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