The cancer burden in the developing world

Sep 25 2007

Only a few years ago cancer was considered to be a disease of westernised, developed countries, but now the burden is increasingly falling on less developed countries, a leading epidemiologist told ECCO 14, the European Cancer Conference.

Professor Peter Boyle, Director of the International Agency for Research on Cancer, Lyon, France, said that a major challenge for low-to-medium resource countries would be to find sufficient resources to treat the large numbers of cancers that would be diagnosed in their populations in the coming years.

In the year 2000, estimates suggest that there were 10.4 million new cases of cancer diagnosed worldwide, 6.5 million deaths from cancer, and over 25 million people living with cancer. Taking account of the growth and ageing of the world’s population, and factoring in an annual increase in cancer incidence and mortality of one percent, in 2030 there may be 27 million new cases diagnosed, 17 million cancer deaths, and 75 million people alive with cancer.

“If we put population growth and ageing to one side,” said Professor Boyle, “the exportation of cancer risk factors, primarily tobacco smoking, from developed countries will continue to be a major determinant of cancer risk and cancer burden in less developed countries.”

Low-to-medium resource countries will be harder hit by cancer than high-resource countries, says Professor Boyle. This is because such countries often have a limited health budget and a high background level of communicable disease. Cancer treatments are not universally available and life-extending treatments, for economic reasons, are available only to a few, if at all.

But something can be done. In Europe, although the number of cancer cases continues to rise, there are starting to be fewer deaths than expected, said Professor Boyle, and this showed that cancer control policies were working. “We have moved from the theoretical to the practical in cancer control,” he said.

In 2006 in Europe there were an estimated 3,191,600 cancer cases diagnosed (excluding non-melanoma skin cancers) and 1,713,000 deaths from cancer. The total number of new cases of cancer in Europe increased by 300,000 between 2004 and 2006. With an estimated 3.3 million new cases (53% occurring in men and 47% in women) and 1.7 million deaths (56% in men and 44% in women) each year, cancer remains an important public health problem in Europe, said Professor Boyle, and the ageing of the population will mean that these numbers will continue to increase even if age-specific rates remain constant.

The Europe against Cancer programme was established in 1985 to try to tackle increasing cancer incidence and mortality. The first stage of the programme had, as its objective, the reduction of the number of deaths expected to be caused by cancer by 15% by the year 2000. This goal was to be achieved by a partnership approach and a programme of activities in primary prevention (particularly tobacco control), screening, and education and training.

“This approach has clearly paid off,” said Professor Boyle. “In the EU in 2000, we expected to see 1,033,083 deaths from cancer on the basis of age-specific rates for the mid 1980s. In fact, we now know that there were 935,219 cancer deaths in the EU in 2000 – 97,684 fewer than expected, or a reduction of 9.5%.

“Cancer and other chronic diseases, which are becoming more common throughout the world, can cause devastating damage to entire families,” he said. “If cancer is not given higher priority through focused global efforts, healthcare systems in low-income and middle-income countries will encounter even further problems as the number of cancer cases increases. More and more people will die prematurely and needlessly from cancer, with devastating social and economic consequences for households, communities, and countries alike. Cancer could become a major impediment to socio-economic development in low income and economically emerging nations.”

“We have clear evidence that cancer can be controlled. The time is right for this to happen in lower-income countries too. The WHO Resolution on Cancer Prevention and Control provides a strong impetus for countries to develop programmes aimed at the reduction of cancer incidence and mortality and to determine strategic priorities to achieve progress. Such priorities must be realistic and achievable. Depending on priorities and competing health priorities, all steps must be taken to avoid those cancers which are avoidable, to treat those which are treatable, to cure those which are curable, and to provide palliation to patients who need palliative care,” he said.