CANCER MANAGEMENT
CANCER CONTROL 2014 73
The current focus on global health and specifically on
non-communicable diseases (NCDs) offers a
tremendous opportunity to reduce the burden of
cancer in the world. Global efforts in cancer registration
provide a huge amount of information on the cancer burden
and allow us to track cancer incidence and mortality across
the world.
Cancer is a complex group of diseases and although we
now know a lot about what causes cancer, how to prevent it,
how treat it effectively, and how to support and palliate
patients with cancer, in many parts of the world this
knowledge has not been optimally applied. It is currently
estimated that a third of all cancers can be prevented and a
significant proportion of cancers can be cured or treated
effectively. The most important factor for cancer prevention
is tobacco control.3 Tobacco-related cancers account for
22% of all cancer deaths. Between 15-30% of cancers, more
in low- and middle-income countries, are infection related
and effective vaccines against HBV and HPV infections are
expected to be effective tools for prevention of cervical and
liver cancers. Cancer prevention is very important but many
cancers are not preventable. In addition, it is well known that
cancer prevention takes decades to show a benefit. Effective
screening and early detection programmes combined with
high quality diagnostic and treatment services have been
shown to cure and prolong life in many cases.
Early detection and effective cancer treatment can save
lives. The access to affordable care represents a challenge in
many countries. In some states, access is limited by the
paucity of health care resources, in others by
underinvestment in cancer. Other barriers to timely access
to care include lack of insurance, lack of trained health
professionals, lack of technologies for diagnosis and
treatment, lack of affordable drugs, etc. Unfortunately,
access to treatment is most limited in low- and middle
income countries that face additional barriers to cancer
care. Cancer is still considered as a relatively rare and mostly
fatal disease not deserving investment. The stigma
associated with cancer presents a huge barrier on all fronts
from the individual to the decision-makers. Other health
priorities, mostly communicable diseases, attract more
attention. For many years now the World Health
Organization recommended that each country develops a
comprehensive cancer control plan adapted to local needs
and resources. Many countries have done so, but many plans
have not begun to be implemented.
The lack of equity in access to cancer care results in
unnecessarily high death rates. In 2011 the International
Atomic Energy Agency (IAEA) stated that low- and middleincome countries have
less than 5% of the world's resources
for cancer. Great disparities exist not only among countries
but also within countries. One of the unaddressed issues in
cancer control is the limited access to cancer care with
massive shortages in diagnostic services, surgical services
RADIOTHERAPY IN GLOBAL
CANCER CONTROL
MARY GOSPODAROWICZ, PRESIDENT, UNION FOR INTERNATIONAL CANCER CONTROL AND
MEDICAL DIRECTOR, PRINCESS MARGARET CANCER CENTRE, UNIVERSITY OF TORONTO, CANADA
Cancer presents an increasing health problem in the world. Previously seen as a problem
of the developed world, it is now recognized as a global issue. Currently, two thirds of all
cancer deaths occur in low- and middle-income countries. The recently published World
Cancer Report from the International Agency for Research on Cancer (IARC) confirms 14.1
million new cancer cases and 8.2 million deaths in 2012. This number represents less than
20% of all deaths in the world but the Global Burden of Disease study shows that the
number of cancer deaths increased by 38% between 1990 and 2010. These data suggest
that if no action is taken it will increase by 50% by 2030. Most of the increase in incidence
will be due to population growth and ageing and most of the increase in cancer deaths
will be due to the lack of access to care.1 The United States cancer statistics have shown
decreasing death rates from cancer in the last two decades. However, most low- and
middle-income countries lack resources to establish effective cancer control strategies.
With modern cancer care many deaths can be prevented.