data on the global cancer burden and discusses priorities for improving the information base. Cancer mortality, incidence, survival, and risk factor surveillance for cancer and other chronic diseases are highlighted (see Box 3-1 for definitions).

WORLDWIDE CHANGES IN MORTALITY PATTERNS

The decline of childhood mortality in developing countries is one of the most significant public health achievements of the 20th century. In 1950, nearly one-quarter of all children born died before their fifth birthday, most in infancy (Table 3-1). Today, about 8 percent will die before age 5. Much of the improvement is due to vaccinations against childhood infections, antibiotics against a wide range of bacterial infections, oral rehydration therapy for diarrhea, and in some places, generally improved living conditions. The upshot is that many more people are surviving to adulthood and old age—even in developing countries. This means more will eventually die from cancer, cardiovascular disease, chronic respiratory disease, diabetes, or another chronic condition of adulthood.

Today’s infants—about 130 million born each year—will experience a much different pattern of deaths than those born in the past century (Table 3-2)—assuming current patterns in risk factors. More than half will live to age 70 and older. Nearly one-third (40 million of each year’s birth cohort), however, will die in middle age, between ages 35 and 69. Most of these deaths will be from chronic, noncommunicable diseases. As many as half of these “premature” deaths could be prevented if patterns in major risk factors were modified, allowing people to live longer and die in old age. Specifically for cancer, the most practicable measures involve reversing the increases in smoking prevalence; preventing liver cancer through infant vaccination against hepatitis B virus (HBV); and preventing cervical cancer through a combination of vaccination against the cancer-causing human papillomaviruses, or HPVs, (as vaccines become available and affordable) and screening for precancerous or early stages.

The importance of cancer as a cause of illness and death will continue to grow, even with effective preventive measures. Appropriate cancer management—diagnosis and treatment—can extend the lives of many, particularly if diagnosed early. For those eventually dying from cancer (and other causes of death that involve chronic pain and other symptoms), at whatever age, palliative care with good pain control can vastly improve the quality of life of the patient and his or her family.



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