Burden of Cancers Related to Smoking among the Indonesian Population: Premature Mortality Costs and Years of Potential Life Lost

Background: As smoking is the leading preventable cause of multiple diseases and premature cancer deaths,estimating the burden of cancer attributable to smoking has become the standard in documenting the adverseimpact of smoking. In Indonesia, there is a dearth of studies assessing the economic costs of cancers related tosmoking. This study aimed to estimate indirect mortality costs of premature cancer deaths and years of potentiallife lost (YPLL) attributable to smoking among the Indonesian population. Materials and Methods: A prevalencebased method was employed. Using national data, we estimated smoking-attributable cancer mortality in 2013.Premature mortality costs and YPLL were estimated by calculating number of cancer deaths, life expectancy,annual income, and workforce participation rate. A human capital approach was used to calculate the presentvalue of lifetime earnings (PVLE). A discount rate of 3% was applied. Results: The study estimated that smokingattributable cancer mortality was 74,440 (30.6% of total cancer deaths), comprised of 95% deaths in men and 5%in women. Cancers attributed to smoking wereresponsible for 1,207,845 YPLL. Cancer mortality costs causedby smoking accounted for USD 1,309 million in 2013. Among all cancers, lung cancer is the leading cause ofdeath and economic burden. Conclusions: Cancers related to smoking pose an enormous economic burden inIndonesia. Therefore, tobacco control efforts need to be prioritized in order to prevent more losses to the nation.The data of this study are important for advocating national tobacco control policy.     

Estimating the Burden of Cancers Attributable to Smoking Using Disability Adjusted Life Years in Indonesia

Tobacco use is a well-established risk factor for many types of cancers. Recent data on selected cancer incidence and mortality related to smoking in the Indonesian population are provided in this study. Morbidity and mortality data were derived from GLOBOCAN 2012 and the population attributable fraction (PAF) was estimated using the standard methodology developed by the World Health Organization. Using these data, we calculated disability adjusted life year (DALY) values for smoking-related cancer. The DALY was estimated by summation of the years lived with disability (YLD) and years life lost due to premature death (YLL). The cancer cases related to smoking in Indonesia numbered 45,132, accounting for 35,580 cancer deaths. The morbidity and mortality of lung cancer can be considered as the highest priority in both men and women. Furthermore the greatest YLD due to smoking in Indonesian men and women were from pancreas and lung cancers. For YLL among men, the highest years lost were from lung and liver cancers. On the other hand, among women lung oral cavity and lip were most important. Based on the DALY indicator, burden priorities for Indonesian men were lung cancer (298,980), liver cancer (60,367), and nasopharynx (46,185), while among Indonesian women they were lung cancer (34,119), cervix uteri (9,213) and pancreas cancer (5,433). In total, Indonesian burden of cancers attributed to smoking was 638,682 DALY. This study provides evidence about the burden of cancers caused by smoking as a rational basis for initiating national tobacco control policies in Indonesia.     

Risk of Cancer Mortality according to the Metabolic Health Status and Degree of Obesity

Background: We investigated the risk of cancer mortality according to obesity status and metabolic healthstatus using sampled cohort data from the National Health Insurance system. Materials and Methods: Data onbody mass index and fasting blood glucose in the sampled cohort database (n=363,881) were used to estimaterisk of cancer mortality. Data were analyzed using a Cox proportional hazard model (Model 1 was adjusted forage, sex, systolic blood pressure, diastolic blood pressure, total cholesterol level and urinary protein; Model 2 wasadjusted for Model 1 plus smoking status, alcohol intake and physical activity). Results: According to the obesitystatus, the mean hazard ratios were 0.82 [95% confidence interval (CI), 0.75-0.89] and 0.79 (95% CI, 0.72-0.85)for the overweight and obese groups, respectively, compared with the normal weight group. According to themetabolic health status, the mean hazard ratio was 1.26 (95% CI, 1.14-1.40) for the metabolically unhealthygroup compared with the metabolically healthy group. The interaction between obesity status and metabolichealth status on the risk of cancer mortality was not statistically significant (p=0.31). Conclusions: We found thatthe risk of cancer mortality decreased according to the obesity status and increased according to the metabolichealth status. Given the rise in the rate of metabolic dysfunction, the mortality from cancer is also likely to rise.Treatment strategies targeting metabolic dysfunction may lead to reductions in the risk of death from cancer.     

