Saturday, November 1, 2014
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Poverty’s Cancer

GENEVA – Cancer is an enormous – and growing – global public-health problem. And, of the 7.6 million cancer deaths every year, 4.8 million occur in the developing world. A disease formerly considered more pervasive in affluent countries now places its heaviest burden on poor and disadvantaged populations.

In some African countries, fewer than 15% of cancer patients survive for five years following diagnosis of cervical and breast cancer, diseases that are highly curable elsewhere in the world. These are shocking statistics, with huge implications for human suffering, health-care systems (and budgets), and the international drive to reduce poverty. So they should be treated as a call to action.

The increase in cancer’s impact on the poor reflects factors such as demographic growth, population aging, the spread of unhealthy lifestyles (including tobacco use), and lack of control of cancer-associated infections. Though many cancers develop slowly, lifestyle changes take place with stunning speed and reach. These trends are not easily reversed.

If no action is taken, the number of cancer deaths in the developing world is forecast to grow to 5.9 million in 2015 and 9.1 million in 2030. While cancer deaths in wealthy countries are expected to increase less dramatically, they are nonetheless predicted to rise by a harrowing 40% over the next 20 years.

Throughout the developing world, most health-care systems are designed to cope with episodes of infectious disease. But most lack the funds, equipment, and qualified personnel needed to provide basic care for cancer patients. Thirty countries – half of them in Africa – do not have a single radiotherapy machine. And these countries certainly do not have the financial resources, facilities, equipment, technology, infrastructure, staff, or training to cope with the long-term demands of cancer care.

They also have little capacity for prevention, public education, or early diagnosis and treatment, whether it be early detection in primary care, surgery, radiotherapy, or chemotherapy. In large parts of Africa, such treatments are usually reserved for those rich enough to seek specialized care abroad.

The demands of chronic care for a disease like cancer are simply overwhelming. Countries and families also pay a huge economic cost, as the lives of millions of people who could otherwise have made productive contributions to their families and communities for many decades are cut short.

The real tragedy, of course, is that many of these patients do not have to die. We know that around one-third of cancers can be prevented. This figure could be increased markedly if more emphasis were placed on identifying additional environmental and lifestyle-associated factors that increase cancer risks. In addition, a diagnosis no longer has to be a death sentence, because one-third of cancers can be cured if detected early and treated properly.

The World Health Organization and the International Atomic Energy Agency are working closely together to improve cancer control in developing countries. The IAEA’s work involves building countries’ capacity for radiation medicine. But technology means nothing without well-trained and motivated staff to use it. That is why both organizations are developing training and mentoring networks and innovative public-private partnerships. With its broad approach to public health, it is also essential to strengthen health-care systems and primary care in order to improve early detection, timely diagnosis and treatment, as well as palliative care.

Preventive measures such as public-health initiatives to curb smoking can be remarkably effective. Vaccines against hepatitis B and human papillomaviruses, if made available at affordable prices, could contribute significantly to the prevention of liver and cervical cancers, respectively. At the International Agency for Research on Cancer, the specialized cancer agency of WHO, further research on the causes of cancer is being conducted, which promises to provide the base of evidence required to alleviate even more of the worldwide cancer burden,.

We are seeing promising results in individual countries, but our efforts are just a drop in a vast ocean of need. In order to respond to the growing cancer epidemic, we need nothing less than concerted global action similar to the successful mobilization against HIV/AIDS.

Cancer should be acknowledged as a vital part of the global health agenda. World leaders should be made aware of the scale of the cancer crisis facing developing countries. We need systematic action at the highest level to end the deadly disparity in cancer survival rates between rich and poor countries, thereby helping to save millions of lives. The goal must be to promote effective cancer control that is integrated into national health-care systems throughout the developing world.

The United Nations General Assembly’s Summit on Non-Communicable Diseases in September provides an opportunity to focus the world’s attention on cancer in developing countries. Let us make cancer control one of the good news stories of 2011.

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