ADVOCACY
increase in the number of cancer cases.
Chief among these risk factors is tobacco. Tobacco use is the
single greatest reason for the continued growth in cancer
With the global spread of consumer
incidence and mortality rates. Today, nearly a billion men and
cultures originating in economically
more than 250 million women are regular smokers – about
developed nations, people in low- and
20% of the world’s population. If current trends continue,
middle-income countries are
tobacco use will kill about 650 million people living today,
increasingly adopting “Western”
including as many as 325 million of the world’s current
lifestyles and behaviours, including
children and teenagers6. Lung cancer and heart disease will
changes in diet and physical activity
account for the majority of these deaths. Of those who
succumb to tobacco-related disease, half will die in middle age
(ages 35–65), just when they are needed most to manage and
support their personal households and local economies7. nations to greater than 75% in urban Samoa. However, even in
In many parts of the world, tobacco is the leading risk factor countries like China where prevalence is low, obesity rates in
for cancer. Recent estimates suggest about 25% of all cancer some cities are almost 20%13. Perhaps even more troubling is
deaths are attributable to tobacco use, and in some parts of the increasing number of overweight and obese children.
the developed world, that number increases to a third of all Worldwide, 40 million pre-school children younger than five
cancer deaths8. In other parts of the world, the number of are estimated to be overweight14.
tobacco-related cancers is lower, but threatens to grow in the Increases in overweight and obesity reflect societal
future. Tobacco use and tobacco-related disease and death are changes. With the global spread of consumer cultures
growing fastest in low- and middle-income countries. By 2025, originating in economically developed nations, people in low-
tobacco will account for nearly 7 million deaths annually in and middle-income countries are increasingly adopting
9
these regions . China alone predicts 2 million tobacco-related “Western” lifestyles and behaviours, including changes in diet
deaths annually by 202510. and physical activity. It is estimated that lack of physical
Poor diet and lack of exercise, along with overweight and activity accounts for 9% of premature mortality worldwide15.
obesity, increases the risks of breast cancer (among post- Shifts toward less physically demanding work have been
menopausal women) as well as cancers of the colon, prostate, accompanied by the globalization of food markets and
endometrium, kidney, and gallbladder among others. spreading of the fast food industry. Together, these trends
Altogether these risk factors account for up to a third of all have fed the obesity epidemic.
cancer deaths in some countries11. Worldwide, more than 1.4 Infectious agents currently account for about a quarter of all
billion adults are overweight. Of these, nearly 500 million are cancers in low- and middle-income countries and 17% of all
clinically obese. The prevalence of obesity has nearly doubled cancers worldwide16. Infectious agents associated with cancer
12
over the last 30 years . Although the number of overweight include human papillomavirus or HPV (cervical cancer),
and obese adults is higher in the developed world, the hepatitis B and C (liver cancer), and Helicobacter pylori
developing world is quickly catching up. Tragically, a number of (stomach cancer), among others. In some of these cases,
low- and middle-income countries are facing a double burden vaccination and early detection can significantly reduce the
of malnutrition and rising obesity. The prevalence of obesity number of new cancer cases and deaths. Pap tests to detect
ranges from below 5% in China, Japan, and most African cervical cancer and vaccination against hepatitis B to prevent
liver cancer have already had a significant impact in many parts
of the world. Other promising interventions, such as visual
inspection for cervical cancer and vaccines for HPV, could
Poor diet and lack of exercise, along
further reduce cancer incidence and mortality rates.
with overweight and obesity, increases
Palliative care, especially pain relief, remains an important
the risks of breast cancer (among post-
quality-of-life issue throughout the world and a particularly
menopausal women) as well as cancers
critical problem in many low- and middle-income countries. At
of the colon, prostate, endometrium,
present, a million people in these countries are dying annually
kidney, and gallbladder among others
with unrelieved cancer pain. By 2020, that number is
projected to grow to two million. Cost is often less of a barrier
to effective pain relief than are policy issues. For example,
CANCER CONTROL 2013 143