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RESEARCH AND DEVELOPMENT

34 CANCER CONTROL 2021

Women's cancers: do variations

in patterns of care explain the

worldwide inequalities in survival and

avoidable premature deaths? The

VENUSCANCER project

Dr Claudia Allemani, Professor of Global Public Health, Cancer Survival Group

London School of Hygiene and Tropical Medicine, UK

Opening the World Cancer Congress in Paris (2016),

the French President, François Hollande, insisted

that women should be at the heart of cancer control,

"because they are victims of inequality in access to prevention,

treatment and screening in every country in the world".

Cancers of the breast, ovary and cervix are a major public

health problem worldwide. Every year, approximately 2.5

million women are diagnosed with one of these cancers, and

they account for over 900,000 deaths (1). Many of these deaths

are avoidable, even in low- and middle-income countries

(LMICs), where cancers in women represent a major economic

burden, both to families that lose a mother, but also to the

national economy (2).

Reducing the numbers of cancer deaths in women will

require improvements in prevention, but also more effective

health systems, to improve the survival of women who do

develop one of these cancers (3). Yet access to safe surgery

varies widely between the richest and poorest countries (4),

and in more than 30 of the poorest countries, radiotherapy

services are not available at all (5,6).

Differences in survival from these three cancers between

high- and low-income countries are striking (7). Inequalities

in survival also exist between high-income countries (8), and

even between regions within those countries. The problem has

been succinctly summarised: "political toleration of unfairness

in access to affordable cancer treatment is unacceptable" (9).

In 2015, the CONCORD programme established worldwide

surveillance of trends in 5-year survival over the 15-year period 1995-2009 (10). It documented for the first time the

very wide global differences in survival trends for most of

the common cancers, including breast, cervical and ovarian

cancers. In 2018, the third cycle of the CONCORD programme

updated worldwide trends in survival for patients diagnosed

up to 2014. In 2010-2014, age-standardized 5-year net

survival for breast cancer varied from 66% in India to 91% in

the United States; from 52% in Ecuador to 77% in Korea for

cervical cancer, and from 16% in India to 57% in Costa Rica for

ovarian cancer (Figure 1) (7).

VENUSCANCER

VENUSCANCER, embedded in the CONCORD programme,

aims to examine in much greater depth why these enormous

differences in survival up to five years after diagnosis still

persist for women diagnosed in the most recent years for

which data are available in cancer registries. Results from

this project will enable us to see how much of the differences

in survival between high- and low-income countries can be

explained, whether by the biological characteristics of the

cancers, or by the health care women receive, or by broader

aspects of society, such as women's socio-economic status or

level of education. This is the first aim of VENUSCANCER.

The second aim is to examine trends in avoidable premature

deaths, in relation with each country's gross domestic product

and total national expenditure on health. In this context,

avoidable premature deaths are defined as deaths that occur

within five years of a cancer diagnosis in a given country that

VENUSCANCER is a European Research Council (ERC)-funded worldwide study designed to

explain the global inequalities in survival from breast, cervical and ovarian cancers, the three

most common cancers in women. The goal is to provide levers for health policy to reduce or

eliminate avoidable differences in survival from these cancers.

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