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Featured researches published by Freddie Bray.


CA: A Cancer Journal for Clinicians | 2005

Global cancer statistics, 2002.

Lindsey A. Torre; Freddie Bray; Rebecca L. Siegel; Jacques Ferlay; Joannie Lortet-Tieulent; Ahmedin Jemal

Cancer constitutes an enormous burden on society in more and less economically developed countries alike. The occurrence of cancer is increasing because of the growth and aging of the population, as well as an increasing prevalence of established risk factors such as smoking, overweight, physical inactivity, and changing reproductive patterns associated with urbanization and economic development. Based on GLOBOCAN estimates, about 14.1 million new cancer cases and 8.2 million deaths occurred in 2012 worldwide. Over the years, the burden has shifted to less developed countries, which currently account for about 57% of cases and 65% of cancer deaths worldwide. Lung cancer is the leading cause of cancer death among males in both more and less developed countries, and has surpassed breast cancer as the leading cause of cancer death among females in more developed countries; breast cancer remains the leading cause of cancer death among females in less developed countries. Other leading causes of cancer death in more developed countries include colorectal cancer among males and females and prostate cancer among males. In less developed countries, liver and stomach cancer among males and cervical cancer among females are also leading causes of cancer death. Although incidence rates for all cancers combined are nearly twice as high in more developed than in less developed countries in both males and females, mortality rates are only 8% to 15% higher in more developed countries. This disparity reflects regional differences in the mix of cancers, which is affected by risk factors and detection practices, and/or the availability of treatment. Risk factors associated with the leading causes of cancer death include tobacco use (lung, colorectal, stomach, and liver cancer), overweight/obesity and physical inactivity (breast and colorectal cancer), and infection (liver, stomach, and cervical cancer). A substantial portion of cancer cases and deaths could be prevented by broadly applying effective prevention measures, such as tobacco control, vaccination, and the use of early detection tests. CA Cancer J Clin 2015;65: 87–108.


CA: A Cancer Journal for Clinicians | 1999

Global cancer statistics

Ahmedin Jemal; Freddie Bray; Jacques Ferlay; Elizabeth Ward; David Forman

The global burden of cancer continues to increase largely because of the aging and growth of the world population alongside an increasing adoption of cancer‐causing behaviors, particularly smoking, in economically developing countries. Based on the GLOBOCAN 2008 estimates, about 12.7 million cancer cases and 7.6 million cancer deaths are estimated to have occurred in 2008; of these, 56% of the cases and 64% of the deaths occurred in the economically developing world. Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death among females, accounting for 23% of the total cancer cases and 14% of the cancer deaths. Lung cancer is the leading cancer site in males, comprising 17% of the total new cancer cases and 23% of the total cancer deaths. Breast cancer is now also the leading cause of cancer death among females in economically developing countries, a shift from the previous decade during which the most common cause of cancer death was cervical cancer. Further, the mortality burden for lung cancer among females in developing countries is as high as the burden for cervical cancer, with each accounting for 11% of the total female cancer deaths. Although overall cancer incidence rates in the developing world are half those seen in the developed world in both sexes, the overall cancer mortality rates are generally similar. Cancer survival tends to be poorer in developing countries, most likely because of a combination of a late stage at diagnosis and limited access to timely and standard treatment. A substantial proportion of the worldwide burden of cancer could be prevented through the application of existing cancer control knowledge and by implementing programs for tobacco control, vaccination (for liver and cervical cancers), and early detection and treatment, as well as public health campaigns promoting physical activity and a healthier dietary intake. Clinicians, public health professionals, and policy makers can play an active role in accelerating the application of such interventions globally. CA Cancer J Clin 2011.


International Journal of Cancer | 2010

Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008.

Jacques Ferlay; Hai-Rim Shin; Freddie Bray; David Forman; Colin Mathers; Donald Maxwell Parkin

Estimates of the worldwide incidence and mortality from 27 cancers in 2008 have been prepared for 182 countries as part of the GLOBOCAN series published by the International Agency for Research on Cancer. In this article, we present the results for 20 world regions, summarizing the global patterns for the eight most common cancers. Overall, an estimated 12.7 million new cancer cases and 7.6 million cancer deaths occur in 2008, with 56% of new cancer cases and 63% of the cancer deaths occurring in the less developed regions of the world. The most commonly diagnosed cancers worldwide are lung (1.61 million, 12.7% of the total), breast (1.38 million, 10.9%) and colorectal cancers (1.23 million, 9.7%). The most common causes of cancer death are lung cancer (1.38 million, 18.2% of the total), stomach cancer (738,000 deaths, 9.7%) and liver cancer (696,000 deaths, 9.2%). Cancer is neither rare anywhere in the world, nor mainly confined to high‐resource countries. Striking differences in the patterns of cancer from region to region are observed.