Premature mortality due to cancer in Japan, 1995 and 2005

To better understand premature mortality due to cancer, we estimated years of life lost (YLL) and average years of life lost (AYLL) due to cancer for the years 1995 and 2005, based on data from the Vital Statistic of Japan. In men, we identified a total of 159,623 cancer deaths in 1995 and 196,603 in 2005. Total YLL were 2,342,560.4 and 2,724,066.0 years, respectively. Averaged for all cancers, people died 14.7 years earlier than life expectancy in 1995 and 13.9 years in 2005. AYLL was longest for brain cancer deaths, at 26.3 years earlier than expected in 1995 and 22.8 years in 2005, followed by leukemia. In women, a total of 103,399 cancer deaths occurred in 1995 and 129,338 in 2005. Total YLL were 1,818,960.4 years in 1995 and 2,160,706.5 years in 2005, corresponding to AYLL for all cancer combined of 17.6 and 16.7 years. The AYLL of brain cancer deaths was also the longest, at 29.4 years in 1995 and 27.8 in 2005, followed by leukemia and female sex‐related cancers. Results showed that cancer of the stomach, colorectum, liver and lung were the most frequent cancers in both sexes in both 1995 and 2005 and responsible for a remarkable number of YLL. Further, AYLL was greatest for brain cancer and leukemia in both sexes and for sex‐related cancers in women, namely breast, cervix and ovarian cancer.     

云南省肿瘤登记地区2012年恶性肿瘤发病与死亡分析

[目的]评估2012年云南省肿瘤登记地区恶性肿瘤发病与死亡.[方法]收集2012年云南省3个肿瘤登记地区上报的恶性肿瘤发病与死亡资料,计算恶性肿瘤发病率、死亡率、前10位恶性肿瘤顺位、构成比、累积率;采用2000年中国标准人口构成和Segi’s世界人口构成分别计算中国和世界人口年龄标化发病/死亡率(中标率和世标率).[结果] 2012年云南省3个肿瘤登记地区共覆盖人口1 483 539人(其中城市429 953人,农村1 053 586人),恶性肿瘤新发病例2861例,死亡病例1775例.恶性肿瘤病理诊断比例为73.53％,只有死亡证明书比例为3.10％,死亡发病比为0.62.全部恶性肿瘤发病率为192.85/10万(男性200.71/10万,女性184.82/10万),中标率为184.60/10万,世标率为144.61/10万,累积率(0～74岁)为16.41％.城市地区发病率(211.88/10万)高于农村地区(185.05/10万).全部恶性肿瘤死亡率为119.65/10万(男性142.39/10万,女性96.43/10万),中标率为113.65/10万,世标率为88.79/10万,累积率(0～74岁)为10.14％.城市地区死亡率(125.36/10万)高于农村地区(117.31/10万).肺癌、结直肠癌、肝癌、宫颈癌、女性乳腺癌是云南省常见的恶性肿瘤,占全部新发病例的53.27％.肺癌、肝癌、结直肠癌、胃癌、乳腺癌是威胁云南省居民生命健康的主要恶性肿瘤,占死亡病例的61.75％.[结论]2012年云南省肿瘤登记地区主要恶性肿瘤为肺癌、肝癌、胃癌、结直肠癌、宫颈癌和女性乳腺癌.     

Mortality Attributable to Second Hand Smoking in Morocco: 2012 Results of a National Prevalence Based Study

Purpose: To estimate the number of deaths attributable to second hand smoking (SHS) in Morocco in 2012. Materials and Methods: prevalence based study focusing on mortality from ischaemic heart disease (IHD) and lung cancer among non-smokers aged 35 and over. Prevalence of SHS among never smokers was gathered from a national cross sectional survey on tobacco and population attributable risk (PAR) was calculated by applying PARs to mortality. The analyses were stratified by sex, age and area of exposure. Results: Rates for exposure to SHS among men aged 35-64 years ranged from 20.0% at home to 57.4% at work. Among non-smoking Moroccans aged 35 and over, 233 (IC: 147 - 246) deaths were attributable to exposure to SHS; 156 (IC: 100 - 221) in women and 77 (IC: 44 -125) in men. A total of 173 (122 - 222) deaths were estimated to have been caused by exposure only at home, 34 (9 - 76) by exposure only at the work place and 26 (15 - 58) by exposure both at home and work places. Exposure to SHS could be responsible for 182 (128 - 237) deaths from IHD and 51 (19 - 109) from lung cancer. Conclusions: These data confirm that SHS needs urgent attention in Morocco.     

