Once thought to be a problem primarily in the developed world, cancer is now a leading cause of death and disability in poorer nations. Almost two thirds of the 7.6 million cancer deaths in the world occur in low- and middle-income countries.

A paper published online Aug. 16 in The Lancet asserts that the international community must now discard the notion that cancer is a “disease of the rich” and instead approach it as a global health priority. This call to action is authored by Paul Farmer, chair of the HMS Department of Global Health and Social Medicine; Julio Frenk, dean of the Harvard School of Public Health; Felicia Knaul, director of the Harvard Global Equity Initiative (HGEI) and HMS associate professor of social medicine; and Lawrence Shulman, chief medical officer at Dana-Farber Cancer Institute and HMS associate professor of medicine.

Nineteen other authors, who are also leaders in the global health and cancer communities, represent the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries (GTF.CCC), including honorary co-presidents Lance Armstrong and HRH Princess Dina Mired of Jordan. The task force was launched in November 2009 at an international conference on breast cancer in the developing world by HMS, HSPH, Dana-Farber, and HGEI, which also serves as the GTF.CCC secretariat (see Focus, Dec. 4, 2009).

“The provision of adequate health care in settings of poverty is by definition difficult, but the past two decades have taught us that setting our standards high can help bring new resources to bear on old problems,” said Farmer, who is also executive vice president and cofounder of Partners In Health. “The integration of cancer prevention and care where both are needed is precisely what we need to do if we are to make the response to the challenge as global as cancer itself.”

The Deadly Disparities

Comparing cancer fatality rates between low- and high-income countries reveals stark disparities. According GLOBOCAN data produced by the International Agency for Research on Cancer (IARC), the fatality rate (approximated by the ratio of mortality to incidence in a given year) in low-income countries is 75 percent; in lower middle-income countries, 72 percent; and in upper middle-income countries, 64 percent. In contrast, the estimated rate is 46 percent in high-income countries. The difference in survival reflects the scope of action that is needed and is particularly large for many highly treatable forms of the disease such as cervical, breast and testicular cancers and acute lymphoblastic leukemia in children.

“The gaps in access to cancer care and control are one of the greatest challenges in global health,” said Knaul, who is also a breast cancer patient whose illness was identified in Mexico. “As a person living with cancer, diagnosed in a developing country, I believe we must address this glaring inequity. Evidence shows that this can be done.” Many of the more than 4 million deaths from cancer each year in low- and middle-income countries can be averted through early detection and treatment. The Lancet paper discusses examples of how cancer care and control is being offered by applying innovative financing and delivery frameworks in Mexico, Colombia, Jordan, Haiti, Malawi and Rwanda.

Ongoing Actions

This suffering and needless loss of life will persist without a rapid recalibration of global and local response. According to Julio Frenk, “In most parts of the world, cancer is a sorely neglected health problem and a significant cause of premature death. To correct this situation we must address the staggering ‘5/80 cancer disequilibrium,’ that is, the fact that low- and middle-income countries account for almost 80 percent of the burden of disease due to cancer yet receive only 5 percent of global resources devoted to deal with this emerging challenge.”

The authors, speaking on behalf of the GTF.CCC, propose and are working toward the following goals:

  • Raise awareness of the impact of cancer on developing countries at the global, regional and national levels through an evidence-based call to action;
  • Define the packages of essential services and treatments needed to provide care in low-resource settings for cancers that can be cured or palliated with currently available therapies;
  • Increase access to the best treatment for cancer through the procurement of affordable drugs and services based on packages of essential services.

For more information, students may contact Felicia Knaul at felicia_knaul@harvard.edu or afsan_bhadelia@harvard.edu.