The 2022 update on cancer statistics provides a staggering figure: 20 million will receive a new diagnosis of cancer, and nearly 10 million will die. The data are derived from estimates provided by the Global Cancer Observatory, which relies on the best available sources of both incidence and mortality from cancer in each country.¹ Population-based cancer survival is a key metric of the effectiveness of health systems in how cancer is managed in individual countries. The monitoring of trends and inequalities in cancer survival is an important metric of overall health system performance, is used to guide investment priorities within oncology, and can help advance locally informed, cost-effective interventions to improve early diagnosis and treatment.

However, we believe there is a major caveat in these figures, which should serve as a flag for all who seek to prevent cancer from occurring or aim to convert it from a deadly disease to one that people live through, if not with; the data are only as valid as they are representative of a true country's burden. As such, the quality of the source information matters greatly, yet only 1% of African countries and 4% of Asian, South American, and Central American countries collect sufficient data for use.² For now, the Global Cancer Observatory does its best with what it has and thus can provide estimates for all parts of the world. To be frank, the lack of high-quality, country-specific cancer registries, particularly in low-income and middle-income countries (LMICs), affects the accuracy of these figures, raising the concern that these estimates are in fact underestimating both the incidence of and mortality from cancer. Moreover, whether trends in cancer by age at diagnosis are mirrored across countries is important to understand. For example, as the report notes, high Human Development Index (HDI) countries are reporting a rise in colorectal cancer diagnoses before age 50 years. Whether people living in lower HDI countries are experiencing the same trend is not known.

These issues are brought to the forefront when one looks at two countries in different parts of the world: Bangladesh and the Republic of Georgia. In Bangladesh, cancer incidence and mortality are based on cancer registries at the hospital level, hiding from view those who are not able to access specialized care, which is often centered in the major cities, like Dakha. As such, conclusions in this report that suggest the risk of developing cancer trends with increasing HDI, although firmly backed by the available data, need to be read with this important restriction in mind. In Georgia, the lack of a nationwide registry was recognized as a significant unmet need over a decade ago; and, in 2011, the Georgian government funded the State Program of Modern Cancer Registry Implementation. With significant support from the International Agency for Research on Cancer (IARC), work between 2011 and 2014 was initiated to build the workforce and infrastructure to realize this goal, and the population-based registry was launched in 2015, with a new imperative to modernize data collection from paper to electronic means starting in 2019. The system is now connected to other demographic data, including birth and death records. This allows the vital status of registered patients with cancer to be obtained through passive follow-up, by linkage between the registry data and the national mortality database.

Beyond screening, this report highlights another salient point: from a global perspective, the access to effective prevention and screening methods is not equitable. Take the risk of lung cancer, which the report discusses at length. Smoking remains an issue in many areas of the world, even as rates in high HDI countries stabilize or even decline. Georgia has one of the highest smoking prevalences among the European countries. In 2017, tobacco-control bills were adopted by the Parliament of Georgia, including bans on smoking in all public transport and buildings, on smoking advertisements, on any sponsorship or promotion of tobacco, on smoking accessories and devices, and on the display of smoking at points of sales, with restriction on smoking as it is portrayed in film and other entertainment forms. This implementation now is intimately a part of the State Program on Health Promotion, which includes training of staff and providers on smoking cessation, the monitoring of enforcement of smoke-free legislation in public premises, developing novel communication tools, and creating school education materials for the country. Despite the strides made by the Georgian Government, this country still faces an uphill battle because of the tobacco industry.

Efforts to detect breast cancer at an earlier stage through the implementation of mammographic screening continues to be a challenge as well, despite the higher mortality rates of breast cancer seen in lower versus higher HDI countries. As such, individuals with breasts face a greater chance of presenting with symptomatic and/or more advanced disease. In Georgia, cancer screening (breast, cervix, and colorectal) has been available for 16 years through national programs. Yet there are low uptake rates to screening, and we continue to see people presenting with advanced breast cancer. This highlights the importance of cultural humility—communication and education about early detection must make sense to the population it seeks to help, and this starts by identifying the barriers and concerns within them.

Prevention efforts should be more widely available given the availability of evidence-based prevention measures, including treatment for Helicobacter pylori and vaccines against both human papillomavirus (HPV) and hepatitis B virus (HBV). This also takes governmental partnership and buy-in. The Government of Georgia and international partners supported the introduction of organized cervical cancer vaccination and screening programs, and, today, HPV vaccination is included in the national vaccination program schedule. The hepatitis B vaccine was introduced nationwide in 2001, and coverage has been ≥90% since 2010. In a nationwide serosurvey among adults in 2015, the prevalence was 2.9% (range, 2.4%–3.5%) for hepatitis B surface antigen and 25.9% (24.1%–27.6%) for antihepatitis B core antibody.³ Notably, in 2021, only 0.03% of children in Georgia were found to have chronic HBV infection, reflecting the success of the infant hepatitis B vaccination program implemented in 2001. With 2.7% of adults (an estimated 77,000 persons) infected in 2021, chronic HBV infection remains a problem among those born before the hepatitis B vaccine introduction. In Bangladesh, the efforts are still in their infancy. Although the government includes HBV vaccination as part of its extended vaccination program starting at infancy, the HPV vaccine is initiating as a pilot project, with the aim of administering a single dose of the bivalent vaccine to teenaged girls across the country and without cost.

