By 2032, researchers estimate there will be 22 million cancer diagnoses and 13 million deaths worldwide each year. But this burden is not—and will not be—shared equally, according to World Cancer Report 2014, published earlier this year by the International Agency for Research on Cancer (IARC), the specialized cancer agency of the World Health Organization (WHO).
Today more than 60 percent of the world’s total cancer cases—and about 70 percent of cancer deaths—occur in Africa, Asia, Central America and South America. Many of the countries in these areas have a two-pronged problem. They are experiencing an increased incidence in the cancers that are associated with a Western or more-industrialized lifestyle, like those of the lung, breast and colon. Yet they are also battling high rates of infection-related cancers, such as those of the cervix, liver and stomach, which many more-developed countries have reduced through effective screening or vaccination programs.
Cancer Today spoke with Christopher P. Wild, co-editor of World Cancer Report 2014 and director of the IARC, about the new report and ways to reduce cancer rates worldwide.
Q: From a global perspective, what are the most striking differences seen in cancer incidence and mortality?
A: The first is the scale of the increase in cancer incidence in low- and middle-income countries. Second, and linked to that, are the poor survival rates seen in these countries. If you take breast cancer as an example, you see that it is more common in high-income countries. But when you look at breast cancer death rates in low-income and high-income regions, you see that some areas are almost identical. The third thing that struck me is the transition in the patterns of cancer, particularly the increasing incidence of cancers associated with an industrialized lifestyle in the low- and middle-income countries.
Q: What types of policies could be implemented now to prevent some of the projected cancer deaths?
A: First and foremost, and it sounds like an old story now, is to really implement the tobacco control policies that are outlined in the WHO Framework Convention on Tobacco Control. I think other things are access to the human papillomavirus (HPV) and hepatitis B vaccines, which can prevent the majority of cervical cancer and liver cancer. There are policies such as regulations on pollutants, including air pollution levels, that can help reduce cancers due to environmental exposures. National policies to support high-quality screening programs for cancers that can be detected early, like breast, cervical and colorectal cancer, would also help. The challenge, of course, is that you need the commitment.
Q: By that do you mean political will or a financial commitment or both?
A: One challenge is on the technical level. We have evidence that vaccines can reduce cancer burden by reducing cancer risk. But there is a real challenge to implementing a vaccination program in the health care setting, especially in the developing world. The second challenge is political will. Many prevention strategies take two to three decades to come to fruition. For example, the dramatic declines we are now seeing in lung cancer in the U.S., Europe, Australia and elsewhere are from efforts to reduce tobacco that were implemented years ago and are now showing their full effect. So you have to have a vision politically and the commitment to cancer prevention to see the benefits.
Q: Is that where the country’s health infrastructure comes into play?
A: It’s not whether screening will work but how you implement those policies and how you determine what will work in that area. We are partway through a study in Lampang, Thailand, on implementing colorectal cancer screening. Part of that includes looking at who participates, what we might do to change participation and whether there is the clinical capacity to deal with those individuals who have a positive result on a screening test.
Q: Is the high cost of cancer drugs part of the problem?
A: These countries can obtain some drugs that are off-license and those can be effective. Yet the reality is that for the developing world, there is little prospect of access to sophisticated, personalized medicine—but those places can have earlier detection.
The situation in the low- and middle-income countries tells us we won’t be able to treat our way out of the cancer problem. We have to put an emphasis on prevention, early detection strategies, and effective and inexpensive treatments. We need to use the tools and knowledge that we do have to do as much as we can to reduce the barrier the cancer burden presents to human development.
June 27, 2014