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 Cancer

The human body is constantly creating new cells and destroying or reabsorbing old cells as a part of the normal physiology.  Cancer is a group of diseases characterised by a loss of normal cell growth control.  In normal tissues, the rates of new cell growth and old cell death are kept in balance.  In cancer, this balance is disrupted. This disruption can result from uncontrolled cell growth or loss of a cell's ability to undergo programmed cell death proxesses such as apoptosis.  These mechanisms act as a means of long-term regulation of tissue structure and function through receptor –mediated induction of old damaged cells to self-destruct.. The resulting malignant over-growth of cells, which continue to divide and multiply completely unchecked within the body, usually ultimately overwhelm the other normal cells and thereby debilitate or kill the patient.

Cancers develop from a single cell in one organ or tissue and the cancer is then said to have arisen from that tissue.  However, the cells tend to shed off and spread to other sites in the body via the blood or lymphatic systems, and then secondary “seedlings” (called metastases) grow at these new body sites to damage the normal tissue at these sites also.

Both external factors (tobacco, chemicals, radiation and infectious organisms) and internal factors (inherited mutations, hormones, immune conditions, and mutations that occur from metabolism) play a role in encouraging the generation and survival of cancerous cells.  Causal factors may act together or in sequence to initiate or promote carcinogenesis.  Ten or more years can often pass between exposure or mutations and detectable cancer.  Cancer is treated by surgery radiation, chemotherapy, hormones and immunotherapy.

Burden of Disease

Over recent decades, the incidence of cancer in industrialized nations has escalated to epidemic proportions, with lifetime cancer risks in the United States approaching one in two for men and one in three for women.  For 2001, the estimated number of new cancer cases was 1.3 million; the estimated number of deaths from cancer was 550,000 (Greenlee et al., 2001). 

The overall increase in the incidence of all cancers in the United States from 1950-1997 was 58 percent [Surveillance, Epidemiology and End Results (SEER), 1973-1997].  Similarly, a survey of 17 other major industrialized nations has shown that non smoking-related cancers are responsible for about 75 percent of the overall increased incidence of cancer since 1950 (Davis and Hoel, 1990).  This is in stark contrast to the death rate related to other major chronic disease, such as cardiovascular disease, which have decreased substantially over the same period.

 

 

Dr. Paul Kleihues, Director of the International Agency for Research on Cancer (IARC) and co-editor of the World Cancer Report said “The World Cancer Report tells us that cancer rates are set to increase at an alarming rate globally". 

The report notes that:

  • In the year 2000, malignant tumours were responsible for 12 per cent of the nearly 56 million deaths worldwide from all causes, and in many countries more than a quarter of deaths are attributable to cancer;

  • Cancer rates could further increase by 50% to 15 million new cases in the year 2020;

  • Cancer has emerged as a major public health problem in developing countries, matching its effect in industrialized nations;

  • The predicted sharp increase in new cases – from 10 million new cases globally in 2000, to 15 million in 2020 - will mainly be due to steadily ageing populations in both developed and developing countries and also to current trends in smoking prevalence and the growing adoption of unhealthy lifestyles;

  • While cancer rates have escalated, our ability to treat and cure most cancers (with the notable exception of the relatively rare childhood and testicular cancers), has remained largely unchanged for decades. Despite general impressions, the five-year survival rates for all cancers in the U.S. population from 1974 to 1990 only increased from 49 percent to 54 percent for all races.

The Economist, in its article “Beating Cancer: The new frontier of molecular medicine” (October 2004),states that projections suggest that 40% of those alive today will be diagnosed with some form of cancer at some point in their lives and that by 2010 that number will have climbed to 50%. It goes on to state that the rate of death from cancer in the USA has increased while mortality from heart disease and strokes has fallen. The article suggests that we are now in the “second golden era of cancer research”.

According to the US National Cancer Institute and Centre of Disease Control and Prevention, cancer is forecast to replace heart disease as the leading cause of deaths in the USA over the next decade. It is already the biggest killer of those under 75 and among those aged between 45 to 64 is responsible for more deaths than the next three causes (heart disease, accidents and stroke) put together. Three decades ago around 50% of cancer patients survived five years or more after diagnosis. Today in the USA this figure has crept only to around 63%.

Sales of Cancer Therapeutics

Some key points related to the Oncology therapeutic market are:

  • Driven by the cytotoxic, adjunct and innovative drug classes, the cancer market grew by 16% in 1999 to a global value of almost $19bn, and is poised on the verge of a period of significant expansion,

  • Oncology drugs forecast to grow at 10-15% per annum of the medium to long term (source: Datamonitoring Aug 2002),

  • Driven by USD15 billion in oncology drugs coming off patent in 2010 (source: Datamonitoring Aug 2002),