On World Cancer Day, February 4th, the international cancer community united to send a clear message: we must act now to prevent, detect, and treat cancer. To empower individuals and communities, Global Oncology and 1,472 advocates came together under the slogan “I Can. We Can.” This rallying call is both local and global. Every person, everywhere deserves a fair chance at preventing or surviving cancer. While anti-cancer work anywhere is a worthy cause, the uneven burden of cancer around the world warrants particular attention and action. Together, we can effectively respond to persistent global inequities in cancer care and outcomes.
Cancer, like other non-communicable diseases (NCDs), is on the rise in low- and middle-income countries (LMICs). As populations age, obesity and other lifestyle risks grow, and infectious disease control extends lives, cancer and NCDs increasingly threaten health. By 2030, the number of new cancer cases worldwide will reach at least 21.6 million per year, with over 70% diagnosed in LMICs. Significant health system improvements are needed to address this escalating human and economic burden.
The challenges to improving cancer outcomes in LMICs are numerous. Too many cancers are diagnosed at an advanced stage, largely due to a lack of cancer education and universal health coverage. Too many treatment facilities are under-resourced in medical personnel, priority medical devices, or essential medicines. Too many people can’t access or afford existing care. Too many who access care ultimately abandon it or are lost to follow up. Too many cases are inadequately documented and tracked, making it difficult to analyze the challenges faced by the most underserved populations.
The unfortunate result is that too many lives are lost to preventable and highly curable cancers. About 2 million cancer cases per year, caused by infectious agents, could have been prevented through improved hygiene and sanitation, infection treatment protocols, and vaccination. In addition to the high cost of lives, these missed opportunities for prevention come at a high price for health systems. According to the Union for International Cancer Control (UICC), an investment of $11.4 billion in core prevention strategies in developing countries can return a savings of up to $100 billion in future cancer treatment costs.
For cancers that are less preventable, but highly curable if detected early, inequalities in outcomes exist across levels of economic development. For example, in 2012, the number of deaths due to breast cancer as a percentage of incident cases was about 25% across more developed regions and nearly 37% across less developed regions. The disparity reflects uneven access to recommended screenings and comprehensive treatment. One study of data from Africa, Asia, and Central America found that variations in cancer survival correlated with early detection initiatives and level of development of health services.
As a public health community, and out of respect for basic human dignity, we cannot accept this reality. Effective, low-cost screening and treatment options are available for several malignancies – including childhood leukemia and breast, cervical, and testicular cancer. At a minimum, making these interventions accessible along with prevention in developing settings must be prioritized. Eight years ago, in The Lancet, Paul Farmer et al. challenged the assumption that cancer will remain untreated in poor countries. Since that time, and even earlier, leaders worldwide and across sectors have come together to address unmet needs in global cancer prevention and care. If sustained, inclusive, and continually self-reflective, this global collaboration can drastically reduce cancer disparities.
Innovation and improved implementation of existing strategies are key to closing the gaps. Multisectoral partnerships can help reduce lifestyle risk behaviors and expand access to diagnostic services, radiotherapy, and surgery. Patient navigators and other social service providers may serve an important role in connecting people to existing services and supporting follow-up care. Recent advances in mHealth, eHealth, telehealth, AI decision support tools, point-of-care diagnostics, and various information and communication technologies may improve health system efficiency. Ongoing studies are assessing how these innovations may facilitate timely screenings, recordkeeping, disease surveillance, health workforce management, patient-provider communication, and more.
Over the last year, NCDs and cancer, specifically, have been a focus of multiple high-profile global health meetings. In November, at the World Cancer Leaders Summit (WCLS) in Mexico City, 350 leaders from 60 countries gathered to discuss strategies for cancer control. UICC directors and members, public officials, and leaders from the private and voluntary sectors participated. The summit’s theme “Cities driving change” aligned with C/Can 2025: City Cancer Challenge, which emphasizes the role of cities in improving access to quality cancer services.
This past January, NCD experts and advocates mobilized to launch a new World Health Organization (WHO) Independent Global High-level Commission on NCDs. The Commission, established by WHO Director-General Dr. Tedros Adhanom Ghebreyesus, will run through October 2019. It will develop a set of recommendations and measures for action, likely including strong political commitment and increased investment in NCD control. The Commission aims to identify new opportunities to reach the Agenda for Sustainable Development target of a one-third reduction in premature NCD deaths by 2030.
To build on years of momentum, we need students, medical professionals (across primary and cancer care), public health advocates, government officials, business leaders, nonprofit executives, and more to champion cancer equity as a global health priority. Together, we must make the social and economic case for governments at all levels to increase investment in health system strengthening and cancer prevention, detection, and care. We must support education and advocacy that promotes healthy lifestyle behaviors, improves health literacy, and fights cancer stigma. And we must pursue low-cost, community-driven innovations that can integrate into existing health and insurance systems.
Cancer is a massive global challenge, but together we can save lives and reduce inequities. If fully scaled, resource-appropriate strategies for prevention, early detection, and treatment could save up to 3.7 million lives annually, 80% in LMICs. While World Cancer Day comes once a year, preventing cancer and improving survival is an everyday effort. If you care about this important work and have time, resources, or connections to share, you can make a difference. Reach out to Global Oncology to see how you can help.
If you’re already engaged in global cancer research, service, or advocacy, consider adding your work to the GO Map. Global cancer is an issue far too large for any individual or group to tackle alone. The GO Map – a free, online platform – is enabling multi-sector partners to build, quantify, and strengthen work to combat cancer. By mapping cancer-related activities and data worldwide, the GO Map facilitates knowledge exchange and collaboration. As a united community, working towards shared goals, we can maximize our impact on global cancer gaps.
World Cancer Day rallied advocates around the world. In almost 20 different countries, landmarks and iconic buildings were lit up in blue and orange to commemorate the day. Over 820 activities took place to support the fight against cancer. The key is channeling that energy into sustained collaboration to address unmet needs. Action now will have a far greater impact than reaction in years to come.