Women's cancer deaths: Discussing global inequity

A three-paper series published this week in The Lancet gives details on the state of breast and cervical cancer in the developing world. Although treatable and preventable, the majority of deaths occur in low- and middle-income countries.

Each year, 800,000 women die of breast and cervical cancer.

Where a woman lives plays a large part in whether she will survive the disease.

A concerning 9 out of 10 cervical cancer deaths occur in low- and middle-income countries (LMICs).

Of course, certain high-cost preventive and treatment measures, such as mammography and radiotherapy, are not available in these regions; but this is not the whole story.

As the papers in The Lancet argue this week, there are cost-effective, proven interventions that could save hundreds of thousands of lives per year.

These include cervical screening and human papillomavirus (HPV) vaccination for young girls. Neither of these interventions needs highly trained medical staff or specialist centers.

The series, launched at the 2016 World Cancer Congress in Paris, France, argues that more must be done by the international community to implement these and other interventions more widely.

Predicting future cancer burden

Predictions made in The Lancet's special edition are bleak. They estimate that the number of women diagnosed with breast cancer across the globe will almost double - from 1.7 million last year to 3.2 million in 2030.

Similarly disturbing, cervical cancer is predicted to increase by 25 percent to over 700,000 by 2030. These increases will be predominantly in LMICs.

"There is a widespread misconception that breast and cervical cancers are too difficult and expensive to prevent and treat, particularly in resource-poor countries where the burden of these diseases is highest. But nothing could be further from the truth," notes series lead author Prof. Ophira Ginsburg.

"This series clearly shows that high-impact, cost-effective interventions exist for countries at all stages of development. Recent estimates suggest that a basic cancer control package could be introduced in low- and middle-income countries for as little as $1.72 per person - equivalent to just 3 percent of current health spending in these countries."

Prof. Ophira Ginsburg

As it stands, LMICs only receive 5 percent of global funding for cancer, which has compounded the problem. The authors call for an international push, similar to the one that led to huge improvements in maternal health. This argument makes a great deal of sense when the figures are examined. Currently, cervical and breast cancer kills almost three times as many women each year than complications of pregnancy and childbirth.

Survival rates by country

To highlight the disparity in early screening, prevention, and treatment, the series compared the 5-year survival rates following breast cancer diagnosis. The range of rates is surprisingly wide.

In South Africa, Mongolia, and India, the 5-year survival rates are just 50 percent. However, rates are over 80 percent in 34 countries, including the United Kingdom, Australia, the United States, Ireland, and Germany.

The overall rates of disease in the countries vary, too. Because cervical cancer screening is commonplace in higher-income countries such as the U.K., Canada, and the U.S., cervical cancer affects just 7.9 per 100,000 women. However, in sub-Saharan Africa, and parts of South America, screening is much less common, and rates can exceed 40 per 100,000.

Even within one continent - Europe - survival rates vary. For instance, in Sweden, the 5-year survival rate is 86 percent, yet, a few hundred miles away in Lithuania, it is 66 percent.

The low cost of prevention

Despite this disparity, the series of papers argue that relatively low-cost interventions could substantially improve the outlook in LMICs - breast and cervical cancer are treatable and preventable.

"With many competing health priorities in low- and middle-income countries, services for women's cancers are given low priority and allocated few resources. But there are several low-cost, feasible interventions that do not require specialized care in hospital or massive capital investment, and which could be integrated into existing healthcare programs."

co-author Prof. Lynette Denny

The researchers estimate that universal HPV vaccination of girls aged 12, using pre-existing child healthcare and immunization programs, could, over their lifetime, prevent 690,000 cases and 420,000 deaths worldwide.

Above all, the papers are a call for action. Richard Sullivan, professor of cancer and global health at King's College London in the U.K., is clear about the situation. He says:

"The global community cannot continue to ignore the problem - hundreds of thousands of women are dying unnecessarily every year, and the need for affordable access to cancer care is projected to increase in the coming decades, as many of the poorest countries face rising rates of cancers."

"Not only are the costs of essential cancer services for women lower than expected, but scale-up of diagnostic, surgical, and treatment services are a highly effective investment compared to the devastating economic cost to countries, communities, and families incurred by the serious shortfall in cancer care," he adds.

"This situation could be turned around by 2030 if the international community, policymakers, politicians, healthcare professionals, and patients address this issue now." Sullivan concludes.

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