World Cancer Day: Addressing Cancer in Developing Countries: The Time Is Now to Debunk the Myths, Help Countries Lead

World Cancer Day: Addressing Cancer in Developing Countries: The Time Is Now to Debunk the Myths, Help Countries Lead

{Photo credit: Rui Pires.}Photo credit: Rui Pires.

In the beginning of my medical career during the early 1990’s, I witnessed the devastating effects of HIV & AIDS.  Nearly 60 percent of the hospital beds I attended were filled with AIDS patients, many of them my close friends and colleagues. At the time, little was known about the AIDS epidemic; no effective treatments were available; and as a physician, I watched helplessly as day after day those closest to me suffered until their death.  

Today, almost three decades later, thanks to increased prevention and access to care and treatment for HIV, most of these hospital beds have emptied of HIV & AIDS patients.  Now, these same beds are filled by those suffering from preventable chronic diseases, including vaccine-preventable cancers.

Today, February 4, we commemorate World Cancer Day, joining the global community to raise awareness about the global cancer epidemic, and renew our commitment to address cancer in low-and middle-income countries (LMICs).

Let’s Talk about Cancer in Low- and Middle-Income Countries

Cancer is a huge and growing global public health concern, with about 14 million people learning that they have cancer each year and about 8 million lives being lost due to cancer yearly. More than 60 percent of these cancers are occurring in developing countries–and people in these countries die younger and faster than in rich countries.

Cancer is killing more people than AIDS, tuberculosis and malaria combined. And 70 percent of cancer deaths occur in developing countries.

[Click thumbnail for full-size image.]Click thumbnail for full-size image.

Despite this huge burden, cancers receive a fraction of global and national attention and resources of other health burdens. Most low- and middle-income countries have limited comprehensive cancer prevention, care and control efforts on their health agendas in the broader context of health system strengthening, and some countries have none.

Cancer misinformation, myths and misconceptions abound. For instance, people in most settings are not comfortable talking about cancer. They don’t believe or know that there are early signs and symptoms, nor are they aware of where to go to get cancer care and treatment. Many do not believe they have a right to receive care.

These myths at the individual level also have parallel implications at the country and global level, where many still do not realize that low- and middle-income countries can and must address the global cancer divide.

If country-level cancer agendas had a map, it would say: Start here.

Based on current evidence and what we know through our work in countries throughout Africa, Asia, Latin America and the Middle East, addressing cancers in low- and middle-income countries is possible through community prevention (including vaccines and health promotion); leveraging systems and integrating health services for access to early diagnosis, treatment, and care; and supporting country-led development and implementation of effective policies and funding mechanisms.

Community prevention and health promotion

Community prevention begins, and largely occurs in the household, family, village, school, and workplace. The good news is that current evidence suggests we can prevent one out three cancers through education, the ousting of myths and misconceptions, and by addressing identified modi&;able risk factors which are known to cause some cancers. For example: we can address tobacco and alcohol use, poor diet and physical inactivity through community prevention, health promotion, and effective policy; some viruses and infections through vaccines; and sun and UV exposure through health promotion and prevention. Furthermore, we can also address barriers on access to prevention, care that includes geographical barriers; access to medicine or out of pocket expenses; and the lack of context-specific national cancer guidelines. Partnerships of all sorts can lead to the best prevention practices.

Access: Leverage systems, integrate services

Bringing life-saving HIV treatment to the most hard-to-reach areas once seemed impossible. Yet, today millions of people have access to antiretroviral treatment in low- and middle-income countries. Now, this groundwork that enabled scale-up of ART—new public infrastructure, drug development technology and pricing, changes in policy and regulation, improved pharmaceutical supply chains, and human resources management—can be used to benefit patients with cancers. Indeed, it already is: cuts in cost of cancer drugs, secured through the GAVI Alliance, are helping to ensure access to the HPV vaccine for girls around the world.

To address cancers, we must also integrate existing services with cancer-related services to reach people early at the point of care–such as through HIV & AIDS, family planning, and immunization visits. For example, working with the government of Uganda, we are leveraging existing infrastructure for HIV and AIDS to provide services for cervical and breast cancer to HIV-positive women. Since March 2011, the project has screened more than 3,000 women for cancer in more than 40 health centers. Uganda is also using family planning and reproductive health visits to screen women for cervical cancer, and child and expanded immunization programs to scale-up HPV vaccines.