Geographic Characteristics of Various Cancers in Yogyakarta Province,Indonesia: A Spatial Analysis at the Community Level

Background: Cancer remains a significant public health problem in Indonesia and worldwide. Yogyakarta Province has the largest number of cancer cases in Indonesia. Maps of the distribution of cancer cases are useful tools for stratification of cancer risk and for selective prevention strategies. The aim of this study was to determine the spatial distribution of cancer cases in Yogyakarta Province. Methods: Cancer patient data registered by the Yogyakarta Provincial Health Office during 2019-2020 were analysed in this study (n=9,933). To evaluate cancer pattern distributions, ArcGIS 10.2 and Excel 2016 software were used. Results: The mean participant age (± standard deviation) was 55.08 ± 15.46 years, and 79.40% were female. Breast and cervical cancer were the most frequently diagnosed, and the majority of patients were located in Sleman district. The incidence of all cancer types varied by county-level. The majority of cancer patients lived below the poverty line. Cancer screening rates were low, and screening was limited to breast and cervical cancer. Conclusion: Various types of cancers were identified in Yogyakarta, Indonesia; of them, breast and cervical cancer predominated. Most of the cancer patients were from Sleman district and economically poor areas. Geospatial techniques are useful for identifying environmental factors related to cancer and improving cancer control strategies and resource allocation.     

LMP1 and LMP2 may be Prognostic Factors for Outcome ofTherapy in Nasopharyngeal Cancers in Indonesia

Nasopharyngeal carcinoma (NPC) is an epithelial malignancy that is invasive and metastasizes easily. Inseveral Asian countries it is the most commonly found of the head and neck malignancies. Epstein Barr virus(EBV) infection is one of the agents causing NPC, so that expression of LMP1 and LMP2 may affect the outcomeof therapy, metastasis, recurrence, and survival of NPC patients. This study aimed to investigate their expressionin relation to therapy outcome and survival in a series of Indonesian NPC patients. The methods used werenested case control and Kaplan-Meier survival analysis. Differences in therapy outcome in relation to LMP1and LMP2 expression were analyzed through chi square statistics. As a result, in post treatment NPC, there wasa significant difference in therapy outcome between LMP2 (+) compared to LMP2 (-) (P = 0.001). There wasalso a significant difference in 24-months-survival between NPCs expressing LMP1 (+) or LMP2 (+) comparedto those expressing LMP1 (-) or LMP2 (-).     

Cancer Premature Mortality Costs in Europe in 2020: A Comparison of the Human Capital Approach and the Friction Cost Approach

The inclusion of productivity costs can affect the outcome of cost-effectiveness analyses. We estimated the value of cancer premature mortality productivity costs for Europe in 2020 using the Human Capital Approach (HCA) and compared these to the Friction Cost Approach (FCA). Cancer mortality data were obtained from GLOBOCAN 2020 by sex and five-year age groups. Twenty-three cancer sites for 31 European countries were included. The HCA and the FCA were valued using average annual gross wages by sex and age group and applied to Years of Potential Productive Life Lost. 2020 friction periods were calculated and all costs were in 2020 euros. Estimated cancer premature mortality costs for Europe in 2020 were EUR 54.0 billion (HCA) and EUR 1.57 billion (FCA). The HCA/FCA cost ratio for Europe was 34.4, but considerable variation arose across countries (highest in Ireland: 64.5 v lowest in Czech Republic: 11.1). Both the HCA and the FCA ranked lung, breast and colorectal as the top three most costly cancers in Europe, but cost per death altered rankings substantially. Significant cost differences were observed following sensitivity analysis. Our study provides a unique perspective of the difference between HCA and FCA estimates of productivity costs by cancer site and country in Europe.     