International Journal of Cancer | 2015

Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012

Jacques Ferlay; Isabelle Soerjomataram; Rajesh Dikshit; Sultan Eser; Colin Mathers; Marise Rebelo; Donald Maxwell Parkin; David Forman; Freddie Bray

Estimates of the worldwide incidence and mortality from 27 major cancers and for all cancers combined for 2012 are now available in the GLOBOCAN series of the International Agency for Research on Cancer. We review the sources and methods used in compiling the national cancer incidence and mortality estimates, and briefly describe the key results by cancer site and in 20 large “areas” of the world. Overall, there were 14.1 million new cases and 8.2 million deaths in 2012. The most commonly diagnosed cancers were lung (1.82 million), breast (1.67 million), and colorectal (1.36 million); the most common causes of cancer death were lung cancer (1.6 million deaths), liver cancer (745,000 deaths), and stomach cancer (723,000 deaths).


International Journal of Cancer | 2001

Estimating the world cancer burden : GLOBOCAN 2000

D. Maxwell Parkin; Freddie Bray; Jacques Ferlay; Paola Pisani

Describing the distribution of disease between different populations and over time has been ahighly successfu l way of devising hypothese s about causation and for quantifying the potential for preventive activities.1 Statistical data are also essentia l componentsof diseasesurveillanceprograms. Theseplay acritical role in the developmen t and implementation of health policy, through identification of health problems, decisions on priorities for preventive and curative programs and evaluation of outcomes of programs of prevention, early detection/screenin g and treatment in relation to resource inputs. Over the last 12 years, aseries of estimates of the global burden of cancer have been published in the International Journal of Cancer. 2–6 The methods have evolved and been refined, but basically they rely upon the best availabl e data on cancer incidence and/or mortality at country level to build up theglobal picture. The results are more or less accurat e for different countries, depending on the extent and accuracy of locally availabl e data. This “databased” approach is rather different from themodeling method used in other estimates. 7–10 Essentially, these use sets of regression models, which predict cause-specifi c mortality rates of different populations from the correspondin g all-cause mortality.11 The constant s of the regression equations derive from dataset s with different overal mortality rates (often including historic data from wester n countries) . Cancer deaths are then subdivided into the different cancer types, according to the best availabl e information on relative frequencies. GLOBOCAN 2000 updates thepreviousl y published data-based global estimates of incidence, mortality and prevalence to the year 2000.12


CA: A Cancer Journal for Clinicians | 2016

Cancer statistics in China, 2015

Wanqing Chen; Rongshou Zheng; Peter Baade; Siwei Zhang; Hongmei Zeng; Freddie Bray; Ahmedin Jemal; Xue Qin Yu; Jie He

With increasing incidence and mortality, cancer is the leading cause of death in China and is a major public health problem. Because of Chinas massive population (1.37 billion), previous national incidence and mortality estimates have been limited to small samples of the population using data from the 1990s or based on a specific year. With high‐quality data from an additional number of population‐based registries now available through the National Central Cancer Registry of China, the authors analyzed data from 72 local, population‐based cancer registries (2009‐2011), representing 6.5% of the population, to estimate the number of new cases and cancer deaths for 2015. Data from 22 registries were used for trend analyses (2000‐2011). The results indicated that an estimated 4292,000 new cancer cases and 2814,000 cancer deaths would occur in China in 2015, with lung cancer being the most common incident cancer and the leading cause of cancer death. Stomach, esophageal, and liver cancers were also commonly diagnosed and were identified as leading causes of cancer death. Residents of rural areas had significantly higher age‐standardized (Segi population) incidence and mortality rates for all cancers combined than urban residents (213.6 per 100,000 vs 191.5 per 100,000 for incidence; 149.0 per 100,000 vs 109.5 per 100,000 for mortality, respectively). For all cancers combined, the incidence rates were stable during 2000 through 2011 for males (+0.2% per year; P = .1), whereas they increased significantly (+2.2% per year; P < .05) among females. In contrast, the mortality rates since 2006 have decreased significantly for both males (−1.4% per year; P < .05) and females (−1.1% per year; P < .05). Many of the estimated cancer cases and deaths can be prevented through reducing the prevalence of risk factors, while increasing the effectiveness of clinical care delivery, particularly for those living in rural areas and in disadvantaged populations. CA Cancer J Clin 2016;66:115–132.


