Professional Documents
Culture Documents
I: Much should be done II: Much could be done III: Much can be and is being done
From anecdote
to evidence
Juanita:
Advanced metastatic breast cancer is the result of a series of missed opportunities
From anecdote
to evidence
Applies a diagonal approach to avoid the false dilemmas between disease silos -CD/NCD- that continue to plague global health
Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries
GTF.CCC
Members
C) Can be done
Myth 4: Impossible
19%
20%
0%
LMICs
High income
-31%
Facets
Men Women
% of population
40
Both sexes
20
Lower Upper High Low middle middle income Age-standardized prevalence of risk factor in adults aged 15+ years
Children
Leukaemia
All cancers LOW INCOME HIGH INCOME LOW INCOME HIGH INCOME
In Canada, almost 90% of children with leukemia survive. In the poorest countries only 10%.
Source: estimates based on IARC, Globocan, 2010.
Cancer especially in Stigma: women and children - adds a layer of discrimination onto ethnicity, poverty, and gender.
C) Can be done
Myth 4: Impossible
Women and mothers in LMICs face many risks through the life cycle Women 15-59, annual deaths
- 35% in 30 years
Mortality in childbirth Breast cancer Cervical cancer Diabetes
342,900
166,577
142,744
120,889
A Diagonal Strategy:
Delivery: Harness platforms by integrating breast and cervical cancer prevention, screening and survivorship care into MCH, SRH, HIV/AIDS, social welfare and antipoverty programs.
Examples:
Rwanda MoH working with Merck and Qiagen
using HPV vaccine as a base for expansion Mexico breast cancer and Oportunidades
C) Can be done
Myth 4: Impossible
Almost 80% of the DALYs lost worldwide to cancer are in LMICs, yet these countries have only a very small share of global resources for cancer ~ 5% or less.
1/3-1/2 of cancer deaths are avoidable: 2.4-3.7 million deaths - 80% in LIMCs
The costs to close the cancer divide may be less than many fear:
All but 3 of 29 LMIC priority cancer chemo and hormonal agents are off-patent: many < $100 / course Cost of drug treatment: cervical cancer + HL + ALL(kids) in LMICs / year of incident cases: $US 280 m Pain medication is cheap Prices drop: HPV 2011, $100/ to GAVI $5 & PAHO $14 Market potential is underutilized and undeveloped: purchasing is fragmented and procurement is unstable Delivery innovations are unexploited including health technology policy
Outcomes in MDR-TB patients in Lima, Peru receiving at least four months of therapy
Failed therapy Abandon 8%
therapy 2%
Died 8%
Cured 83%
Champions
Nobel Amartya Sen,
Cancer survivor diagnosed in India 50 years ago
Embryonal Rhabdomyosarcoma
12
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
2005
1955
2010
Source: Knaul et al., 2008. Reproductive Health Matters, and updated by Knaul, Arreola-Ornelas and Mndez based on WHO data, WHOSIS (1955-1978), and Ministry of Health in Mexico (1979-2010)
2010
Mexico, Colombia, Dominican Republic, Peru China, India, Taiwan Rwanda, Kenya
Yet. Mexico still does not have a national cancer registry. Globally, there is no registry of projects or formal evaluations to socialize evidence on successes.
Thoughts
IARC is uniquely positioned to drive this agenda Progress global and national requires better data and evidence Advocacy: If you lack $ for policy, knowledge is key demand induces supply Evidence is essential to make tough choices where access is low Apply diagonal solutions: prime example is strengthening data collection and research capacity in countries
Be an optimist optimalist
Expanding access to cancer care and control in LMICs: Should, Could, and Can be done