For individuals with cancer in LMICs, the simple reality is that access to modern cancer treatment, particularly targeted cancer treatments, is extremely limited. In Bangladesh, multiple barriers exist to cancer drug development, which is an intrinsically time-consuming and expensive process, particularly in LMICs where the infrastructure and resources needed for drug development are not readily available. In Georgia, the population has access to the Universal Health Care Program, which includes access to cancer treatment for all citizens, regardless of income, within the framework of the Universal Health Care Program. Although treatment is financed, there is a cap which, without copayment, is 25,000 GEL ($9000 US dollars) annually. However, the costs of modern targeted treatment and/or immunotherapy far exceed this cap, and patients are expected to make up the difference. Consequently, limits are often expended quickly, and even before cancer treatment has started.

Although international partnerships and efforts, such as the World Health Organization Essential Medication List, can help improve access, unless the drugs are available in any one country, the discussion about access will be moot.⁴ Economic and access barriers exist in each country, whether they consist of the cost of any agent compared with the purchasing power of the country or the willingness of the pharmaceutical industry to engage with lower HDI regimens to make drugs available on trials. Still, lower HDI countries are attempting to respond. In Bangladesh, there are in-country production capabilities for both monoclonal antibodies and immunotherapy, and this type of production of biosimilar drugs can have a significant impact on cancer care in LMICs.⁵

In conclusion, this work on global statistics is of the utmost importance. We need to understand that the issue of cancer is an international concern, affecting each country regardless of their health system and access to care. However, understanding the scope of the issue requires a coordinated and sustained approach to data collection to ensure that the statistics are accounting for everyone diagnosed with cancer, as well as requiring continued collaboration in the efforts to bring global equity for cancer screening, treatment, and postcancer care. We will all thrive within a healthier population; and, no matter where you are in the world, no one deserves cancer.

2022 年癌症统计数据更新提供了一个惊人的数字：2000 万人将被新诊断出癌症，近 1000 万人将死亡。这些数据来自全球癌症观测站提供的估计，该观测站依赖于每个国家癌症发病率和死亡率的最佳可用来源。 ¹基于人群的癌症生存率是衡量各个国家卫生系统在癌症管理方面的有效性的关键指标。对癌症生存趋势和不平等的监测是整体卫生系统绩效的重要指标，用于指导肿瘤学领域的投资优先事项，并有助于推进当地知情、具有成本效益的干预措施，以改善早期诊断和治疗。

然而，我们认为这些数字有一个重大警告，它应该成为所有寻求预防癌症发生或旨在将其从一种致命疾病转变为人们生活中的疾病的人的一面旗帜；这些数据只有代表一个国家的真实负担才有效。因此，源信息的质量非常重要，但只有 1% 的非洲国家和 4% 的亚洲、南美洲和中美洲国家收集了足够的数据供使用。 ²目前，全球癌症观测站已尽其所能，因此可以提供世界各地的估计数据。坦率地说，缺乏高质量的、针对特定国家的癌症登记处，特别是在低收入和中等收入国家 (LMIC)，影响了这些数字的准确性，引发了人们的担忧，即这些估计实际上低估了癌症的发病率和死亡率。此外，了解各国诊断时年龄的癌症趋势是否相同也很重要。例如，报告指出，人类发展指数 (HDI) 高的国家报告 50 岁之前结直肠癌诊断率上升。生活在人类发展指数较低国家的人们是否也经历着同样的趋势尚不清楚。

当人们审视世界不同地区的两个国家：孟加拉国和格鲁吉亚共和国时，这些问题就被摆在了最重要的位置。在孟加拉国，癌症发病率和死亡率基于医院一级的癌症登记处，隐藏了那些无法获得专门护理的人，这些护理通常集中在达卡等主要城市。因此，本报告中的结论表明，随着人类发展指数的增加，罹患癌症的风险也随之增加，尽管有现有数据的有力支持，但在阅读时仍需牢记这一重要限制。在格鲁吉亚，十多年前，缺乏全国性的登记被认为是一个未得到满足的重大需求； 2011 年，格鲁吉亚政府资助了现代癌症登记实施国家计划。在国际癌症研究机构 (IARC) 的大力支持下，2011 年至 2014 年间启动了建设劳动力和基础设施以实现这一目标的工作，并于 2015 年启动了以人口为基础的登记，现代化的新要求从 2019 年开始，数据收集从纸质到电子方式。该系统现已连接到其他人口数据，包括出生和死亡记录。这使得通过登记数据和国家死亡率数据库之间的链接，通过被动随访可以获得登记的癌症患者的生命状态。