European Journal of Cancer | 2001

Cancer burden in the year 2000. The global picture

Donald Maxwell Parkin; Freddie Bray; S.S. Devesa

Although the general idea of ‘burden’ of a disease to a community seems fairly straightforward, there are multiple dimensions in which it may be expressed, either in terms of disease frequency (the ‘need’ for services) or the demand which it places upon them. In this review, we confine ourselves to three elementary measures of cancer frequency: incidence, mortality and prevalence. Incidence is the number of new cases occurring. It can be expressed as an absolute number of cases per year (the volume of new patients presenting for treatment) or as a rate per 100 000 persons per year. The latter provides an approximation to the average risk of developing a cancer, and is necessary if we wish to compare the risk of disease between populations (countries, ethnic groups, or different time periods within a country, for example). When considering the impact of primary prevention strategies, a reduction in incidence (occurrence of new cases) is the appropriate statistic to use. Mortality is the number of deaths occurring, and the mortality rate the number of deaths per 100 000 persons per year. The number of deaths provides one measure (and a rather unambiguous one) of the outcome or impact of cancer. It is the product of the incidence and the fatality of a given cancer. Fatality, the inverse of survival, is the proportion of cancer cases that die and this is generally assumed to be the most severe sequel of the disease. Mortality rates therefore measure the average risk to the population of dying from a specific cancer, while fatality (1-survival) represents the probability that an individual with cancer will die from it. Mortality rates are sometimes used as a convenient proxy measure of the risk of acquiring the disease (incidence) when comparing different groups, since they may be more generally available (as described below). However, when used in this way, an assumption of equal survival/fatality in the populations being compared is introduced. Since this is rarely correct—there are, for example, quite large differences between countries—it is safer to use mortality as a measure of outcome rather than occurrence. Prevalence: There is no agreed definition of ‘prevalence’ of cancer. Strictly speaking, it is the number of persons in a defined population alive at a given time who have had cancer diagnosed at some time in the past. However, the resource requirements for treating newly diagnosed patients are very different from those for supporting long-term survivors. Thus, overall prevalence is not particularly useful for healthcare planning purposes, especially as a large proportion of long-term survivors can be considered cured. Partial prevalence, which limits the number of patients to those diagnosed during a fixed time in the past, is therefore a more useful measure of cancer burden. Prevalence for cases diagnosed within 1, 3 and 5 years are likely to be of relevance to the different stages of cancer therapy, namely, initial treatment (1 year), clinical follow-up (3 years) and cure (5 years). Patients who are still alive 5 years after diagnosis are usually considered cured since the death rates of such patients are similar to those in the general population. There are some exceptions, primarily that of female breast cancer, for which the risk of death remains higher than the general population for many more years. Several other more complex statistics have been used to measure the impact of disease, particularly in health economics. They include person-years of life lost (how many years of normal lifespan are lost due to deaths from cancer). This measurement may be refined by giving different values to life-years at different ages, so that a year saved at, for example, age 20 years, is valued


International Journal of Cancer | 1999

Estimates of the worldwide mortality from 25 cancers in 1990

Paola Pisani; D. Maxwell Parkin; Freddie Bray; Jacques Ferlay

We present here worldwide estimates of annual mortality from all cancers and for 25 specific cancer sites around 1990. Crude and age‐standardised mortality rates and numbers of deaths were computed for 23 geographical areas. Of the estimated 5.2 million deaths from cancer (excluding non‐melanoma skin cancer), 55% (2.8 million) occurred in developing countries. The sex ratio is 1.33 (M:F), greater than that of incidence (1.13) due to the more favourable prognosis of cancer in women. Lung cancer is still the most common cause of death from cancer worldwide with over 900,000 deaths per year, followed by gastric cancer with over 600,000 deaths and colorectal and liver cancers accounting for at least 400,000 deaths each. In men, deaths from liver cancer exceed those due to colo‐rectal cancer by 38%. Over 300,000 deaths of women are attributed to breast cancer, which remains the leading cause of death from cancer in women, followed by cancers of the stomach and lung with 230,000 annual deaths each. In men, the risk of dying from cancer is highest in eastern Europe, with an age‐standardised rate for all sites of 205 deaths per 100,000 population. Mortality rates in all other developed regions are around 180. The only developing area with an overall rate of the same magnitude as that in developed countries is southern Africa. All of eastern Asia, including China, has mortality rates above the world average, as do all developed countries. The region of highest risk among women is northern Europe (age‐standardised rate = 125.4), followed by North America, southern Africa and tropical South America. Only south‐central and western Asia (Indian subcontinent, central Asia and the middle‐eastern countries) and Northern Africa are well below the world average of 90 deaths per 100,000 population annually. Our results indicate the potential impact of preventive practices. It is estimated that 20% of all cancer deaths (1 million) could be prevented by eliminating tobacco smoking. Infectious agents account for a further 16% of deaths. Int. J. Cancer 83:18–29, 1999.