Cigarette Consumption and Nutrient Intake in Indonesia: Study of Cigarette-Consuming Households

Objective: This study aims to investigate the impact of cigarette consumption on household’s nutrition adequacy (NA). This study also examines the opportunity cost of cigarette expenditure to children’s nutritional adequacy. Methods: We used an Indonesian cross-sectional household level nationwide data of 2018 National Socio-Economic Survey (SUSENAS). Using multivariate Ordinary Least Square (OLS) regression, we estimated the impact of cigarette consumption on household’s NA as defined by household protein and energy intakes. With the same specification, we further ran a segregated OLS regression by household quintile expenditure. While the opportunity cost of cigarette consumption to children’s nutrition adequacy defined the estimated forgone nutrition due to cigarette consumption by following the Ministry of Health (MOH) definition of Recommended Dietary Allowance (RDA) for children aged 4 – 6. Results: Cigarette consumption decreases household’s protein and energy intakes. We found statistically significant correlation between household’s cigarette consumption and household’s per capita protein intake while no statistically significant correlation on energy intake. Furthermore, the segregated estimate is significant for both protein and energy intakes among 60% lowest household quintile expenditure groups. The lower the quintile expenditure, the higher the decline in household NA due to cigarette consumption. With the average cigarette expenditure of IDR12,956 per household per day, giving up daily cigarette spending could meet children’s energy intake by 27% – 85,4% of RDA and protein intake by 180.12% – 300.48% of RDA. Conclusion: Household cigarette consumption has negative impact on household’s daily energy and protein intakes. The poorest group is most vulnerable to nutrition inadequacy due to cigarette consumption. Giving up household’s cigarette expenditure daily could result in a substantial nutrition gain for children at their critical growth stages.     

Estimating the Incidence of Leukemia Attributable to Occupational Exposure in Iran

Objective: The aim this study was to estimate the fraction of leukemia incidence in Iran attributable tooccupational exposure to benzene, ionizing radiation, and ethylene oxide. Methods: Nationwide exposure toeach of these leukemogens was estimated using workforce data available at the ILO (International LaborOrganization) website. The prevalence of exposure to leukemogens in each industry was estimated using exposuredata from the CAREX (CARcinogen EXposure) database. The magnitude of the relative risk of leukemia foreach leukemogen was from published literature. Using the Levin’s population attributable risk (incidence),fractions of leukemia incidences attributed to workplace leukemogens were then estimated. Results: The totalworkforce in Iran according to the 1995 census included 12,488,020 men and 677,469 women. Agriculture wasthe largest sector with 24.5% of the males and 0.27% of the females, and the electricals-related sector was thesmallest with 1.16% of the males and 0.66% of the females. After applying the CAREX exposure estimates toeach sector, the proportion exposed to leukemogens was 0.016% for male workers and 0.02% for female workers.Estimating a relative risk of 3.6 (95% CI of 3.2–4.2) for high exposure and 1.9 (95% CI 1.7–2.1) for low exposureand employing the Levin’s formula, the fraction of leukemia attributed to leukemogens in the workplaces amongfemales was 3.6% (95% CI of 3.1-4.5) and among males was 7.6% (95% CI of 6.4-9.2). These fractionscorresponded to estimated incidences of 0.60 (95% CI of 0.50-0.70) and 0.22 (95% CI of 0.16-0.23) cases ofleukemia per 100,000 populations for males and females, respectively. Conclusion: The incidence of leukemiadue to occupational exposure is very low in Iran, although males are at greater risk than females.     

