PFIZER FACTS The Burden of Cancer in Asia

1 PFIZERFACTSTheBurdenofCancerinAsiaMedica lDivisionPG2 83 663 200 8 Pf izerIn c. All rightsre te d in USA/December 2008Th ebu rden of Cancer in AsiaIn 2002, mil lionnewcancercases 39%of newcas es wo rld wi de were di agno sed among3. 2 billio n persons(48%of the worldpopulation)liv ing in th e fif tee n mosthighlydevelopedco untries in South,East,and Sou theastAsia:Ja pan, Taiwan, Si ng ap ore, SouthKore a, Mal ay sia,Th ailan d, Chi na,Phil ippines, Sri Lanka,Vietnam,Indonesia, Mo ngolia, In dia,La os, andCambodia. ChinaandIndia,together acc oun tin g for 37% of the wor ldw id e pop ul ati on , reported3 millio n of thesenewly diagnosed can ce r ca ses .De mographic characteristics varywi del y in thes e fift ee n countrie s me dia n age s in Ind ia, China,andJap an are 25, 34, and44 years, respe cti ve ly ye t co lle ctiv el y, theyca rry a disp roport ion ateburdenof worldw ide liver , sto mach, and es oph ag ea l can cer.

2 Three fo ur ths of new worl dwideliv erca nce r case s in malesandtw o th ir ds in fema les occurin the se fi ftee n asia n coun tri es. Gre ate rtha n 50%of the world snew casesof sto mach can cer, and gr ea ter than70% of new ly diagno sedes ophagea l ca ncerworldwide occ ur in the se Asi an cou ntr ies. Ch in a alo ne con tri but es moreth anhal f of thewor ld snewlydi ag nos ed liv er and esop hagea l can ce r ca se s, an d 42%of ne wlydia gnosed stomach Cancer co mpa riso n, fe wer tha n 4% of the worl d s ne w ca ses of eac hof thes e ca ncersoc cur in the Un ite d Sta te 7 of theseAs ian countries, lun g ca nce r ha s the high est inci den ce rat e (age-standardize d) of allcancers in males , andbreast ca nc er is the highest in ci de nt ca nc er fo r females.

3 Lungcanc er has thehigh est death rate (age-stan da rdized) for ma les in the majori ty of th ese Asiancount ries,and br eas tcancerran ks amo ng the top -f ive mor ta li ty ra te Cancer s for fema le s in al l but 2 of the As ian cou ntr ies .The re are mi mill ion fe males liv ing with ca nce r in thes e asia n co unt ries ;Chi na alonehas millionmale an d 1. 5 mi lli on fem ale can cer su rviv ors . Th e magn itu de of th esur vivingpopulationis a fun cti on of inc idence rate s newca se s di agn ose d du rin g the ye ar aswell as associated mortalityrat es. Al th ou gh the Un ite d Sta tes has a much sma lle r popu lat ion tha nChi na (3 03 mil lion),it has 50%moreca nce r surv iv ors ( n mal es and2.)

4 3 mill ion fema lesliv ing withca ncer).In mostof the Asian co untrie s, ca nce r of the co lon and rec tumis th e mos tcom mo n amongmalecancer su rv iv ors; amon g fem ale surv iv ors,brea st can cer is themostcom mo n in mos t Asiancoun tr s iss ue of Pfiz er Factspresents ne w ana ly ses of in ter na tio nal da ta ba ses to ga in ins igh t int o th eburdenof ca nc er amongAs ians,inc lud in g canc er morb id ity and mor ta lity , and pre ve nt ableriskfac tors . For purposesof com pari son , can cer st ati sti cs are als o pre sen te d for th e Uni ted Sta te , , rectorSeniorDirector/TeamLeaderSe nior MedicalDirector , OncologyComparativeEffe ctiveness&ComparativeEffectiveness&Med icalLe adAsiaOncologyPopulationSt ud ie sPopulationStudiesMed icalandRegulatoryAffairsJapan/AsiaEviden ce-BasedSt rategiesEvidence-BasedStrategiesTab le of content sHighlights1 Demographiccharacteristics5 Morbidityandmortality8 Preventablerisk factors63 AppendicesI.

5 Methods67II. Datatables72 Abou t the an al ysesThi sre por tpres en tscanc erst at istic sfor th efift een mo st highly develo ped countri esin South, Ea st ,and Southe as tAsi a; in dec rea si ngord er, th ey are :Japa n, Taiw an,Si ngap ore ,South Kor ea, Mal ays ia,Tha iland ,Chi na ,Phil ippin es,Sr iLa nka,Vi etna m, Indone sia,Mongol ia, Indi a, Lao s,and Cam bo di rpu rp os es ofcom par ison, ca nce rst at isticsar eal sopr esen ted fo rthe Unit ed Sta tes .The ranki ng is bas ed on the Human Dev elop men tIn dex (H DI), amea su recreatedby the Unit ed Nati on sDe vel opm ent Pro gram to cat eg ori ze coun tr ies asdeveloped,deve loping ,or unde rd eve lop HDIissc al edfrom zer otoone ,an disanave ra geofth ree co mp on ent indices : Lifeexpe cta nc yatbi rth, expr es sed as anor ma lized inde x.

