S
ubstantial improvements have been achieved in
reducing deaths among women from infectious
diseases and from complications of pregnancy and
childbirth. Although maternal mortality levels and infectionassociated causes of death continue to be unacceptably high,
non-communicable (NCD) causes now dominate the burden
of disease in low- and middle-income countries.1,2 For women,
some 65% of all deaths globally are due to NCDs, many of
which occur during childbearing age.3
The complexity of the health challenges that face girls and
women in resource-constrained settings provides a
compelling case - on health, equity and economic grounds -
for adopting a life cycle approach. Applying this approach
implies taking advantage of the range of opportunities to
WOMEN'S REPRODUCTIVE HEALTH
IN TRANSITION: THE OVERLAPPING
CHALLENGE OF BREAST AND
CERVICAL CANCER
FELICIA M KNAUL, HARVARD GLOBAL EQUITY INITIATIVE, BOSTON, MA, USA AND HARVARD MEDICAL SCHOOL,
BOSTON, MA, USA;
AFSAN BHADELIA, HARVARD GLOBAL EQUITY INITIATIVE, BOSTON, MA, USA AND HARVARD
MEDICAL SCHOOL, BOSTON, MA, USA;
HECTOR ARREOLA-ORNELAS, MEXICAN HEALTH FOUNDATION, MEXICO CITY, MEXICO;
ISABEL DOS-SANTOS-SILVA, DEPARTMENT OF EPIDEMIOLOGY AND POPULATION HEALTH, LONDON SCHOOL OF
HYGIENE & TROPICAL MEDICINE, LONDON, UK;
DANIELLE RODIN, HARVARD GLOBAL EQUITY INITIATIVE, BOSTON, MA, USA AND DEPARTMENT OF RADIATION
ONCOLOGY, UNIVERSITY OF TORONTO, TORONTO, ON, CANADA;
RIFAT ATUN, HARVARD SCHOOL OF PUBLIC HEALTH, HARVARD UNIVERSITY, BOSTON, MA, USA;
ANA LANGER, HARVARD SCHOOL OF PUBLIC HEALTH, HARVARD UNIVERSITY, BOSTON, MA, USA AND
JULIO FRENK, HARVARD SCHOOL OF PUBLIC HEALTH, HARVARD UNIVERSITY, BOSTON, MA, USA
Substantial improvements have been achieved in reducing the mortality of women from infectious
diseases and from complications of pregnancy and childbirth. The emerging disease burden, primarily
associated with chronic and non-communicable diseases, requires a new approach that maintains an
expanded focus on reproductive health. The evolution over time and across countries of the two leading
causes of cancer death in women - cancer of the cervix and of the breast, both associated with maternal
and reproductive health - poignantly illustrates how low- and middle-income countries are faced with the
challenges of responding to a complex burden of disease that demands both prevention and treatment
interventions and falls most heavily on the poor. This paper combines global, cross-country and historical
time-series data from a selection of countries to describe the cancer transition for women. The equity
issues are presented using sub-national, time series data for Mexico that illustrate the dual burden of
women's cancers in poorer states where women continue to face high rates of both cervical and breast
cancer. The protracted and polarized nature of the women's cancer transition is emblematic of the equity
imperative of meeting the challenge of cancer globally and closing divides between rich and poor. The
findings highlight the need to develop integrated programmes and policies that consider both treatment
and prevention, underpinned by a life cycle approach to effectively respond to the burden of cancer faced
by women globally. Integration with maternal and reproductive health interventions is the effective
strategy to meet the emerging challenges to women's health of chronic and non-communicable disease.
CANCER MANAGEMENT
50 CANCER CONTROL 2014