We Can’t Let Cancer Be a Death Sentence in Poorer Countries
In this, the final article in our month-long series on the disparities and inequities of cancer, we look beyond the U.S. at the huge impact the disease has around the world, and particularly among the poor.
Even when you've got the best doctors and the best treatments, having cancer is, to put it mildly, simply horrible. Imagine, then, what it's like for people in the poorest parts of the world. The disease takes its biggest toll in low- and middle-income countries—in fact, that's where 60 percent of cancer deaths occur. What's worse, cancer rates in poorer countries are rising and there are fewer resources to prevent the disease and less effective healthcare to treat it.
Now, however, an international effort is shaping up to address this major, developing health problem. In the past, international organizations such as the United Nations (UN) and World Health Organization have focused largely on infectious diseases, such as HIV, polio, or malaria, in developing countries. But a 2011 UN meeting changed that, says Dr. Benjamin Anderson, a professor of surgery and global health at the University of Washington. The meeting was held to recognize how much non-communicable diseases (like cancer) are taking a toll on developing nations.
"That created a political interest," Anderson told TakePart. "If you asked 10 years ago, is cancer really a problem in low- and middle-income countries, many would say no. The fact is that not only is it a rising problem, it's becoming a dominant problem."
Here are some sobering statistics:
• The majority of breast cancers now occur in developing countries. New breast cancer cases are occurring at three times the rate in developing countries compared to the United States.
• A study published this month in the journal Lancet Oncology found that 94 percent of child cancer deaths occur in low-income countries and that the proportion continues to rise.
• In less-developed regions of the world, the number of cancer cases in individuals 65 and younger will increase by 3.3 million cases per year by 2020 and by 3.9 million cases in patients 65 or over, according to the International Agency for Research on Cancer.
• Of the 5.4 million people who die each year from tobacco-related diseases (like lung cancer), 70 percent are from developing nations, according to the International Network for Cancer Research and Treatment.
"There is a huge shift in realizing that we have this problem that absolutely must be addressed," says Anderson of the Seattle Cancer Care Alliance. "We have this choice of, do we address this now or wait until it's more catastrophic?"
Why are cancer rates rising so fast in other parts of the world? That has to do with increasing life expectancy, Anderson says. "There are demographic changes that are bringing this to fruition," he says. "Because we're doing better with infectious disease, people are living longer. That is when cancer becomes more common."
But many risk factors for cancer are higher in developing nations—such as higher rates of smoking in some countries. About a billion of the world's estimated 1.4 billion smokers live in developing countries.
As nations develop, people may move away from traditional native diets and adopt a Western diet that's higher in fat, sugar, and foods from animals. Trade subsidies, such as corn subsidies, have introduced more cheap but unhealthy foods into those countries, experts say. The result: more diet-related diseases, such as obesity, diabetes, heart disease, and cancer.
Substandard living conditions can also increase the cancer risk. Polluted air and water have been linked to some types of cancers. People in developing countries are also plagued by cancers caused by infections. About 25 percent of tumors are linked to infectious agents, according to the International Agency for Research on Cancer. "Liver cancer rates are higher in Africa. That is because of the hepatitis virus that causes cirrhosis," Anderson says. "Infectious causes of cancer are very important in these regions."
Human papillomavirus (HPV), which is a sexually transmitted disease, is now recognized as the primary cause of cervical cancer. About 85 percent of 300,000 deaths from cervical cancer per year occur in low- and middle-income countries, according to the Institutes of Medicine. Both HPV and hepatitis B infections can be prevented with vaccines. However, vaccine coverage is very low to nonexistent in many developing nations.
Organizations such as UNICEF are trying to address this disparity with expanding vaccination programs. But other cancers cannot be prevented as easily, Anderson says. "Breast cancer does not have that single, underlying cause," he says. "That's why, while prevention is ideal, cancer strategies still require early detection, diagnosis, and treatment."
With a lot of help from international health organizations, some developing countries are, for the first time, creating their own national strategies to address rising cancer rates.
"Often, healthcare ministers are not physicians or not even medically trained," he says. "They are often politicians who have a limited knowledge-base about these areas. Providing this information through the UN or the Susan G. Komen Foundation or other organizations is very important."
What do you think might be the best ways to improve cancer prevention, detection, or treatment in developing countries?