CANCER CONTROL 2014 7
According to the World Health Organization's
(WHO) International Agency for Research on
Cancer, cancer occurs in an estimated 14.1 million
people and causes 8.2 million deaths worldwide each year.
About two-thirds of these deaths take place in the
In some countries, cancer cases are exploding, for reasons
that are not well understood. In India, cancer is placing
enormous burdens on an already thinly stretched health
care system. That country's statistics are sobering. One
death occurs from cancer every 50 seconds. Breast cancer
has become the most common type of malignancy, with a
five-year survival rate of only 52%. Cancer is projected to
cause economic losses of US$ 20 billion in India by 2030 and
is the disease most likely to impoverish families.
In view of developments such as these, the emphasis of
Cancer Control on the early detection, prevention and
treatment of cancer in low- and middle-income countries is
especially welcome. This edition includes reports from
different regions around the world, where attention to
cancer and its control has often taken a backseat to other
pressing health matters. Cervical cancer is being given
According to the latest WHO statistics, cervical cancer
kills more than 270,000 women every year. More than 85%
of these deaths are in low- and middle-income countries.
Cervical cancer illustrates some of the approaches that are
being used to bring quality cancer control to resourceconstrained
First, the recent emphasis on frugal innovation is resulting
in the development of simple and low-cost yet effective new
tools that do not depend on sophisticated environments and
highly skilled staff. Research conducted by IARC has shown
that early cervical cancer can be detected through simple
visualization of the cervix coated with vinegar, with
cryotherapy used by a nurse to freeze off lesions, all in a
single visit to a health centre.
Second, negotiations between international organizations
and industry can get prices down substantially, as happened
most dramatically with antiretroviral therapy for AIDS.
When a vaccine against human papillomavirus was
developed, its high price looked like an insurmountable
obstacle for the developing world. As I have heard so often
from ministers of health, a vaccine that is too expensive for
the developing world is worse than no vaccine at all.
Fortunately, negotiations with industry have driven the price
of the vaccine down to levels that even very poor countries
can afford, with support from the GAVI Alliance.
Cervical cancer is not alone as a target of prevention
through new vaccines. IARC research has demonstrated an
association between cancers that are especially common in
the developing world and persistent infections with viruses,
bacteria and parasites. According to IARC estimates,
persistent infections with certain agents account for nearly
20% of the cancer burden worldwide, with developing
countries the hardest hit.
The challenges of cancer control are daunting for every
country in the world. We need solidarity, between rich and
poor countries but also between scientific and medical
disciplines. We need to apply what is already known better
and more equitably, and to support research, especially
needs-driven research that puts the developing world first. l
DR MARGARET CHAN, DIRECTOR-GENERAL,
WORLD HEALTH ORGANIZATION