Redefining global health priorities: Improving cancer care in developing settings.

Abstract

Every year, more than 10 million people are diagnosed with cancer. Over half of them live in the developing world, where the cancer incidence rate has reached pandemic proportions. In 2008 there were upward of 12.4 million estimated new cases of cancer, with approximately two–thirds of the estimated 7 .6 million cancer deaths occurring in low–and middle–income countries [1]. Although low– and middle–income countries bear the majority of the disease burden, their health systems are inadequately prepared to address the challenge of care. Since cancer kills more people worldwide than HIV/AIDS, tuberculosis, and malaria combined, it needs to be a global health priority. Low– and middle–income countries bear the greatest burden of new cancer cases as well as deaths, amid an ever–increasing total number of affected individuals worldwide. In 2012 an estimated 14 million new cases were reported, with this figure anticipated to rise to 22 million over the next twenty years [1]. Significantly, more than 60% of the world’s total cancer cases occur in Africa, Asia, Central America, and South America, while greater than 70% of the world’s cancer deaths come from these same regions [2]. By 2030 the developing world is expected to account for 70% of newly reported cancer cases. What is more, survival rates are meager in poor countries and on the rise in wealthy ones [3]. For a wide range of cancers, an individual’s likelihood of surviving is closely and positively related to country income (Figure 1 and ​and22). Figure 1 Countries in the developing world bear the greatest burden of new cancer cases as well as deaths. By 2030, the developing world is expected to account for 70% of newly reported cancer cases [3]. Figure 2 Deaths due to cancer, HIV/AIDS, tuberculosis (TB), and malaria in the developing world. Cancer kills more people worldwide than HIV/AIDS, TB, and malaria combined [3]. Part of the reason why low– and middle–income countries lag behind wealthy nations in cancer survival rates is a lack of awareness, prevention, and early detection, as well as inaccessibility of new and more effective treatments that have been developed in recent decades and made available to many in the first world. Greater than 30% of cancer–related deaths in the developing world are estimated to be preventable [2]. Thus, in the case of low– and middle–income countries, the demand for cancer prevention and treatment services is far from being met. With burgeoning survival rates among those suffering from AIDS and other diseases in low– and middle–income countries the prevalence of cancer will only increase, thereby resulting in an even greater need for cancer services in these areas. While significant attention and financial support has resulted in expanded access to treatment for AIDS and other infectious diseases over the past decade, cancer is a concern that remains relegated to the periphery of the global health community. Despite its prevalence throughout the developing world cancer is conspicuously absent from central global health programs, including the United Nations Millennium Development Goals [4]. Cancer is a leading cause of mortality in low– and middle–income countries, equaling over five million annually. Disproportionate access to prevention and treatment, in addition to an ageing and growing population and decreasing mortality rates resulting from infectious diseases, will cause new cancer cases and cancer mortality to continue to rise in coming years. The global health community must take decisive action to bridge the cancer divide between wealthy and poor nations. Such action should take the form of increased access to drugs for treatment and palliation, expanded coverage for preventive and diagnostic services, as well as development and implementation of innovative health care delivery options to support rapid scale–up, while integrating access to patients in resource–poor regions through national health insurance systems.