By Felicia M. Knaul, MA, PhD and Jonathan D. Quick, MD, MPH
On this World Cancer Day, we celebrate the remarkable progress in prevention, detection, care and treatment of cancer. Overall, treatment success has increased dramatically, with survival rates in high income countries like the U.S. now reaching over 90 percent for certain cancers such as breast, prostate, and testicular for patients with access to treatment. But this life-giving progress has yet to reach most of the world's people, who live in developing countries, where over half of new cases and nearly two thirds of all cancer deaths occur. Unforgivably, there is a huge "cancer divide" between rich and poor.
This year's World Cancer Day theme set by the Union for International Cancer Control (UICC) -- "together it is possible"-- calls on all individuals, organizations and governments to do their part to reduce premature deaths from cancers by 25 percent by 2025.
But there have been four myths that have held back cancer care and control in developing countries. On this World Cancer Day, let's start a global pink revolution to replace the myths with truths and the complacency with action.
The first myth is that cancer is "not a problem in developing countries." The truth is that cancer already causes more deaths in low and middle income countries than AIDS, tuberculosis and malaria combined. Breast and cervical cancer together account for more deaths among women in these countries than maternal mortality. In the poorest countries, 90 percent of children with the most common leukemia die of the disease, compared to 10-15 percent in the U.S. and Canada. Despite this burden, only 5 percent of global spending on cancer is in the developing world. In Africa, just one in 20 cancer patients receives needed chemotherapy.
The second myth is that there is "little that developing countries can do" to address cancer. The truth is that successful cancer programs exist in a number of lower income countries in Asia, Africa and Latin America; many for several decades. Proven options for both prevention and cure of many cancers already exist. Effective national programs can increase access to pain control for the 5.5 million cancer patients who today suffer and die with no effective palliation.
The third myth is that responding to the cancer challenge will "divert attention from more urgent global health priorities" set by the UN's Millennium Development Goals, such as HIV/AIDS or maternal health. The truth is that synergies exist for simultaneously addressing multiple health needs. We must avoid a zero-sum, competitive mentality. The recent launch of the Pink Ribbon Red Ribbon Partnership is an exciting program to integrate breast and cervical cancer screening into existing programs testing for HIV/AIDS in Africa and Latin America through the initiative of the Susan G. Komen Foundation, George W. Bush Institute, the U.S. State Department and UNAIDS.
The fourth myth is that developing countries "cannot afford cancer interventions." The truth is that the world cannot afford not to invest in cancer care and control in these countries. Tobacco use accounts for over 30 percent of all cancer deaths and will claim an estimated one billion lives in this century, most in developing countries where 80 percent of today's smokers live. Yet accelerated tobacco control efforts would cost less than U.S. $0.16 per person year for countries like China and India. A vaccine which prevents 70 percent of cervical cancer is available through the GAVI Alliance to low income countries for $15 per full 3-dose immunization. The global cost of increasing access to cancer medicines is less than we might think -- under $500 per patient for cervical cancer and Kaposi's Sarcoma (a common cancer in AIDS patients) and Burkitt's lymphoma (a childhood cancer seen most in Africa).
These four myths are familiar to the international public health community because only a decade ago the same myths held back progress in AIDS. Fortunately, grassroots activism and collective action dispelled these flawed beliefs. Paradoxically, AIDS treatment has extended the lives of people living with HIV/AIDS to an age where they develop cancer and other chronic non-communicable diseases (NCDs) such as heart disease and diabetes.
One vital step to move the pink revolution beyond rich countries to all countries is to transform and strengthen national health systems. In the first 50 years of international health, developing country health systems evolved in response to acute illness, treating chronic disease as a series of unrelated episodes, not as a single disease with continuing and long term care needs. The pink revolution must support an integrated health systems approach that builds on pioneering national cancer programs and investments in HIV/AIDS, tuberculosis, maternal, child, reproductive health and other priority areas.
Health financing reform to ensure universal health coverage is taking root in several pioneering developing countries, including China, India, Colombia, the Dominican Republic and Rwanda. Since Mexico included childhood cancers in its social health insurance program Seguro Popular, 30-month survival has increased from approximately 30 percent to almost 70 percent. To address human resources constraints, Haiti, Malawi and Rwanda have used primary and secondary care providers to safely provide chemotherapy with supported links to specialists and specialty centers, but no on-site oncologist.
Given the huge and avoidable suffering caused by cancer, confronting the unmet need for cancer care and control in developing countries is a moral imperative. Global action on cancer will yield benefits that exceed the costs. Access to these benefits should not be determined by income or geography. Investing in strong national health systems that expand prevention, detection, and treatment is essential and represents the economics of hope -- hope that takes the pink revolution to everyone in need.
Felicia M. Knaul, MA, PhD, is the Secretariat for the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries and co-editor of the forthcoming book 'Closing the Cancer Divide: An Equity Imperative.'
Jonathan D. Quick, MD, MPH, President of the nonprofit Management Sciences for Health, is a contributor to that book.
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