浙江省1990～2002年恶性肿瘤死亡特征分析

[目的]分析恶性肿瘤的死亡特征，为开展恶性肿瘤防治和研究工作提供信息。[方法]以死亡率作为分析指标，比较全部恶性肿瘤和主要肿瘤的分城市农村和性别的年龄别死亡率，分别计算1990年～1992年和2000年～2002年标化死亡率，并比较其变化情况。[结果]城市农村恶性肿瘤死亡均占全死因的首位。1990年～2002年浙江省恶性肿瘤死亡率为131．85／10万，城市居民死亡率前3位分别为肺癌、肝癌和胃癌，农村地区则为胃癌、肝癌和肺癌。1990年～1992年和2000年～2002年两阶段总恶性肿瘤死亡率比较．城市居民男女分别上升5．44％和3．75％，而农村居民男性上升了17．55％，女性上升了18．06％。无论城市还是农村地区，女性肺癌死亡率上升均超过36％。[结论]胃癌、肝癌、肺癌是浙江省肿瘤的主要死亡原因，在重视城市地区肿瘤防治的同时，农村地区工作不容忽视。女性肺癌快速上升原因有待进一步研究。     

涡阳县常见恶性肿瘤死亡率分析

[目的]了解安徽省涡阳县恶性肿瘤死亡状况及趋势,为制订本地区肿瘤防治策略提供依据.[方法]采用流行病学回顾性调查法,由各村医生收集本村所有死亡病例上报,设计调查表入户调查;计算恶性肿瘤死亡率;用Cox-Stuart法分析其死亡趋势.[结果]1992年～2001年安徽省涡阳县的恶性肿瘤死亡率呈总体上升趋势(P＜0.05),粗死亡率从81.78/10万(标化率为78.35/10万)上升至150.93/10万(标化率为143.23/10万),居死因首位.女性恶性肿瘤死亡率增长速度高于男性.男性恶性肿瘤死亡居前6位的分别是胃癌、肝癌、肺癌、食管癌、肠癌、白血病.其中白血病增速最快,其他依次为肠癌、胃癌、肺癌、肝癌;食管癌死亡率呈下降趋势,但未见显著性(P＞0.05).女性恶性肿瘤死亡居前6位的分别为胃癌、肺癌、食管癌、肝癌、乳腺癌、宫颈癌.其中肝癌增速最快,其他依次为宫颈癌、肺癌、乳腺癌.食管癌死亡率呈下降趋势.胃癌死亡率呈下降趋势,但无显著性(P＞0.05).[结论]安徽省涡阳县1992年～2001年恶性肿瘤死亡呈总体上升趋势,胃癌、肺癌、白血病、肝癌、肠癌、女性乳腺癌、宫颈癌为防治的重点.     

Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries

This article provides an update on the global cancer burden using the GLOBOCAN 2020 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer. Worldwide, an estimated 19.3 million new cancer cases (18.1 million excluding nonmelanoma skin cancer) and almost 10.0 million cancer deaths (9.9 million excluding nonmelanoma skin cancer) occurred in 2020. Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%), followed by lung (11.4%), colorectal (10.0 %), prostate (7.3%), and stomach (5.6%) cancers. Lung cancer remained the leading cause of cancer death, with an estimated 1.8 million deaths (18%), followed by colorectal (9.4%), liver (8.3%), stomach (7.7%), and female breast (6.9%) cancers. Overall incidence was from 2-fold to 3-fold higher in transitioned versus transitioning countries for both sexes, whereas mortality varied <2-fold for men and little for women. Death rates for female breast and cervical cancers, however, were considerably higher in transitioning versus transitioned countries (15.0 vs 12.8 per 100,000 and 12.4 vs 5.2 per 100,000, respectively). The global cancer burden is expected to be 28.4 million cases in 2040, a 47% rise from 2020, with a larger increase in transitioning (64% to 95%) versus transitioned (32% to 56%) countries due to demographic changes, although this may be further exacerbated by increasing risk factors associated with globalization and a growing economy. Efforts to build a sustainable infrastructure for the dissemination of cancer prevention measures and provision of cancer care in transitioning countries is critical for global cancer control.     

