Asia and cancer management

in the 21st century

Asia is on the cusp of a major cancer epidemic of unprecedented proportions. The population is expanding rapidly—many times faster than in Europe and the USA—and the proportion of people aged 65 years and older is rising at an even more alarming rate. Over the past 25 years, the population in China has increased by 31% and the number of people older than 65 years by 81%. By comparison, in the UK, the population has risen by 6% and the proportion of people aged 65 years or older by 7%. These disparities are worrying because most cancers present in people of older age. Indeed, current projections suggest that the number of new cases of cancer in Asia will increase from 3.5 million in 2002 to 8.1 million by 2020 if current prevention and management strategies remain unchanged.

Managing the cancer burden in Asia presents many unique challenges. About twice as many men in Asia smoke compared with their northern European counterparts, and the number of tobacco-related deaths is expected to double by 2025. This will equate to about 1 million men aged 25-69 years dying from tobacco-related causes per year in India alone. Similarly, infection is an underlying cause of nearly 20% of cancers worldwide; and in south-central Asia, 75% of the population carry Helicobacter Pylori, which increases the risk of stomach cancer by five to six times, and in south-east Asia, Hepatitis B is endemic, which substantially increases the risk of liver cancer. Exposure to sunlight is also a major source of cancer risk: the global solar UV index for Asia is about twice that of countries in the northern hemisphere. And finally, diet, nutrition, and physical exercise are all vital components of cancer risk, but the rapid rate of economic development in some Asian countries-534% increase in gross domestic product per capita in China over the past 25 years compared with 348% in the UK—along with the accompanying industrialisation and urbanisation, are contributing to an ever-increasing risk of cancers such as breast, colon, prostate, endometrium, kidney, and oesophagus.

Despite this backdrop, very few cancer screening programmes are available in Asia; access to treatment is inadequate—for example, Indonesia has fewer than an eighth of the number of radiotherapy machines needed to provide sufficient coverage for the entire population; and research is still but a fraction of the worldwide effort—in 2005, just 51 registered trials out of 3270 were being done in Asia. Perhaps unsurprisingly, the number of cancer survivors in Asia is very small compared with numbers in Europe and the USA.

The Lancet Asia Medical Forum 2007 offered a unique opportunity for leading regional and international experts to come together with a unified goal of addressing these issues. The Forum focussed on the ten most prevalent cancers in Asia-Pacific and examined aspects of prevention, diagnosis, treatment, and palliation. In addition, world opinion-leaders discussed cancer aetiology, health-care systems, and the challenges of providing effective disease management with limited resources, along with views on state-of-the-art techniques in the areas of diagnostics, medical oncology, radiation therapy, and surgical oncology. Finally, the Forum also hosted a didactic workshop on how to run a clinical trial, presented by world-renowned specialists, to help foster new clinical research.