It also means utilizing what we know works to strengthen health systems. For example, through the time-tested MSH-led Leadership Development Program (LDP), the Kenyatta National Hospital Cancer Center team reduced waiting times for treatment for cancer patients from five weeks to one week – and continues to work together to improve the health of cancer patients.

[A patient at Kenyatta National Hospital Cancer Treatment Center receives chemotherapy.] {Photo credit: MSH staff.}A patient at Kenyatta National Hospital Cancer Treatment Center receives chemotherapy.Photo credit: MSH staff.

Countries lead

Effective country-led policies are another key to addressing cancers in LMICs. We assist countries to develop strategies and policies for addressing cancers, translate their chronic disease-related strategies and policies into meaningful action, and cost chronic disease activities. The Ministry of Health of Kenya, with support from MSH, World Health Organization, and other partners, recently developed and launched national guidelines to address the growing cancer epidemic—the country’s third leading cause of mortality. While still in the dissemination and implementation phase, country leaders hope the guidelines will lead to early screening, diagnosis, and management of cancers, reduced cancer-related mortality, and improved health outcomes.

Embarking on a new era toward UHC

We have acceptance that [universal health coverage] is possible. It is a myth that poor countries cannot afford UHC. There is no country that cannot afford UHC… It is a matter of social justice.

~ Sir George Alleyne

To address the cancer epidemic our best hope of success is to position cancer and chronic diseases in the context of an integrated, locally driven commitment to universal health coverage (UHC). Strategic new partnerships, including with the private for-profit and not-for-profit sector, are essential for us to tackle the growing challenge of cancers, utilizing universal health coverage as the key to offering a package of services that are available when needed, without causing financial hardship to the beneficiary.

The International Agency for Research on Cancer, an arm of the World Health Organization (WHO) provided another tool for the global health community to talk about and address cancer with the release of the new World Cancer 2014 Report. This report provides regional cancer data specific to the continents. The report also shows the importance of having population-based data, a way of ensuring standardized cancer registries, and a renewed focus on efficacious prevention strategies.

Cancer is not a disease of the rich. Access to cancer treatment doesn’t have to be determined by where you were born. Low- and middle-income countries, with global support, can and must invest in addressing the growing cancer epidemic. We cannot afford ignorance or inaction. By promoting vaccines and community prevention; providing access to early diagnosis, care, and treatment through an integrated diagonal approach; helping countries lead on national guidelines and UHC; together, in partnerships, we can address the growing burden of cancer in LMICs.

Dr. Gloria Sangiwa is a Tanzanian physician and public health specialist with more than twenty years of experience in management and technical leadership in global HIV/AIDS programs, international public health program management, development, and research and training throughout Africa, Asia, Latin America and the Caribbean. She is the global technical lead for chronic diseases at Management Sciences for Health.

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Comments

Ben Simms
It is good that you are focusing on cancer. However, none of us benefit from they way you are setting up the response to cancer as a competition to HIV and AIDS. ‘Cancer kills more than’… so… what? We shouldn’t care that 1.6 million people died of AIDS in 2012? That we have not yet ended AIDS? Good health, and access to universal health coverage, are goals we should be working on together, especially as we approach the decisive moment of 2015.
Gloria Sangiwa, MD
@Ben Simms, thank you for the thoughtful comment. We agree! All lives lost are a tragedy. The data regarding cancer deaths are shared to help debunk the myths that cancer isn’t a global problem. It most certainly is NOT about pitting one disease versus another! Our vision is for a world where everyone has the opportunity for a healthy life. To achieve this, we address multiple health areas and building blocks of the health system. We address chronic diseases, preventable and treatable diseases, including HIV & AIDS, malaria, and TB, and other public health challenges, including maternal and infant mortality rates, family planning & reproductive health, and malnutrition. We must work together, leverage existing systems, and integrate services. Instead of treating a single disease: treat the person as a whole. Thank you again for sharing your important thoughts.

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