The end of the 20th century brought about major shifts in the burden of disease plaguing low- and lower-middle-income countries (LICs/LMICs). Indeed, ever increasing industrialization and population aging have catalysed an epidemiological transition towards an increase in cancers, cardiovascular conditions and other non-communicable diseases 1. When compounded with the already significantly high rates of poor health outcomes and mortality, the case of LICs/LMICs can appear to be bleaker than ever. It is easy to become so immersed in the complexities of the many obstacles to development faced by these countries, that, resultantly, cancer is widely still believed to be a disease of wealthier nations 2. Accordingly, cancer as an emerging global health challenge has been termed a silent epidemic 3.
Cancer incidence rates are projected to rise to a staggering 21.6 million by 2030 with the greatest proportional increase occurring among the world’s poorest and most vulnerable populations 4,5,6. This shift is, in part, driven by advancements in other major public health priority areas, notably that of reductions in infectious disease and under five child mortality rate, that have seen to an overall increase in life expectancy and survival 6. Owing to increased life expectancy, people in LICs/LMICs are now vulnerable to numerous cancers and other age-associated noncommunicable diseases. Despite this, there has only recently been a shift in global health priorities to include cancer reduction efforts. Rather, we have continued to categorize diseases as communicable or noncommunicable and tackled them as priority areas in LICs/LMICs and upper-middle and high-income countries (UMICs/HICs) respectively. Ironically, a comprehensive cancer control agenda requires a shift in perspective to include both communicable and noncommunicable disease strategies as approximately one fifth of the global burden in cancer stems from infectious agents such as Hepatitis B virus (HBV), Human Papillomavirus (HPV), Human Immunodeficiency Virus (HIV) and others 6. Specifically, the spread of cancers associated with infectious agents are disproportionately more prominent in LICs/LMICs and are often almost entirely preventable in parts of the world where access to regular medical care is an option.
Global health narratives that discuss the rise in cancer among the world’s poorest and most vulnerable populations are often met with the rebuttal that there is little point focusing on diseases such as cancer when communicable diseases continue to ravage vulnerable communities. Indeed, effective cancer prevention requires regular screening and, in some cases, preventative vaccinations. As these areas often see limited access to basic medical services, let alone refined prevention and treatment campaigns, cancers are often only diagnosed at a much later stage when treatments are less likely to be effective. This has served as the foundation for ethical concerns regarding the moral implications of screening for cancer when outcomes are likely to be bleak owing to a lack of accessible and affordable treatment options, thus, deterring the global conversation on how to better prevent and treat cancers in vulnerable areas 6. Without the ability for a topic to become prominent in public discourse, we cannot expect that it will become prominent in public policy and catalyze the much needed investments in cancer aid and advocacy initiatives in LICs/LMICs.
The fight against the spread of cancer in LICs/LMICs needs to acknowledge that innovative cancer prevention and screening campaigns will not, and certainly cannot, rely solely on invention but must also draw attention to application. This notion becomes particularly prominent in the advent of cancers such as cervical cancer, among other cancers caused by infectious agents, which are viewed as almost entirely preventable with access to gold standard care recommendations. Here, we have the solutions but we are quite simply unable to reach those in need of them. As global health scholars, advocates, and implementers, we are quick to disregard good statistics as areas where our work is complete without questioning how those numbers were improved and achieved. For example, we disregard a vaccination coverage statistic in the 99% percentile and focus on how we can improve the vaccination system in a country where coverage is below 10%. In doing so, we fail to acknowledge that these cases of high coverage are indicative of interventions so successful in their application that almost every individual in a country has benefitted from them. First and foremost, this means that the infrastructure to reach an individual in order to deliver a service exists and can be leveraged and repurposed for the delivery of life-saving cancer prevention and screening initiatives.
We have made major progress in combating infectious disease and increasing life expectancy in LICs/ LMICs, to date. However, in order to implement a new global health agenda that incorporates a comprehensive cancer control policy, it is critical that we study the very mechanisms of success underscoring these past health campaigns, particularly with respect to reach. It is only through doing this that we will be able to effectively combat the spread of cancer to the most vulnerable of individuals and take our first step towards globally accessible cancer prevention and screening. However, in order to do so, we need to abolish the divide between conversations concerning communicable and noncommunicable diseases as separate entities and acknowledge that the fight for global health encompasses the fight for the health of every individual regardless of their diagnosis.
Kimberly Skead graduated from Trinity College, the University of Toronto with a Hon. BSc in Global Health and Genome Biology. She is a fellow of the Reach Project housed at the Munk School of Global Affairs and funded by the MasterCard Centre for Inclusive Growth. She will be starting her Ph.D. in the Department of Molecular Biology at the University of Toronto in the fall of 2018. Her main interests in global health include the development of novel, accessible diagnostic tools and the parallel analysis of how existing health-related behavioral patterns, policies and interventions can be leveraged to ensure that these tools are available to the world’s poorest and most vulnerable populations.
- Institute of Medicine (US) Committee on Cancer Control in Low- and Middle-Income Countries; Sloan FA, Gelband H, editors. Cancer Control Opportunities in Low- and Middle-Income Countries. Washington (DC): National Academies Press (US); 2007. 3, The Cancer Burden in Low- and Middle-Income Countries and How It Is Measured. Available from: https://www.ncbi.nlm.nih.gov/books/NBK54028/
- Crawford, C. (2013). Cancer: A Global Issue. Angle Journal. Retrieved from http://anglejournal.com/article/2013-05-cancer-a-global-issue/
- Sharara, N (2017) Tackling the Silent Epidemic of Cancer in Low and Middle-Income Countries. Retrieved from https://www.dalberg.com/our-ideas/tackling-silent-epidemic-cancer-low-and-middle-income-countries
- Bray F, Soerjomataram I. The Changing Global Burden of Cancer: Transitions in Human Development and Implications for Cancer Prevention and Control. In: Gelband H, Jha P, Sankaranarayanan R, et al., editors. Cancer: Disease Control Priorities, Third Edition (Volume 3). Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2015 Nov 1. Chapter 2. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26913347
- Kanavos, Panos (2006). The rising burden of cancer in the developing World. Annals of oncology: official journal of the European Society for Medical Oncology / ESMO. 17 Suppl 8. viii15-viii23. 10.1093/annonc/mdl983.
- Frenk, J (2009). Cancer is on the rise in developing countries. Retrieved from: https://www.hsph.harvard.edu/news/magazine/shadow-epidemic/