除了筛查之外，本报告还强调了另一个要点：从全球角度来看，获得有效预防和筛查方法的机会并不公平。报告详细讨论了肺癌的风险。尽管高人类发展指数国家的吸烟率稳定甚至下降，但吸烟仍然是世界许多地区的一个问题。格鲁吉亚是欧洲国家中吸烟率最高的国家之一。 2017年，格鲁吉亚议会通过了控烟法案，包括禁止在所有公共交通工具和建筑物内吸烟、禁止吸烟广告、禁止任何烟草赞助或促销、禁止吸烟配件和装置以及禁止展示吸烟在销售点，如电影和其他娱乐形式中所描绘的那样，限制吸烟。这一实施现已成为国家健康促进计划的重要组成部分，其中包括对工作人员和提供者进行戒烟培训、监督公共场所无烟立法的执行情况、开发新颖的通讯工具以及为儿童制作学校教育材料。国家。尽管格鲁吉亚政府取得了长足的进步，但由于烟草业，该国仍然面临着一场艰苦的战斗。

尽管人类发展指数较低的国家与人类发展指数较高的国家相比，乳腺癌死亡率较高，但通过实施乳房X线照相筛查来早期发现乳腺癌仍然是一项挑战。因此，有乳房的人更有可能出现有症状和/或更严重的疾病。在乔治亚州，癌症筛查（乳腺癌、宫颈癌和结直肠癌）已通过国家计划开展了 16 年。然而，筛查的接受率很低，而且我们仍然看到人们患有晚期乳腺癌。这凸显了文化谦逊的重要性——有关早期检测的沟通和教育必须对其寻求帮助的人群有意义，而这首先要确定他们内部的障碍和担忧。

鉴于有循证预防措施，包括幽门螺杆菌治疗以及人乳头瘤病毒 (HPV) 和乙型肝炎病毒 (HBV) 疫苗，预防工作应该更加广泛地开展。这也需要政府的合作和支持。格鲁吉亚政府和国际合作伙伴支持推行有组织的宫颈癌疫苗接种和筛查计划，如今，HPV 疫苗接种已纳入国家疫苗接种计划表。乙型肝炎疫苗于2001年在全国推广，2010年以来覆盖率≥90%。2015年全国成人血清调查显示，乙型肝炎表面抗原患病率为2.9%（范围2.4%​​~3.5%），乙型肝炎表面抗原患病率为25.9%。抗乙型肝炎核心抗体% (24.1%–27.6%)。 ³值得注意的是，2021 年，格鲁吉亚只有 0.03% 的儿童被发现患有慢性乙肝病毒感染，这反映出 2001 年实施的婴儿乙型肝炎疫苗接种计划的成功。2021 年，2.7% 的成年人（估计有 77,000 人）感染乙肝病毒，对于乙型肝炎疫苗引入之前出生的人来说，慢性乙型肝炎病毒感染仍然是一个问题。在孟加拉国，这些努力仍处于起步阶段。尽管政府将乙型肝炎疫苗接种作为从婴儿期开始的扩展疫苗接种计划的一部分，但 HPV 疫苗仍作为试点项目启动，目的是免费为全国少女注射单剂二价疫苗。

对于中低收入国家的癌症患者来说，一个简单的现实是，获得现代癌症治疗，特别是靶向癌症治疗的机会极其有限。在孟加拉国，癌症药物开发存在多重障碍，这本质上是一个耗时且昂贵的过程，特别是在药物开发所需的基础设施和资源不易获得的中低收入国家。在格鲁吉亚，人们可以享受全民医疗保健计划，其中包括在全民医疗保健计划的框架内，所有公民，无论收入如何，都可以获得癌症治疗。尽管治疗是有资金支持的，但如果没有自付额，每年的上限为 25,000 GEL（9000 美元）。然而，现代靶向治疗和/或免疫治疗的费用远远超过了这一上限，患者有望弥补差额。因此，甚至在癌症治疗开始之前，限制往往很快就会耗尽。

尽管世界卫生组织基本药物清单等国际伙伴关系和努力可以帮助改善可及性，但除非任何一个国家都能获得这些药物，否则有关可及性的讨论将毫无意义。 ⁴每个国家都存在经济和准入障碍，无论是与国家购买力相比的任何药物的成本，还是制药行业参与较低 HDI 方案以使药物可用于试验的意愿。尽管如此，人类发展指数较低的国家仍在尝试做出回应。孟加拉国拥有单克隆抗体和免疫疗法的国内生产能力，这种生物仿制药的生产可以对中低收入国家的癌症治疗产生重大影响。 ⁵

总之，这项全球统计工作至关重要。我们需要明白，癌症问题是一个国际关注的问题，影响着每个国家，无论其卫生系统和获得护理的情况如何。然而，了解问题的范围需要采取协调和持续的数据收集方法，以确保统计数据考虑到每个被诊断患有癌症的人，并需要继续合作，努力实现癌症筛查、治疗和治疗的全球公平。癌后护理。我们都将在更健康的人群中茁壮成长；而且，无论您身在世界何处，没有人应该患上癌症。