In The Lancet Oncology, a commission of global cancer experts publish major new assessments of the quality of cancer care in China, India and Russia.
In combination, China, India and Russia have more than half of the world's deaths from cancer.
These regions are comprised of enormous and diverse populations - each presenting their own complex and idiosyncratic obstacles to effective cancer care.
The commission's report finds that in all three cases, there are large disparities in access to cancer care, most often divided among lines of rich versus poor and urban versus rural. Cancer prevention of all types presents major challenges across the three countries.
"It is impossible to understand the issues that affect delivery of cancer care in China, India, and Russia," says commission lead Prof. Paul Goss, of Harvard Medical School and Massachusetts General Hospital Cancer Center, "without first understanding the social, economic, and attitudinal factors which influence the way that cancer care is delivered and received in these countries."
We present key findings from each report below.
China is the most populous and largest low-middle income country in the world, where cancer comprises 21% of all deaths.
Despite a doubling in beds for cancer care between 2005 and 2010, they are unevenly distributed across China, with twice as many beds in urban areas as rural areas.
The commission consider that an aging population, socioeconomic growth and increasing environmental pollution are accelerating China's cancer burden. They recommend that an urgent and ongoing effort should be made to reduce pollution in China's air, water and soil.
The Chinese public are not well-informed of the risks of cancer, the commission believe, and so they emphasize a need for education programs to not only enhance public awareness but also promote cancer prevention, early detection and treatment.
China has built more than 200 cancer hospitals, but in order to bridge cultural resistance to modern anti-cancer strategies, the report also suggests encouraging acceptance by integrating traditional Chinese medicine into the care plans.
Also, despite a doubling in beds for cancer care between 2005 and 2010, they are unevenly distributed across China, with twice as many beds in urban areas as rural areas.
An extreme shortage of doctors and health care workers presents a huge barrier to improved cancer care in India, as does a general disregard for health as a priority.
Like China, India has a growing economy and increasing levels of pollution. Unlike China, the median age of the population is very young, but an increase "will drive cancer incidence strongly," according to the report.
The report also finds significant socio-cultural obstacles. These include not only the caste system and poor standards of education and gender inequality, but also widespread prevalence of superstitions and traditional methods of healing.
Fatalistic beliefs about cancer - such as that death is inevitable, and so treatment is not required - are common and likely to impair progress.
In 1975, the Indian government launched the National Cancer Control Programme, which resulted in the formation of 27 cancer centers and funding for oncology services in more than 80 hospitals. But an extreme shortage of doctors and health care workers presents a huge barrier to improved cancer care in India, as does a general disregard for health as a priority.
Cancer accounts for 15% of all deaths in Russia, and life expectancies have not risen in line with the increasing wealth of the nation.
Russia is defined as being both a high-income country and an emerging economy by the World Bank.
Despite this, economic disparities in Russia are extreme, and health care expenditure on the poor is very low in comparison with similar income countries.
Cancer accounts for 15% of all deaths in Russia, and life expectancies have not risen in line with the increasing wealth of the country.
Men also die much younger than the women of the country.
New public health initiatives on alcohol and tobacco control are welcomed by the commission, but the report warns that "significant improvement" in enforcing and monitoring these policies is needed in order to reduce cancer incidence or improve outcomes.
The risk of dying from cancer in Russia is double that in the US.
Recently, Medical News Today reported on a study that blamed the abnormally high death rates in Russia - among men especially - on vodka consumption, a lifestyle factor strongly linked to liver and throat cancer.
The commission consider that financial and human resources for cancer control, in all cases, require improvement and more equal distribution.
Also, developing a national cancer plan, they say, is inexpensive and should be mandatory.
But because of the vast geography of the three areas, and the sheer scale of human diversity within China, India and Russia, accurate data collection has also presented severe problems - a factor that could lead to bad policy making. As commission lead Prof. Paul Goss explains:
"Inadequate and unrepresentative cancer data precludes policy makers from having a transparent understanding of the size and trajectory of the problems they face, and this leaves them unable to devise a forward-looking, modern, national cancer plan."
Written by David McNamee