Expanding Cancer Prevention and Treatment in the Developing World

T he incidence of curable childhood cancer in East Africa is comparable to that of advanced industrial countries, yet the death rate is five times higher. Cervical cancer rates in many lowand moderate-income countries are two to three times higher than in richer countries, and the mortality rate is twice as high, even though cervical cancer is preventable with vaccinations and treatable if caught early. Faced with those stark differences, Rwanda ’ s health minister, Agnes Binagwaho, M.D., will soon launch a major campaign to detect and treat cancer among the country ’ s 11 million people, despite the presence of just two pathology labs and three hospitals that can analyze biopsy samples. The fi rst focus will be on childhood cancers. “We ’ re targeting the cancers where we can save the most lives with the simplest [drug] regimens,” she said. The country is piggybacking on its successful effort to combat infectious diseases such as HIV/AIDS in the aftermath of the 1994 genocide, which killed nearly 1 million Rwandans, including many of its besteducated citizens. Life expectancy is again over 50 years, due largely to the country ’ s success in curbing its infectious-disease epidemics. “We know how to control infectious disease,” Binagwaho said in a telephone interview from Kigali, the nation ’ s capital. “We need to know how to prevent and treat noncommunicable disease.” The nascent Rwanda program is one of the fi rst examples of a global campaign to expand basic cancer prevention and treatment services in lowand moderate-income countries, where noncommunicable diseases are emerging as a major public-health challenge. Countries moving up the income ladder are seeing more adults reach the age when most cancers begin to appear. Recognition is also growing that increased smoking, alcohol abuse, and obesity, as well as a shift toward diets that include more processed, sugary and fat-laden foods, are contributing to the rising incidence of cancer, along with chronic lung disease, heart disease, and diabetes. “Death and disease from noncommunicable diseases now outstrip communicable diseases in every region except Africa, where the rate of such diseases are quickly rising,” according to a United Nations report issued last year. The report projects that by 2030, noncommunicable diseases will cause nearly fi ve times as many deaths as communicable diseases worldwide, including lowand middle-income countries. Cancer incidence and mortality rates in the developing world are shockingly high, even though the general public — even in poor countries — rarely thinks about cancer in impoverished regions. The developing world accounted for an estimated 55% of the 12.7 million new cancer cases and 64% of the 7.6 million cancer deaths worldwide in 2008. According to a report last October from the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries, an estimated 80% of the life-years lost to cancer occurred in these countries, yet they consumed just 5% of the resources devoted to fi ghting the disease.