NCRI conference session: global inequalities in cancer

Over half the world’s cancer deaths occur in developing countries

Despite common (mis)conception that cancer is a ‘modern’ disease of Western society (which we’ve discussed here), well over half of the world’s cancer deaths happen in developing countries. But it’s true that many cases of cancer are linked to our lifestyles. And, as people in the poorer countries of the world start living longer and adopting more Western lifestyles, cancer rates will rise.

And while breakthroughs in prevention, diagnosis and treatment are made in the richer parts of the world, too often their benefits don’t reach the world’s poorest.

For example, eight out of 10 cancer patients in Africa have no access to radiotherapy, while endoscopies, biopsies, chemotherapy and pain relief are also too often unavailable.

This growing problem was the subject of a pivotal session at this year’s NCRI conference.  We heard from three leading experts working to improve cancer outcomes across the world – Cancer Research UK’s Professor Max Parkin, Dr Rengaswamy Sankaranarayanan from the International Agency for Research on Cancer (IARC), and Dr Rajendra Badwe from the Tata Memorial Centre in Mumbai.

Tobacco and infection

Professor Parkin got the session going with a reminder of what causes the patterns of cancer we see across the world. As in the developed world, tobacco is firmly in the frame. But in the developing world, infection comes a close second, causing nearly a quarter of cancers – a total of 1.6 million cases each year.

The impact of infection on cancer rates can easily be seen by looking at some of the most common cancer types in developing countries – liver cancers, stomach cancers and cervical cancers. Not only could many of these cancers be prevented, but liver and stomach cancers in particular have low survival rates overall and new, expensive treatments are difficult to get hold of.

Reasons to be hopeful

But for some cancers linked to infection there are reasons to be hopeful – particularly cervical cancer. The international vaccination-funding organisation (GAVI) has recently added the HPV vaccination to the list of vaccines that they subsidise. High-risk strains of HPV (human papillomavirus) infections cause cervical cancer. GAVI’s welcome decision opens the doors for the governments of poorer countries to offer this vaccine to their populations, protecting them from cervical cancer – one of the most common and deadly cancers in these parts of the world.

As a result, twelve low- and middle-income countries are already introducing HPV vaccination programmes including Rwanda, one of the world’s poorest, along with Mexico, Colombia, Malaysia, Bhutan and others.

As Dr Sankaranarayanan, Head of Early Detection and Prevention at the World Health’s Organisation’s cancer division (IARC) told delegates, “in countries where resources are scarce, it may be easier and most effective to bring in HPV vaccination, but ideally I’d like to see this alongside at least a one-off screening for HPV in women aged 35 to 49.This could comprehensively address cervical cancer.”

So for cervical cancer at least, there’s significant cause for optimism. And the same could also be the case for breast and mouth cancers.

For breast cancer, mammography isn’t likely to be a viable option in many low-resource settings, but simply promoting breast awareness among women should have quite an impact in getting cancers diagnosed early, when surgery on its own has a good chance of successfully treating the cancer, and there’s less need for costly and scarce drugs, and radiotherapy.

Mouth cancers can often be detected early just by looking into the mouth, and a trial showed that this visual screening can reduce mortality by a third in tobacco and alcohol users. This represents a real opportunity to make a huge difference to the outcomes for patients with these cancers.

Further work

But there’s much more to be done. Rates of difficult-to-treat cancers such as lung, liver and stomach cancers continue to rise in poor countries – the latter a particular problem as smoking rates increase.

And while research in the Western world can be really valuable in making sure that treatments and prevention are evidence-based across the world, there’s a need for other research that’s based in different areas of the world, and informed by the very varied challenges people face there.

Finally, Dr Rajendra Badwe explained how, in India, the development and expansion of cancer registries are providing much-needed information to help identify problems and plan services.

He’s carrying out research to improve cancer diagnosis and care, and supporting and encouraging research in cancer centres across the country, to help provide answers that are specific and relevant to the particular setting. In our view, this is a principle that we can all benefit from, no matter where in the world we live.

It seems only right that at an event showcasing some of the best cancer research in the world, some thought is given to how to make sure scientific breakthroughs benefit those who shoulder the greatest burden of cancer illness and death.

As Dr Max Parkin put it, “We would like to thank the conference organisers for including this session on cancer in low and middle income countries, enabling us to highlight this important area which is something of a departure from the conference’s usual focus.”

Hazel and Jess