The American Cancer Society has released the second edition of The Cancer Atlas book and, for the first time, a companion website. The Cancer Atlas provides in-depth information on the global burden of cancer, major risk factors, and cancer prevention and control measures.
Changes in developing countries leading to more cancer
It is estimated that the global burden of cancer is expected to rise from 14.1 million new cancer diagnoses in 2012 to 19.3 million in 2025 simply due to the aging and growth of the population. This is because the risk of getting cancer is greater as you age. During this period, even more cancers are diagnosed in less economically developed countries, increasing from 59% to 68% of the total cancer cases worldwide. In addition to aging, the burden is likely to increase as countries transition from a farming-based economy to an industry-based economy and as people change their work environments (office instead of farm), modes of transportation (driving instead of walking), and dietary habits (eating out instead of home cooked) – all of which lead to more obesity and physical inactivity, known risk factors for many common cancers.
Also, women are having fewer children and, therefore, also breastfeed for less time over the course of their lives, both of which may increase the risk of breast cancer. In addition, economically developing countries are being increasingly targeted by the tobacco, fast food, and beverage industries in search of new markets, leading to greater obesity, less physical activity, and more smokers. As a result, in many less developed countries more cancers such as lung, colorectal (colon), and breast are being diagnosed, and more people are dying from cancers typically associated with western lifestyles. In more developed countries, including the United States, rates of cancer diagnoses and deaths are decreasing or leveling off for the same cancers. [more]
Along with the increasing burden of cancers associated with economic development and adoption of western lifestyles, people in less developed countries continue to bear a disproportionately high burden of cancers related to bacterial or viral infections – such as liver, cervix, and stomach cancers. Infection-related cancers account for 23% of total cases in less developed countries, compared to only 7% of the total cases in more developed countries. In several sub-Saharan Africa and Asian countries, infection-related cancers remain the most commonly diagnosed cancers and/or the leading cause of cancer death. For example, cervical cancer remains the most commonly diagnosed cancer in women in many African countries.
Cancer innovations don’t always reach developing areas
In the past several decades, important scientific discoveries have been made in cancer prevention, early detection, and treatment, as well as in palliative care. These discoveries have contributed to substantial decreases in suffering and deaths from cancer in economically-developed countries. However, these lifesaving interventions are not accessible to millions of cancer patients in developing countries because of a lack of resources including a trained health work force, equipment, and infrastructure. For example, 6 out of 10 cancer patients would benefit from radiation therapy in the course of their cancer treatment. However, about 20 countries in Africa do not have a single radiation treatment facility. And even when radiation facilities are available, as is the case in several countries in Africa and Asia, coverage is woefully inadequate. For example, Ethiopia, a country of around 90 million people, is served by a single radiation treatment center located in the capital city. Cancer patients usually wait 4-6 months to receive treatment, and, sadly, many patients come back for treatment with more advanced disease than when they first sought treatment. This, of course, means that more people die from cancer. According to the International Atomic Energy Agency, about 5,000 radiation therapy machines are needed to meet the needs in less developed countries.
Some of the barriers to proven cancer prevention measures in less developed countries involve a lack of regulatory and political will. For example, although we know that raising cigarette taxes is the most effective tobacco control measure, almost no countries in Africa or Asia have raised their cigarette tax to the level recommended by the World Health Organization (75% of the cigarette retail price).
Similarly, although morphine to treat cancer pain is plentiful, safe, and easy to use, millions of terminally ill cancer patients in Africa and Asia die in pain because of regulatory restrictions, cultural misperceptions about pain, and concerns about addiction. Eighty-five percent of the global population lives in low- and middle-income countries, but consumes just 7% of the medicinal opioids, like morphine.
Not all bad news
On the bright side, there are efforts and collaborations among different sectors to improve access to known cancer prevention, early detection, and treatment services in less developed countries. The following are examples of these efforts from The Cancer Atlas:
- With financial support from Gavi, the Vaccine Alliance, many countries in Africa have introduced projects for vaccination of girls against HPV (human papillomavirus), which causes cervical cancer.
- The hepatitis B vaccine, which prevents liver cancer, has been introduced in 181 countries around the world, and 75% of children have received the three necessary doses.
- Uganda now makes oral morphine available to patients at no cost.
- The government of Kenya has committed to expanding availability of pain relief through the public sector.
- Nigeria, which is home to approximately 20% of the population of Sub-Saharan Africa, has embarked on a new initiative to improve access to oral morphine.
- The Framework Convention Alliance (FCA) is supporting global tobacco control efforts through the World Health Organization (WHO) Framework Convention on Tobacco Control.
- The International Atomic Energy Agency, through its Advisory Group on Increasing Access to Radiotherapy and Programme of Action for Cancer Therapy, is developing affordable radiation equipment packages and promoting expansion of radiotherapy services in low- and middle-income countries.
- The Global Initiative for Cancer Registry Development is working to develop and build cancer registry capacity in countries around the world, which will form the basis for assessing the cancer burden and taking action.
- Reach To Recovery International improves the quality of life for women with breast cancer and their families through peer support and advocacy.
- The McCabe Centre for Law and Cancer is building capacity for the effective use of law in cancer control.
- A palliative care advocacy network that includes the Union For International Cancer Control, Human Rights Watch, and the World Palliative Care Alliance is working to position palliative care on the WHO agenda and drive action at a national level.
Cancer leaders worldwide can find out more about such initiatives and other interventions needed to better control cancer worldwide in The Cancer Atlas. We hope that the information in The Cancer Atlas is used by cancer control advocates, government and private public health agencies, and policy makers, as well as patients, survivors, and the general public to promote cancer prevention and control worldwide.
Dr. Jemal is vice president of surveillance and health services research for the American Cancer Society.