Cancer Congregates in Poor Countries

Where a woman lives will largely determine her chance of avoiding breast and cervical cancer.

A woman's ethnicity, socioeconomic and migration status will largely determine whether she will develop one of these common cancers, and ultimately whether she will survive.

Each year 800,000 women die of cervical and breast cancer, mostly in low and middle income countries (LMICs).

Some diagnostic and treatment services like mammography are likely unaffordable in these impoverished countries. But, several proven, cost-effective interventions exist to tackle these common cancers.

For example, estimates suggest that universal HPV vaccination of all girls aged 12 years using existing child health programs could prevent 690,000 cases and 420,000 deaths worldwide over their lifetime, most of which would be in LMICs.

Cervical cancer, for example, is almost entirely preventable thanks to cost-effective routine human papillomavirus (HPV) vaccination and cervical screening with treatment of pre-cancers.

Neither of which require oncologists, or specialist cancer centres.

New estimates produced as part of the Series reveal that the cost of inaction will be huge. The number of women diagnosed with cervical cancer is predicted to rise by at least 25% to over 700,000 by 2030, most in LMICs.

“There is a widespread misconception that breast and cervical cancers are too difficult and expensive to prevent and treat, particularly in resource-poor countries where the burden of these diseases is highest. But nothing could be further from the truth,” explains Professor Ophira Ginsburg from the University of Toronto, Canada.

In high-income countries like Canada, the USA, and the UK where large-scale, cervical cancer screening is common, age-standardised cervical cancer rates are relatively low (less than 7.9 per 100000 women).

This data compares with countries in sub-Saharan Africa (Malawi and Zimbabwe) and central and South America (Guyana and Bolivia) where regular screening is uncommon and incidence rates are especially high (exceeding 40 per 100000 women).

Yet, breast and cervical cancer are not inevitably fatal and can be prevented and treated, say the authors, particularly if they are detected and treated at an early stage.

“With many competing health priorities in low-and middle-income countries, services for women’s cancers are given low priority and allocated few resources. But there are several low-cost, feasible interventions that do not require specialised care in hospital or massive capital investment, and which could be integrated into existing health-care programmes”, explains co-author Professor Lynette Denny from Groote Schuur Hospital, University of Cape Town, South Africa.

These authors argue that the response to women’s cancers needs to be seen as a vital part of international commitments to achieve universal health coverage and the new Sustainable Development Goals.

These global health initiatives provide a perfect platform to address breast and cervical cancer control in LMICs, and to help all women access cancer care.

According to co-author Richard Sullivan, Professor of Cancer and Global Health at King’s College London, UK, “The global community cannot continue to ignore the problem—hundreds of thousands of women are dying unnecessarily every year, and the need for affordable access to cancer care is projected to increase in the coming decades, as many of the poorest countries face rising rates of cancers.”

“Not only are the costs of essential cancer services for women lower than expected, but scale-up of diagnostic, surgical, and treatment services are a highly effective investment compared to the devastating economic cost to countries, communities, and families incurred by the serious shortfall in cancer care.”

“This situation could be turned around by 2030 if the international community, policymakers, politicians, healthcare professionals, and patients address this issue now,” said Sullivan.