International Journal of Cancer | 2013

Global estimates of cancer prevalence for 27 sites in the adult population in 2008

Freddie Bray; Jian Song Ren; Eric Masuyer; Jacques Ferlay

Recent estimates of global cancer incidence and survival were used to update previous figures of limited duration prevalence to the year 2008. The number of patients with cancer diagnosed between 2004 and 2008 who were still alive at the end of 2008 in the adult population is described by world region, country and the human development index. The 5‐year global cancer prevalence is estimated to be 28.8 million in 2008. Close to half of the prevalence burden is in areas of very high human development that comprise only one‐sixth of the worlds population. Breast cancer continues to be the most prevalent cancer in the vast majority of countries globally; cervix cancer is the most prevalent cancer in much of Sub‐Saharan Africa and Southern Asia and prostate cancer dominates in North America, Oceania and Northern and Western Europe. Stomach cancer is the most prevalent cancer in Eastern Asia (including China); oral cancer ranks as the most prevalent cancer in Indian men and Kaposi sarcoma has the highest 5‐year prevalence among men in 11 countries in Sub‐Saharan Africa. The methods used to estimate point prevalence appears to give reasonable results at the global level. The figures highlight the need for long‐term care targeted at managing patients with certain very frequently diagnosed cancer forms. To be of greater relevance to cancer planning, the estimation of other time‐based measures of global prevalence is warranted.


Lancet Oncology | 2012

Global cancer transitions according to the Human Development Index (2008-2030): A population-based study

Freddie Bray; Ahmedin Jemal; Nathan Grey; Jacques Ferlay; David Forman

BACKGROUND Cancer is set to become a major cause of morbidity and mortality in the coming decades in every region of the world. We aimed to assess the changing patterns of cancer according to varying levels of human development. METHODS We used four levels (low, medium, high, and very high) of the Human Development Index (HDI), a composite indicator of life expectancy, education, and gross domestic product per head, to highlight cancer-specific patterns in 2008 (on the basis of GLOBOCAN estimates) and trends 1988-2002 (on the basis of the series in Cancer Incidence in Five Continents), and to produce future burden scenario for 2030 according to projected demographic changes alone and trends-based changes for selected cancer sites. FINDINGS In the highest HDI regions in 2008, cancers of the female breast, lung, colorectum, and prostate accounted for half the overall cancer burden, whereas in medium HDI regions, cancers of the oesophagus, stomach, and liver were also common, and together these seven cancers comprised 62% of the total cancer burden in medium to very high HDI areas. In low HDI regions, cervical cancer was more common than both breast cancer and liver cancer. Nine different cancers were the most commonly diagnosed in men across 184 countries, with cancers of the prostate, lung, and liver being the most common. Breast and cervical cancers were the most common in women. In medium HDI and high HDI settings, decreases in cervical and stomach cancer incidence seem to be offset by increases in the incidence of cancers of the female breast, prostate, and colorectum. If the cancer-specific and sex-specific trends estimated in this study continue, we predict an increase in the incidence of all-cancer cases from 12·7 million new cases in 2008 to 22·2 million by 2030. INTERPRETATION Our findings suggest that rapid societal and economic transition in many countries means that any reductions in infection-related cancers are offset by an increasing number of new cases that are more associated with reproductive, dietary, and hormonal factors. Targeted interventions can lead to a decrease in the projected increases in cancer burden through effective primary prevention strategies, alongside the implementation of vaccination, early detection, and effective treatment programmes. FUNDING None.

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Isabelle Soerjomataram

International Agency for Research on Cancer

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Jacques Ferlay

International Agency for Research on Cancer

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David Forman

International Agency for Research on Cancer

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Ariana Znaor

International Agency for Research on Cancer

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Åsa Klint

National Board of Health and Welfare

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Mathieu Laversanne

International Agency for Research on Cancer

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