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Cancer in the Developing World: An Under-Prioritized Threat to Health and Development

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The rise of hundreds of millions of people out of poverty during the past 50 years is a story of tremendous, unprecedented human progress. A significant factor in this success has been the global community's coordinated effort to tackle serious health and economic barriers, like HIV, malaria, pneumonia, and lack of access to family planning.

During the last two decades, the number of deaths of children under 5 has fallen by about half. The conversation about eradicating polio is now focused on only three countries and seems within reach. Even regarding HIV and AIDS, the scourge of a generation, we may be seeing the beginning of the end. The call for an "AIDS-free generation" seems more plausible now than it did only a few years ago.

Much work still remains to be done in these areas, but the foundation of multi-sector collaboration around the issues is an encouraging sign. It is imperative that we apply this same degree of coordination and sense of urgency to the growing burden of cancer in the developing world -- a health and economic crisis that is going largely unaddressed.

The Growth of Cancer as a Major Health Threat in the Developing World

The Institute for Health Metrics and Evaluation, as demonstrated recently in The Lancet, has shown that non-communicable diseases, including all forms of cancer, are now the leading causes of death in the developing world, excluding sub-Saharan Africa. And even there, where infectious disease has done its worst damage in the modern era, non-communicable disease burdens are growing fast.

Today, cancer claims more lives around the world than HIV/AIDS, TB and malaria combined. Cancer affects men and women, young and old, rural villages and large cities. By 2030, some two-thirds of the estimated 21.4 million new cancer cases each year will occur in developing countries, and that proportion will grow as other causes of mortality are addressed.

Unlike the large budgets to address cancer in more developed nations, the developing world suffers from a dearth of cancer funding. This is an example of how funding is not always available or aligned with the greatest health needs in developing nations. It is a problem that the global health community and funding partners must work together to address. Some 40 percent of all development aid for health is allocated to HIV/AIDS, from which 1.5 million tragically died in 2010. In that same year, non-communicable diseases such as cancer killed 34.5 million people.

Our response in the global health community must not be "spend less on AIDS." Our response should be: Spend wiser and better on NCDs, especially on cancer, where the burden is growing fastest. In particular, as our experiences with HIV, malaria, tuberculosis and other health areas has taught us, we need to work to ensure that all families, regardless of where they live, have access to life-saving cancer information and services that they need to stay healthy.

Case Study: Cervical Cancer

Cervical cancer exemplifies the degree to which cancer disproportionately affects the developing world, as well as the importance of health information and access.

Cervical cancer is the third most common form of cancer among girls and women. More than 85 percent of 270,000 annual cervical cancer deaths occur in developing countries where access to life-saving screening and treatment options are scarce. Too often, women are not aware of cervical cancer as a potential health risk for themselves. Even in places where services are available, women may not seek them because they have not been educated about the importance of screening or have misunderstandings about the process and potential for treatment. In countries where cancer-screening services are prioritized, governments often lack the resources needed to reach the majority of the population.

Increasing the cervical cancer capacity of both private and public health providers, particularly in rural areas, is imperative.

My organization, PSI, is working to help achieve this goal. We are beginning to integrate cervical cancer screening and treatment services through our network of 10,000 private health clinics and providers in Africa, Asia, and Latin America. These clinics have a strong female client base, which will allow us to reach more women with a full range of services under one roof, where and when it is most convenient for them, at minimal additional cost.

When female clients visit the clinic, whether for family planning, TB, immunizations, HIV services, or treatment of childhood illnesses, they will also be introduced to the importance of cervical cancer screenings and offered access to affordable, high quality screening and prevention services. Caught early, treatments can be incredibly cheap and effective, even in very low resource settings. Our efforts are complemented by the work of mobile teams that operate in communities located too far from the nearest health facility. All of our programs are executed in close collaboration with Ministries of Health and other global health partners to ensure referrals for advanced cases are carefully coordinated.

It's a high-impact model that, with the right partnerships and investments, can be replicated at scale globally.

Looking Ahead

Our collective global health work is not done; it is evolving, as it should, to bring new attention to the different burdens of disease in the parts of the world where all of us have a stake in reducing poverty, increasing productivity, saving lives and securing communities and societies. We mustn't lose sight of our past successes -- indeed, we must learn from them to focus on future challenges, such as cancer and other non-communicable diseases.

It's a goal I know we can achieve.