About The Atlas

There has perhaps never been a more exciting time to be part of the fight against cancer. Never before have we faced such great challenge, or such great opportunity, in our work to combat this disease worldwide and to ultimately bring it under control.

In recent years, we have made marked progress against cancer in many countries. In the USA, for example, we have seen 20 successive years of declines in cancer mortality rates, which translates to a total of more than 1.3 million cancer deaths averted.

Yet as you will see in the pages of this Atlas, in far too many corners of the globe, cancer threatens lives and livelihoods as never before. Africa, for example, is poised to become the epicenter of the tobacco pandemic, which threatens to kill 1 billion this century, if left unchecked—many of those deaths from cancer. Other regions are threatened by this scourge as well. And across the map, low- and middle-income nations are struggling with how to effectively turn the tide against the rising threat of cancer and other chronic diseases, which is burdening ill-prepared health care systems and emerging economies alike.

If we are to bring cancer under control as a major public health problem, it will take all of us, working together, to do so. We must work across all sectors, and learn from and with one another, sharing the proven strategies and best buys we’ve developed while fighting this disease. The American Cancer Society is so pleased to participate in this second edition of the Cancer Atlas because it embodies this spirit of collaboration and the open exchange of information that must take place if we are to save more lives.

We at the Society believe this critical publication will be an essential and accessible resource for everyone involved in the cancer fight—from advocates and agencies to policymakers and patients, and everyone in between. This timely, evidence-based publication offers a wealth of compelling data to help combat cancer in communities and nations worldwide. Information is a powerful tool in the hands of passionate, dedicated individuals, and this book provides an unparalleled resource to arm and inform everyone committed to this fight.

This edition of The Cancer Atlas is unique because it brings together expert opinions from around the globe, with more than 40 contributing authors and peer reviewers. Just as it is designed as a resource for diverse groups, so too do the contributing experts come from diverse backgrounds, ranging from centers of academia to government institutions and nongovernmental organizations. It is also unique in its accessibility, as the Atlas will be available for the first time in an interactive and free online edition.

The American Cancer Society is committed to working relentlessly to save more lives from cancer both at home and worldwide, and to one day finishing this fight for good. We believe this second edition of The Cancer Atlas will be a valuable tool that helps us all work collectively toward this laudable— and achievable— goal. As you peruse the pages that follow, I am sure you will agree.

In September 2011 at the United Nations (UN) in New York, all countries committed to a Political Declaration on non-communicable diseases (NCDs), which many commentators suggested put cancer on the global health agenda for the very first time. It was only the second UN high-level meeting on a health issue—the previous one being on HIV/AIDS in 2001—and expectations were high that this significant event would be a turning point in the way cancer and the other NCDs would be addressed in future years in all countries.

Since then, the World Health Organization (WHO) has marshalled member states through a three-year process that has resulted in agreement to a global goal to reduce premature deaths through cancer and the other NCDs by 25% by 2025, a refreshed Global Action Plan on NCDs, and a large number of targets and indicators to be adopted by countries to measure their progress in delivering a dramatic change in the morbidity and mortality of cancer around the globe. A combination of effective advocacy, dynamic leadership from some countries and the infusion of great evidence and data at the appropriate junctures has placed cancer on the global health map for the very first time.

The Union for International Cancer Control (UICC) believes that we have sufficient knowledge on cancer prevention, early detection, and treatment services for cure and improving quality of life to achieve the goals set out by the United Nations, which we have now embedded in a refreshed World Cancer Declaration launched in Cape Town in November 2013. What we need is the engagement of governments and national cancer leaders around the world to put that knowledge into practice – wholeheartedly addressing cancer risk factors like tobacco use, implementing population-based vaccination and screening programs, reducing the myths, misconceptions and stigma so often associated with cancer through comprehensive education programs, and improving the way in which primary care informs and engages patients to encourage the early presentation of the disease. These steps do not need breakthrough science to be effective. They demand the application of known interventions which are effective in all situations, as well as the transfer of knowledge so the challenge of cancer becomes manageable in the minds of the many.

The Cancer Atlas is an important tool in our ambition to engage with communities around the world to convey the facts about a disease that is misunderstood by many who we hope will commit to address the disease in their country. The Atlas informs in a very clear and concise way the challenges faced in dealing with cancer around the world. It is a valuable addition to the toolkit of the advocate, the library of the oncologist, the knowledge of the patient, the resource base of the journalist, the database of government officials and scientists. UICC and its membership in more than 150 countries will ensure that the Atlas is available to all those committed to improve national cancer control planning. I am delighted that working with our partners the American Cancer Society and the International Agency for Research on Cancer (IARC), we have been able bring together such an impressive publication to inform the world.

We cannot treat our way out of the cancer problem. In even the wealthiest countries, the social and economic burden of cancer exacts a cost that cannot be met through improvements in therapy alone, however much targeted and refined to exploit the underlying molecular basis of the disease. Such necessary emphasis on clinical care must be complemented by public health measures, which include cancer prevention, early detection and diagnosis. The 2nd Edition of The Cancer Atlas serves as an outstanding reference both in content and form, providing a reliable foundation for action across the full spectrum of cancer control measures.

The first step to prevention is an understanding of the causes and, in this context the Cancer Atlas provides a valuable summary of major cancer risk factors, emphasizing the geographic variation in their prevalence. This theme of heterogeneity is continued in the descriptions of the regional variation in cancer burden. A clear picture of cancer incidence, mortality, survival and prevalence at regional and national levels is a vital platform for cancer control planning. Without such information there is a major risk of misplaced emphasis and wasted investment. The Cancer Atlas draws on the sources available, notably IARC’s GLOBOCAN database, but also provides a reminder of how much progress is still required in establishing reliable population-based cancer registries in many low and middle-income countries where data remain sparse. This paucity of data on occurrence also extends to include information on many of the risk factors. In this sense, this valuable publication can also be viewed as a call to greater action in these areas of surveillance.

The Cancer Atlas not only describes the problem but relates some of the available solutions, encompassing primary prevention, screening and early detection, treatment and palliative care. This comprehensive approach provides a balanced picture of what could be achieved already if the scientific evidence was to be translated into practice. Perhaps the most striking message from The Cancer Atlas, however, is not the variation in occurrence of risk factors and cancer patterns but the inequalities in access to the very interventions that can either prevent or effectively treat and manage the disease. This inequality is seen both between and within countries, and it is visible in respect to all aspects of cancer control and management. In relation to cancer, where you live affects your risk of developing the disease, how you live with the disease, and ultimately whether you survive the disease. One of the great cancer control challenges of the 21st century is to bring the benefits of effective interventions to as many people as possible, including in developing countries.

Cancer is a barrier to sustainable human development. This important conclusion is now being recognized at international and national levels, not least because of the emphasis placed by the United Nations on non-communicable diseases (NCDs). This political recognition must be translated to changing priorities particularly in relation to expenditure on development assistance for health, where donors to date have paid little attention to cancer and other NCDs. Here I am convinced The Cancer Atlas will provide its greatest value, in its superb presentation of reliable information in accessible, useable format for decision-makers, advocates, patients and the general public. I am confident, therefore, that the collaboration between the American Cancer Society, the Union for International Cancer Control, and IARC on The Cancer Atlas can be an agent for change in cancer control on a global scale.