Childhood cancer: unequal progress

Abstract

September is Childhood Cancer Awareness Month. Each year more than 300 000 children younger than 19 years are diagnosed with cancer worldwide. Numbers of deaths have been steadily increasing mostly because of new cases in low-income and middle-income countries (LMICs). The extraordinary progress made in treating childhood cancer in high-income countries is in stark contrast with the situation in LMICs. For example, in high-income countries, Burkitt's lymphoma has a 90% survival rate, whereas in LMICs, the rate is only 20%. The burden of cancer worldwide also affects countries disproportionately. According to a recent study in The Lancet Oncology, 82% of the global burden of childhood and adolescent cancer, measured in disability-adjusted life-years, occurred in LMICs in 2017. Unlike adult cancers, childhood cancer is difficult to prevent or screen for because the causative genetic and environmental factors are less understood. However, some well described associations exist: the incidence of Burkitt's lymphoma is much higher in malaria-endemic regions than in non-endemic areas, whereas Kaposi's sarcoma is often associated with HIV infection. Concomitant infections, concurrent disease, and late stage of presentation make diagnosis and treatment very challenging. Other major challenges for tackling childhood cancer in LMICs include stigma, treatment abandonment because of disbelief or high cost, low awareness, financial resources, medicine shortages, health insurance, and medical expertise. Last year, WHO established the 2018 Global Initiative for Childhood Cancer, which aims to achieve a global survival rate of at least 60% for all children diagnosed with cancer by 2030. We welcome this initiative, which fostered awareness and secured a place for childhood cancer on the international health agenda. However, to achieve the target, the current cure rate needs to double over the next decade to save the lives of an additional 1 million children. This goal will only be possible with stronger international commitment, through collaborations between national and global political leaders, to help deliver medical advances to every child. The global burden of childhood and adolescent cancer in 2017: an analysis of the Global Burden of Disease Study 2017The GBD 2017 results call attention to the substantial burden of childhood cancer globally, which disproportionately affects populations in resource-limited settings. The use of DALY-based estimates is crucial in demonstrating that childhood cancer burden represents an important global cancer and child health concern. Full-Text PDF Open Access