One of the primary aims of IARC is to describe and elucidate the occurrence of cancer worldwide. The Section of Cancer Surveillance (CSU) systematically collects, analyses, interprets, and disseminates cancer data and statistics to inform global, regional, and national priorities for cancer control action. The Section documents the continuing cancer transitions while advocating for local data collection via three essential areas of work.
Cancer registry support and development
Support to cancer registries remains a key priority for the Section. Collaborations with population-based cancer registries at IARC date back half a century, and since 1974 CSU has provided the Secretariat for the International Association of Cancer Registries (IACR; http://www.iacr.com.fr/), the professional society dedicated to fostering the aims and activities of cancer registries worldwide. This direct link to registries remains vital to the Section’s remit of expanding the availability of quality-assured cancer data. The IACR supports the exchange of information among registries through annual scientific meetings held in different locations worldwide, and ensures international comparability in studies using registry data through various means. These include regular updates of the International Classification of Diseases for Oncology (ICD-O) with the World Health Organization (WHO), the development of international guidelines for registry practices and standard definitions, and the publication of the Cancer Incidence in Five Continents series, the compilation of high-quality cancer incidence datasets based on expert review, which is now in its 11th volume.
Through the Global Initiative for Cancer Registry Development (GICR; http://gicr.iarc.fr/), CSU has developed a programme of work that aims to markedly increase the coverage, quality, and use of data from population-based cancer registries in low- and middle-income countries (LMICs). Coordinated by IARC, the GICR brings together major international and national agencies committed to working collaboratively to improve the level of cancer surveillance worldwide. Six IARC Regional Hubs for Cancer Registration have been established that cover Africa, Asia, the Caribbean, Latin America, and Oceania. Each Hub acts as the main point of contact for countries within its catchment area as the overall regional coordinating body for GICR activities. A designated Principal Investigator has local responsibility for the operations of each Hub. Regional Hub Advisory Committees provide strategic advice to guide decisions.
To better serve the needs across each region, IARC GICR Collaborating Centres are being established. The objective is to identify established cancer organizations as partners to strengthen capacity in cancer registration. Each Collaborating Centre contributes to one or more Hubs through specific functions, specific subject interests, and, in some cases, identified geographical areas. Currently, a key activity is knowledge translation. This has been enhanced through the launch of the GICRNet, a Train the Trainer model whereby standardized teaching materials for cancer registries are developed jointly between IARC and local experts. Work is also under way to develop self-learning e-modules, together with a GICR Mentorship Programme.
Global cancer indicators
CSU compiles, estimates, and reports cancer statistics through its flagship projects and databases and through high-impact peer-reviewed publications. The Cancer Incidence in Five Continents series and the GLOBOCAN estimates provide international compendiums of high-quality registry data and national estimates of incidence, mortality, and prevalence, respectively. The Global Cancer Observatory (GCO; http://gco.iarc.fr) is an interactive web-based platform presenting global cancer indicators of direct relevance to cancer research and policy, based on these sources as well as those resulting from CSU’s descriptive research programme. The GCO is constantly evolving; at present there are five subsites:
- Cancer Today – showcases the global burden today, based on the national GLOBOCAN estimates of incidence, mortality, and prevalence, which are derived using available data from cancer registries and national vital statistics offices worldwide.
- Cancer Tomorrow – provides predictions of the future cancer burden worldwide, based on the GLOBOCAN estimates and various projection scenarios.
- Cancer Causes – provides estimates of the global burden attributable to specific major causes of cancer.
- Cancer Survival – provides comparable survival estimates in different populations, based on CSU’s continuing cancer survival research work.
- Cancer Over Time – currently under development, this subsite will provide detailed analyses of cancer incidence and mortality trends nationally.
Descriptive epidemiology of cancer
The Section’s activities revolve around several major lines of research that use the databases held at CSU, including in-depth assessments of the international variations for specific cancer types, quantification of the major risk factors contributing to the current cancer burden, and an assessment of the long-term benefits of preventive interventions.
CSU is involved in many collaborative studies seeking to describe and interpret the changing magnitude and the transitional nature of cancer profiles around the world, through observation of variations by geography and over time. The Section is increasingly engaged in a quantification of the potential impact of cancer prevention. CSU completed a comprehensive assessment of the established causes of cancer in France, and provided estimates of the cervical cancer burden until 2100 based on a scale-up of screening and human papillomavirus (HPV) vaccination programmes, driven by the WHO Global Initiative for Cervical Cancer Elimination. Current work includes an estimation of the impact of the implementation of effective tobacco control measures on the prevalence of tobacco use in Europe, based on measures of national adherence to the WHO Framework Convention on Tobacco Control.
A major component of CSU’s research work involves the development of comparable population-based cancer survival estimates. Three international projects are under way that seek to assist planners in assessing the effectiveness of cancer services in different settings:
- Cancer Survival in High-Income Countries (SURVMARK-2; https://survival.iarc.fr/Survmark/en/) compares cancer survival, alongside incidence and mortality, across seven cancer types in seven countries, as part of the International Cancer Benchmarking Partnership (ICBP). The project is measuring international differences in cancer survival (where feasible, by stage) to identify factors driving the observed differences.
- A Consortium on Risk Factors and Cancer Survival (SURVPOOL; https://survival.iarc.fr/Survpool/en/) is building a consortium of cohort studies with the aim of exploring the role of lifetime exposure to modifiable risk factors, such as how cumulative exposure to overweight and obesity affects cancer survival.
- Cancer Survival in Countries in Transition (SURVCAN-3; https://survival.iarc.fr/Survcan/en/) is the third IARC initiative seeking to produce comparable survival statistics for countries in transition, with a major expansion of the coverage area compared with previous iterations. In addition to benchmarking survival in LMICs, SURVCAN-3 aims to enhance local capacity to collect follow-up data and perform survival analyses.
Three additional interlinking projects of critical importance cross-cut these core activities:
The International Incidence of Childhood Cancer (IICC; https://iicc.iarc.fr/) series is a flagship project of CSU undertaken in collaboration with the IACR that produces quality-assured incidence data on cancer in children and adolescents, based on collaborations with paediatric and general cancer registries worldwide. With unprecedented efforts to raise awareness of the impact of childhood cancer and the marked disparities in childhood cancer survival observed between low- and high-income settings, CSU’s surveillance and research work is increasingly embedded within the GICR programme and linked to the continuing efforts of the WHO Global Initiative for Childhood Cancer.
Social inequalities and cancer
IARC convened an expert workshop of multidisciplinary scientists to identify research priorities for reducing social inequalities in cancer, leading to the production of IARC Scientific Publication No.168. On this basis, several research projects on social inequalities and cancer are being developed within CSU, including the documentation of social inequalities in cancer between and within countries, with a primary focus on the gradient of the association, as well as temporal and geographical variations.
Building on several collaborative descriptive economic studies within CSU, the aim is to better understand the economic burden of cancer, to national economies and health systems as well as to individuals and households. In close collaboration with WHO, a tool is being developed to assist national policy-makers in identifying value-for-money priority interventions, as part of national cancer planning.