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.