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Editorial

The good news about cancer in developing countries


More than 50% of all new cancers and two-thirds of the annual cancer mortality worldwide happen in lowincome and middle-income countries. The cancer burden disproportionately aects poor people, who are more exposed to risk factors, often have no access to care or cannot aord care, and are further propelled into abject poverty by the eects of the disease. Whereas 90% of children with leukaemia are cured in highincome countries, 90% who live in the worlds poorest 25 countries will die from the disease. Palliative care and pain relief is woefully inadequate. Low-income and middle-income countries now face, similar to the epidemiological transition, a cancer transition with infection-related and preventable cancers, such as cervical cancer and hepatocellular carcinoma, still rampant, and previously less common cancers, such as breast cancer, on the increase. So what is the good news? In its report Closing the Cancer Divide, released on Oct 28, the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries presents a compelling case for comprehensive action on expanded access to cancer care and control with realistic recommendations that will be benecial beyond cancer. The task force, which was convened in November, 2009, by Harvard Medical School, Harvard School of Public Health, the Dana-Farber Cancer Institute, and the Harvard Global Equity Initiative, is upbeat and clear in its three-part summary of the report: much should be done; much could be done; much can be done. The premise that much should be done is presented with both an equity lens and an economic argument. The glaring disparities in painful deaths from preventable and treatable cancers as well as in stigma, suering, and lack of information between high-income and low-income countries need to be addressed on humanitarian and rights-based grounds. But equally important, and perhaps more compelling to policy makers, is the argument that avoidable cancer deaths and shortening of lives will be costly in terms of economic productivity and development. The authors state that, for all estimates, the economic value of the human life that could be saved exceeds the cost of cancer care and control. Much could be done, the report argues, by applying what its authors call a diagonal approach. For example, existing programmes, such as services for sexual and reproductive health or
www.thelancet.com Vol 378 November 5, 2011

for HIV/AIDS, could be expanded to screen for and treat cancers. One such approachthe Pink Ribbon Red Ribbon initiativewhich screens and treats for breast and cervical cancer in combination with an HIV/AIDS programme, is a good example of how services for both infectious and noncommunicable diseases can be combined. With health systems strengthening as a central goal and its emphasis on synergies and expansion of existing mechanisms, the task force deserves praise for its cooperative and inclusive approach. All too often global health initiatives are competing with one another for funds and attention to the ultimate detriment of the people whose lives they hope to improve. In the section that explains that much can be done, the report highlights a series of interventions in each of the six areas of the cancer care and control continuum: prevention, detection, diagnosis, treatment, survivorship, and palliation. The overarching areas for action recommended are ve key strategies. First, innovative delivery of care, such as using telecommunication with partners at national or international centres of excellence, will allow non-specialists to bridge the human resources gap. Second, improvement of access to aordable medicines and vaccines can be achieved through price reduction strategies. Third, innovative nancing mechanisms should be expanded to include cancer care and control. Or existing initiatives, such as the UN General Secretarys Every Woman Every Child strategy, might provide a commitment-based model that could be adopted for cancer control funding. Fourth, improved evidence through health information systems, such as national cancer registries, and research will help to formulate priorities and decision making at a national level. All countries are encouraged to develop, implement, and monitor national cancer plans. And fth, stewardship and leadership for cancer care and control needs to be strengthened. Here, WHO and the International Agency for Research on Cancer are strongly called upon to take lead roles. The report is optimistic and uncompromising: move away from disease silos and the distinction between communicable and non-communicable diseases and put the human being at the centre of action. If this message is acted upon, cancer care and control in low-income and middle-income countries might indeed become a good news story in the years to come. The Lancet

For Closing the Cancer Divide see http://ghsm.hms.harvard.edu/ uploads/pdf/ccd_report_111027. pdf For more on the Pink Ribbon Red Ribbon initiative see http:// www.state.gov/r/pa/prs/ ps/2011/09/172244.htm

1605

2011 President and Fellows of Harvard College

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