The World Health Organization (WHO) today spells out the need to step up cancer services in low and middle-income countries. WHO warns that if current trends continue, the world will see a 60 per cent increase in cancer cases over the next two decades. The greatest increase (an estimated 81 per cent) in new cases will occur in low- and middle-income countries, where survival rates are currently lowest.
This is largely because these countries have focused limited health resources on combating infectious diseases and improving maternal and child health, while health systems do not have the capacity to adequately prevent, screen, diagnose and treat people with cancer. In 2019, more than 90 per cent of high-income countries reported that comprehensive treatment services for cancer were available in the public health system compared to less than 15 per cent of low-income countries.
“This is a wake-up call to all of us to tackle the unacceptable inequalities between cancer services in rich and poor countries,” says Dr Tedros Adhanom Ghebreyesus, Director-General, WHO. “If people have access to primary care and referral systems, then cancer can be detected early, treated effectively and cured. Cancer should not be a death sentence for anyone, anywhere.”
Yet, progress in poorer countries is achievable. WHO and the International Agency for Research on Cancer (IARC) are releasing two coordinated reports on World Cancer Day (4 February), in response to government calls for more research into the scope and potential policies and programmes to improve cancer control.
“At least 7 million lives could be saved over the next decade, by identifying the most appropriate science for each country situation, by basing strong cancer responses on universal health coverage, and by mobilizing different stakeholders to work together,” explained Dr Ren Minghui, Assistant Director-General, Universal Health Coverage/ Communicable and Noncommunicable Diseases, World Health Organization.
WHO highlights a wide range of proven interventions to prevent new cancer cases. These include controlling tobacco use (responsible for 25 per cent of cancer deaths), vaccinating against hepatitis B to prevent liver cancer, eliminating cervical cancer by vaccinating against HPV, screening and treatment, implementing high-impact cancer management interventions that bring value for money and ensuring access to palliative care including pain relief.
“The past 50 years have seen tremendous advances in research on cancer prevention and treatment,” says Dr Elisabete Weiderpass, Director of IARC. “Deaths from cancer have been reduced. High-income countries have adopted prevention, early diagnosis and screening programmes, which together with better treatment, have contributed to a 21 per cent reduction in premature mortality between 2000 and 2015, but low-income countries only saw a reduction of six per cent. We need to see everyone benefitting equally.”
The challenge will be for countries to select treatments balancing considerations including cost, feasibility and effectiveness. It will be important to recall that newer treatments may have only marginal benefits over older, very effective, cost-effective, and more affordable off-patent medicines.
“In the Americas region, the Pan American Health Organization (PAHO), is working to increase access to essential medicines for cancer treatment through the PAHO Strategic Fund. This offers a pooled procurement mechanism for high quality and cost effective essential medicines, including for cancer treatment,” said PAHO Director Dr Carissa Etienne.
Cancer in the Americas
In the Americas, cancer is the second leading cause of death. In 2018, an estimated 3.8 million people were diagnosed, and 1.4 million people died from the disease. Approximately, 57 per cent of cases and 47 per cent of cancer deaths occurred in people aged 69 years and younger.
The most frequently diagnosed types of cancer among men are prostate (21.7 per cent), lung (9.5 per cent), colorectal (8 per cent), and bladder (4.6 per cent). Among women, the most common cancers are: breast (25.2 per cent), lung (8.5 per cent), colorectal (8.2 per cent), and thyroid (5.4 per cent). Even though it can be eliminated through HPV vaccination, and screening and treatment of precancerous lesions, cervical cancer is one of the most common cancers among women in Latin America and the Caribbean.
The type of cancers with the highest mortality rates in men are lung (19.6 per cent), prostate (12.1 per cent), colorectal (9.3 per cent), liver (6 per cent) and stomach (5.4 per cent). The cancers that cause the most deaths among women are lung (17.4 per cent), breast (15.1 per cent), colorectal (9.5 per cent) and cervical (5.2 per cent).
It is anticipated that by 2030, the number of people newly diagnosed with cancer will increase by 32 per cent to more than 5 million people each year in the region, due to the aging population, and exposure to risk factors, among other issues.
PAHO is working with Ministries of Health to improve prevention, screening, diagnosis, and access to treatment for all people in the Region of the Americas.