagnosed with breast or cervical cancer, yet where a woman lives, her socioeconomic status, and agency largely determines whether she will develop one of these cancers and will ultimately survive. In regions with scarce resources, fragile or fragmented health systems, cancer contributes to the cycle of poverty. Proven and cost-effective interventions are available for both these common cancers, yet for so many women access to these is beyond reach. These inequities highlight the urgent need in low-income and middle-income countries for sustainable investments in the entire continuum of cancer control, from prevention to palliative care, and in the development of high-quality population-based cancer registries. In this first paper of the Series on health, equity, and women's cancers, we describe the burden of breast and cervical cancer, with an emphasis on global and regional trends in incidence, mortality, and survival, and the consequences, especially in socioeconomically disadvantaged women in different settings.

Fig 1a

Global map of the age-standardised (world) incidence rates of female breast cancer in 2012, with the range divided into quintiles. Source: GLOBOCAN (http://globocan.iarc.fr)

Fig 1b

Global map of the age-standardised (world) mortality rates of female breast cancer in 2012, with the range divided into quintiles. Source: GLOBOCAN (http://globocan.iarc.fr)

Fig 1c

Global map of the age-standardised (world) incidence rates of cervical cancer in 2012, with the range divided into quintiles. Source: GLOBOCAN (http://globocan.iarc.fr)

Fig 1d

Global map of the age-standardised (world) mortality rates of cervical cancer in 2012, with the range divided into quintiles. Source: GLOBOCAN (http://globocan.iarc.fr)

Figure 2

Global distribution of age-standardised 5-year net survival (%) for women diagnosed aged 15-99 years with (a) breast or (b) cervical cancer during 2005–09, by continent and country. Legend: Survival estimates for each country are ranked from highest to lowest within each continent: Africa (grey), America (Central and South) (red); America (North) (light red); Asia (yellow); Europe (blue); Oceania (green). Error bars represent 95% confidence intervals. Survival estimates are flagged as follows: *=100% coverage of national population; †=not age-standardised, or §=less reliable because the only estimate(s) available are from a registry or registries in this category.

Figure 3

The proportion of new cases of cervical and breast cancer in 2012 compared with the total cancer burden from all cancers combined in both sexes by country and four-level Human Development Index (HDI), and sort by HDI within these quartiles. Source: GLOBOCAN (http://globocan.iarc.fr)

Figure 4

Estimated annual percentage change (EAPC) 1993-2007 based on cancer incidence obtained from cancer registries included in several volumes of Cancer Incidence in Five Continents (top). Predicted number of breast and cervical cases (thousands) in 2030 assuming average trends in the EAPC are observed in every country up to 2030 seen in the incidence series, or assuming rates remain unchanged in every country from those estimated in GLOBOCAN in 2012.

Figure 5

Age-adjusted DALYs per 100 000 population for cervical and breast cancer in 2008 and four-level Human Development Index. DALYs=disability-adjusted life-years. YLL=years of life lost. YLD=years of life lived with disability. Source: Soerjomataram et al.