New York – Although long treated as a problem exclusive to high-income and developed countries, cancer is also a major cause of mortality in the developing world. A group of leading cancer and global health experts is now calling for new strategies to effectively prevent and treat cancer in poor countries.
The paper, published Sunday in The Lancet and written by Dr. Felicia Knaul, from the Harvard Global Equity Initiative, together with Drs. Paul Farmer, Julio Frenk and Lawrence Shulman, aims to draw attention to the inequalities in the standards of cancer treatment across the countries.
“Cancer in developing countries remains an unforeseen and underrecognised health priority,” Knaul told IPS, adding that “it is still perceived as a disease of the rich and the developed world.”
Out of the 7.6 million people who die of cancer every year, two-thirds come from developing countries.
In 1970, only 15 percent of reported cancers were from low and middle income countries. In 2008, the figure rose to 56 percent and is predicted to reach the 70 percent mark by 2030.
The rising proportion is due to population growth, ageing and reduced mortality from infectious diseases. And survival rates for certain cancers, such as cervical, breast and testicular, are directly related to country income.
In Western countries such as the United States, cancer incidence and mortality have declined since the peaks of the 1990s, thanks to the wide availability of low-cost effective treatments, better prevention and higher awareness.
However, affordable access to treatment in developing countries is rare. Because of this the authors of the paper and conveners of the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries (GTF.CCC) emphasise the importance of prevention by tackling the major risk factors in these countries.
Strong anti-tobacco campaigns and wider availability to human papilloma virus and Hepatitis B virus vaccines will hopefully lead to the decline of cancer incidence and reduce treatment costs in the long term.
“Many of the treatments for cancer are not that expensive, including palliation and pain control,” Knaul says. However, reducing the costs of treatments is precisely one of GTF.CCC’s goals.
Over the last 10 years there has been an increase in international attention and financial aid dedicated to improving health resources in poor and under developed countries, but the focus has been mainly on infectious diseases such as HIV and tuberculosis.
Although the programmes to combat these diseases have been successful in reducing the number of affected people and in offering better and more accessible care, the challenges they faced at the beginning resemble those now faced by the advocates of better care and prevention of cancer.
Critics argue that resources for global health should not be spent on expensive vaccines and care for cancer, and that such complex care would be impossible within the weak framework of health systems of developing countries.
However, Knaul says that “cancer control and care can be delivered in ways that strengthen the entire health system, thus reinforcing ability to provide care for other diseases.”
“We need to eliminate the zero-sum argument about what diseases to exclude and start increasing resource availability and strengthening health systems to meet the needs of patients,” she said.
One of the biggest difficulties in offering cancer care in resource-poor countries is the absence of specialists and oncologists. However, recent experiences in Malawi, Haiti and Rwanda are proving that even this obstacle is not insurmountable.
In collaboration with the national ministries of health, an organisation called Partners in Health helps operate clinics in rural districts, and in the absence of specialists has trained local physicians and nurses.
Despite the success of these programmes, “the reach of these pilot initiatives has been dwarfed by the burden of the disease,” the paper says.
According to the authors, it is important that treatment be delivered free of charge, but the scale up of these projects is constrained by lack of funding.
A positive example of the scale-up of cancer treatment is its inclusion in national health insurance programmes, such as in Mexico and Colombia.
Although successful, the lessons from these two countries are only really applicable in middle income countries, as many don’t have national health insurance or offer financial protection in health to the poor.
For lower income countries, Knaul told IPS, “Expanding international support will be essential.”
“Global resources should be mobilised and these resources should be applied in ways that strengthen entire health systems and begin to offer financial protection in health focusing on the poorest segments of the population,” she said.
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