Estimating the Economic Burden of Premature Mortality Caused by Cancer in Iran: 2006-2010

Background: Cancer is currently one of the main public health problems all over the world and its economic burden is substantial both for health systems and for society as a whole.To inform priorities for cancer control, we here estimated years of potential life lost (YPLL) and productivity losses due to cancer-related premature mortality in Iran from 2006 to 2010. Materials and Methods: The number of cancer deaths by sex and age groups for top ten leading cancers in Iran were obtained from the Ministry of Health and Medical Education. To estimate theYPLL and the cost of productivity loss due to cancer-related premature mortality, the life expectancy method and the human capital approach were used, respectively. Results: There were 138,228 cancer-related deaths in Iran (without Tehran province) of which 76 % (106,954) were attributable to the top 10 ranked cancers. Some 63 % of total cancer-related deaths were of males. The top 10 ranked cancers resulted in 106,766,942 YPLL in total, 64,171,529 (60 %) in males and 42,595,412 (40%) in females. The estimated YPPLL due to top 10 ranked cancers was 58,581,737 during the period studied of which 32,214,524 (54%) was accounted for in males.The total cost of lost productivity caused by premature deaths because of top 10 cancers was 1.68 billion dollars (US$) from 2006 to 2010, ranging from 251 million dollars in 2006 to 283 million dollars in 2010. Conclusions: This study showed that the economic burden of premature mortality attributable to cancer is significant for Iranian society. The findings provide useful information about the economic impact of cancer for health system policy/ decision makers and should facilitate planning of preventive intervention and effective resource allocation.     

Trends in Early Mortality From Multiple Myeloma: A Population-Based Analysis

IntroductionDespite significant improvements in multiple myeloma (MM) treatment modalities, patient mortality early in the course of disease has been identified as a persistent phenomenon with variable reported rates and causes. Trends in early mortality over time have not been clearly defined.Patients and MethodsThe Surveillance Epidemiology and End Results (SEER) database was used to identify adult patients with MM between 1975 and 2015. Association of available sociodemographic factors with all-cause and MM-specific early mortality (death within 6 months after the diagnosis of MM) was conducted by multivariate analysis. Trends in early mortality were studied by joinpoint regression analysis.ResultsOf the 90,975 MM cases included in this analysis, early mortality was noted in 21%. Median age was 68 years overall, and 75 years for the early mortality cohort (P < .01). The most common causes of death for early mortality were MM itself, followed by cardiovascular, infections, and renal failure. Male gender, “other” race/ethnicity group, advancing age, and West, Midwest or South regions (reference Northeast) were associated with increased risk of both all-cause and MM-specific early mortality. Joinpoint regression analysis of trends data resulted in 1 joinpoint for all-cause 6-month mortality (2006-2015), while 2 joinpoints were noticed for myeloma-specific 6-month mortality (1975-1987 and 2003-2015).ConclusionEarly mortality remains a significant unmet need for MM patient care, despite improving trends in recent years. Understanding the factors associated with early mortality can help develop individualized plans of patient care and mitigate circumstances that may contribute to early mortality among MM patients.     

Attributable Causes of Liver Cancer Mortality and Incidence in China

Objectives: To estimate the proportion of liver cancer cases and deaths due to infection with hepatitis B virus(HBV), hepatitis C virus (HCV), aflatoxin exposure, alcohol drinking and smoking in China in 2005. Studydesign: Systemic assessment of the burden of five modifiable risk factors on the occurrence of liver cancer inChina using the population attributable fraction. Methods: We estimated the population attributable fractionof liver cancer caused by five modifiable risk factors using the prevalence data around 1990 and data on relativerisks from meta-analyses, and large-scale observational studies. Liver cancer mortality data were from the 3rdNational Death Causes Survey, and data on liver cancer incidence were estimated from the mortality data fromcancer registries in China and a mortality/incidence ratio calculated. Results: We estimated that HBV infectionwas responsible for 65.9% of liver cancer deaths in men and 58.4% in women, while HCV was responsible for27.3% and 28.6% respectively. The fraction of liver cancer deaths attributable to aflatoxin was estimated to be25.0% for both men and women. Alcohol drinking was responsible for 23.4% of liver cancer deaths in men and2.2% in women. Smoking was responsible for 18.7% and 1.0% . Overall, 86% of liver cancer mortality andincidence (88% in men and 78% in women) was attributable to these five modifiable risk factors. Conclusions:HBV, HCV, aflatoxin, alcohol drinking and tobacco smoking were responsible for 86% of liver cancer mortalityand incidence in China in 2005. Our findings provide useful data for developing guidelines for liver cancerprevention and control in China and other developing countries.