6 Know ledge and educ at ion, as meas ured by th eadu lt lite racy ra te (tw o-t hirdswei ght ing )and the combi ne dpr imar y, seco ndar y, andtert iary gro ssen rol lmentrat io (one- thi rd we ighti ng) . Gr os sdom esti cpr od uct (GD P) pe rca pita atpu rch asin gpowe rpa ri ty (PPP) inUnit ed Sta te sdol lar s,exp re ss edas anormal ize dindex .An HDI va lue of 0. 8or mor esi gnal sa high de vel op men t cou ntr y. In cluded inthis cate gor yarefi ve As ian countr ies:Jap an ,Tai wan ,Singa po re ,Kor ea ,andMal ays rem ai ni ng ten cou ntr ies hav eHD Ibe twee and ,and arecl ass ifi ed inthe me di um dev el opme nt grou es inthis repo rt ar ebas edon the latest avai labl edata des cr ibingcancerincide nce ,pr ev al enc e, and mor tal ity inth eGLOB OC AN 2002dat ab asecov eringal lcountr iesof th ewor ld, mai nt aine dbytheIn ter na tio na lAg enc yfo rRes earchon Canc er (IA RC).

7 The qual ity of the da ta varie sby cou nt ry, dep end ingon theext ent and ac cura cy of the loc al ly avail ab le data .Da ta fro mth epo pu lation-basedTai wan ca nce rre gi str yfor the yea r200 5are use dfo rTai wa nca nce rincidenceand mor ta lity but da ta avai labi lityare limited to th ei r10 mos tco mmon on pr ev enta bl erisk fa ct ors ar eta ke nfro mth eWo rld He alt hOr ga nizationSt ati sti ca lInf orm ati on Sys te m(W HO SIS )da ta ba se 200 3, 200 5, an int era ctivedat abas ebri ng ing toge the rcor ehe al th sta tist ics forthe WHO memb erst ula tion stat isti cs ar ebase dondat afro mthe Unit ed Sta tes Cens us Bur eauInter nat iona lDa ta Bas e(I DB) ,2008. Al lag e-s tan da rd izedra te sin th ere port usethe Wor ldHea lth Org aniz at ion (W HO )Wor ld Sta ndar dPop ula ti on.

8 Thr ough out th is re port ,non- melanom ask in ca ncers are exclud ed fro mthe anal ysesof tota lcan ce rs ,and br ea st canc er an aly ses are limit ed to cas es in fema les .Sou th Kor eaisref er red to as Kor ea inthis repo rt .The bu rd en of ca ncer in AsiaHig hlight sDemographiccharacteristics The fi ftee nAs ian count riescover edinth is re por t Ja pa n, Ta iwa n,Si ngapore,Kor ea ,Ma lays ia, Thai land, Chi na, Philip pi ne s,Sr iLa nka,Vi etn am, Ind onesia,Mon gol ia, Indi a, La os, and Cam bodi a com pr ise 48% of th ewo rld spopul at ion (6. 7bi llion). Chi naand Indi ato get her ac count for 37% ofworld po pulatio n. The medi anage of the popul ati on var ies wi del yamo ng the co un tr ies ,fr omalowof 19 ye ar sinLa os (3% age d65year sandolder) toahighof44year sinJap an (22% aged 65 ye ar sand ol der ).

9 Media nagesin the popul at ion sof Chinaand Indi aar e34 year sand 25 year s,re spec tively .MorbidityandmortalityIn cid en ce Am ongthe 15 As iancountr iesthe hi ghest inci den ce rate s(a ge- sta nd ardized) forto tal ca nce r(a ll site s)in mal esar ein Taiwa n, Kor ea ,an dJa pa n; fema letot alcanc er inci de nce rat esar ehi ghe st inTaiwa n,Sing apo re, andPh ilipp ines. Lung ca nce ris the mos tcom mon or sec ond -mo st comm oncan ce ramo ng mal esin all Asi ancou ntrie sbut for In dia, Ja pan, Mong olia,an dTai wa n. St oma ch ca nce ris the hi ghes tinci den t-r ate ca nc er amon gbot hma les andfe mal esinKore a;itisthe mos tcom mon amo ng fema lesinChi na ,andthe mostcom mon among male sinJapa n. Am on gfe ma les,br eas tcanc er is the highes tinc ident can cer in7co un tr ies In done sia,Japa n, Mal ays ia, Phi lippi nes, Si ng ap ore, Sri Lan ka,and Ta iwan.

10 41% of all ne wcanc er sdi agno se dinma les ,an d37% ofca nc ers diagn osed infe mal esar einthe fi ft ee nAs ian count ries a bo ut 3time sas man yca se sas thatin the Uni te dSta te s. Live r, sto mac h, and esopha gea lcancer ar erela tiv el yco mmo nin asia : Thr ee four ths of wor ldwi de liver ca ncer ca sesin mal es an dtwo th irds infema lesocc ur inthe fi fte en Asi an coun tri es. China ha smore than hal fofnew ly dia gno sed liv er ca ncer ca ses inthe wor bu rd en of ca ncer in Asia1 The fi fte enAsia ncountr ies acc ount fo ralmos ttwo th ird sof new stomachcanc er casesinmal esand mor ethan half of newcas es infema les . China ha sgr ea te rtha n40% of th ewo rld s new st oma chcan cer cas es . Esopha ge al ca nc eral so oc cur sdi spr oporti onate ly inAsi a gr ea ter than70% of ne wcas es inmal esand fem ales occu rin th efifte en As ian countr ies.