Cancer Control Opportunities in Low‐ and Middle‐income Countries

In January, the American Cancer Society (ACS) reported the second consecutive annual decline in US cancer deaths since recordkeeping began in 1930.1 Three thousand fewer Americans died from cancer in 2004 than in 2003. This recent announcement, in addition to the decline in US cancer mortality rates that has been observed over the past 15 years, provides further evidence of the slow but steady progress being made in the war against cancer. There is, however, another rarely reported side to this story: the numbers of death from cancer in many lowand middle-income countries have been rising rapidly. This increase in cancer cases and deaths in lowand middle-income countries is part of a pronounced shift in the global disease burden. Over the next 10 years, deaths from infectious or communicable diseases are expected to decline by 3%, while those from chronic or noncommunicable diseases will increase by 17%.2 By 2030, there are projected to be 50 million deaths from noncommunicable diseases—more than 3 times the 15.5 million deaths projected for communicable, maternal, perinatal, and nutritional conditions.3 In all regions of the world, with the exception of Africa, the number of deaths from noncommunicable diseases will be significantly higher than those for communicable diseases. And while the death toll alone is staggering, the morbidity and economic impact on those affected, their caregivers, and society at large is also profound. According to the World Health Organization(WHO), people in lowand middle-income countries tend to develop chronic diseases “at younger ages, suffer longer—often with preventable complications—and die sooner than those in high income countries.”2 Despite the dramatic increase in chronic disease mortality and morbidity in lowand middle-income countries, public awareness of the problem is low. Moreover, recognition of the problem among policy makers, the press, and even the public health community has been muted. The agenda for the G8 Group of industrialized nations emphasizes infectious diseases, but does not address chronic disease.4 The UN Millennium Development Goals single out HIV/AIDS and malaria, but only broadly reference “other diseases,” and the Millennium Goals 2006 Report focuses exclusively on HIV/AIDS and tuberculosis. Infectious diseases remain a threat to the health and well-being of millions of individuals throughout the world, and their control should be a top priority, but we must also begin to elevate awareness and support for controlling chronic diseases. Robert Beaglehole, former Director of WHO’s Chronic Disease Program, and Derek Yach, Director of Global Health at the Rockefeller Foundation, paint a distressing picture of the current situation: “The growing global burden of noncommunicable diseases in poor countries and poor populations has been neglected by policy makers, major multilateral and bilateral aid donors, and academics. Despite strong evidence for the magnitude of this burden, the preventability of its causes, and the threat it poses to already strained health care systems, national and global actions have been inadequate.”5 Cancer comprises a major part of this chronic disease burden. Today, cancer—grouping all types of the disease— is the second leading cause of death worldwide, accounting for 7.6 million (13%) of the world’s 58 million total deaths in 2005. Already, more than 70% of cancer deaths occur in lowand middle-income countries, and this proportion will likely grow as deaths from cancer continue to rise. Worldwide, an estimated 9 million people are projected to die from cancer in 2015, and 11.4 million in 2030.6 Cancer Control Opportunities in Lowand Middle-income Countries