Page 0052

invest in the health of a woman at each stage in her life

through appropriate preventive, supportive, curative and

palliative interventions.4,5

The emerging disease burden, primarily associated with

chronic diseases and NCDs, requires a holistic approach to

women´s health that maintains a focus on reproductive and

maternal components, while extending the reach of

programmes and policies beyond reproduction to encompass

the health challenges that are faced by women over their

lifespan.

4 The impressive gains in the life expectancy of

women and recent improvements in maternal mortality

rates6,7 will be seriously undermined if emerging health issues

affecting women are not addressed.

In line with the suggestions of the High-level Meeting of the

General Assembly on the Prevention and Control of Noncommunicable Diseases,8

much of the recent literature on

NCDs in low- and middle-income countries has focused on

opportunities for risk factor reduction and primary

prevention - arguing correctly that these represent key and

cost-effective opportunities to prevent future disease.

However, there is an emerging discourse, some

encompassed in the WHO Action Plan for the Prevention and

Control of NCDs 2013-2020,9 that argues for incorporating

necessary and effective treatment interventions - with one

of the key diseases of concern being breast cancer.10-16 This

broader approach takes advantage of the many instances

where treatment-related interventions are appropriate in

the low- and middle-income country context. Many

treatments for cancer, for example, are relatively inexpensive

as they use off-patent medications for curative intent.

Further, the risk-factor-only focus has stifled efforts to

develop appropriate treatment guidelines in accord with the

needs and financial capacity of each country and has thus

ignored the opportunities to reduce the costs of treatment by

developing innovative approaches to deliver medicines and

other life-saving care.17-19

The response to the emerging challenge of chronic disease

and NCDs in low- and middle-income countries has been

inadequate. Cancer, and especially cancer in women, is a case

in point. Recent studies have coined the term "cancer divide"

to refer to the concentration of risk factors, incidence of

preventable cancers, stigma, uncontrolled pain, and death

and disability from treatable cancers in low- and middleincome countries as well as amongst the poor in both lowand

middle-income countries and in high-income countries.20

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 reproductive

health - poignantly illustrates how low- and middle-income

countries are faced with the equity challenges of responding

to both the preventable and treatable aspects of disease.21

Trends in women's cancers also highlight the equity

imperative of meeting the challenge of cancer globally and

closing divides between rich and poor. Further, the focus on

these cancers recognizes the specific risks to women

associated with their role in reproduction, and highlights the

need for dedicated actions, particularly because diseases

specific to women often receive delayed and lower quality

care and are neglected in other health agendas, especially in

low- and middle-income countries, where gender inequities

are most pronounced.21

This paper presents cross-country global data, historical

data from specific countries and within-country data from

Mexico to illustrate the cancer transition for women. The

analysis focuses on the equity imperative of meeting the

challenge of both diseases in the context of protecting and

promoting the health of women over the life cycle. The first

part describes the cancer transition as part of the

epidemiological transition. The next section introduces the

data used in the paper, followed by a discussion of the

empirical results.

The findings highlight the need to develop integrated

responses that consider and include both treatment and

prevention interventions. They also indicate the importance

of framing the challenges of the cancers of women within a

life cycle approach that considers the risks of disease at

different stages of their lifetimes.

Cancer transition

The epidemiological transition was originally put forward by

Omran.22 The decline in the incidence of communicable,

reproductive and nutritional diseases and a rise in that due to

NCDs and injury have been demonstrated empirically, most

recently by the 2010 Global Burden of Disease Study (GBD).1

The GBD shows a global decline in communicable,

maternal, neonatal and nutritional causes of death from

34.1% in 1990 to 24.9% of deaths in 2010.1 By contrast,

CANCER MANAGEMENT

CANCER CONTROL 2014 51

The response to the emerging

challenge of chronic disease and

NCDs in low- and middle-income

countries has been inadequate.

Cancer, and especially cancer in

women, is a case in point

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