The Lancet calls for tobacco control

The editorial can also be accessed here

40 years ago, cancer was a scourge mainly affecting developed nations. But, as the latest global cancer data from the International Agency for Research on Cancer (IARC) confirm, most new cases of cancer and deaths from cancer now occur in developing countries.

Released on June 1, IARC’€™s GLOBOCAN 2008’€”an online resource that provides the most accurate estimates of cancer incidence and mortality in countries currently available’€”shows that in 2008, 53% of the 12 ·7 million new cases of cancer and 63% of the 7 ·6 million cancer deaths worldwide occurred in developing countries.

Projections from GLOBOCAN 2008 also suggest that this trend is likely to remain over the next couple of decades.

The proportion of new cancer cases in developing nations has increased in part because of better control of infectious diseases in these countries, population growth and ageing, and changes in lifestyle.

Meanwhile, in developed nations, cancer prevention and early detection have improved. Additionally, low survival rates for cancer in developing countries and improved survival in the developed world have led to the biggest concentration of cancer deaths falling on the poorest nations.

However, cancer control and care have remained a low priority in developing countries and on global health agendas. Data from GLOBOCAN 2008 should help to change this situation. On a practical level, countries can use the software to produce an important piece of public health documentation showing the priority cancers in their populations.

Acting on the data will, of course, prove more difficult. Most low-income and middle-income countries have health systems that are poorly prepared to grapple with the double burden of infectious and non-communicable diseases such as cancer. Poor economies cannot currently access curative therapies, state-of-the-art surgery, or expensive cancer drugs that are the mainstay of cancer care in developed nations.

Therefore, scaling up prevention and early diagnosis will be the most cost-effective ways of dealing with cancer in developing countries in the near future.

Tobacco control will be key. Overall, smoking prevalence continues to increase in many low-income and middle-income countries: 82% of smokers are in these nations.

All countries, including developing nations, need to sign and ratify the Framework Convention on Tobacco Control, which contains evidenced-based provisions to reduce tobacco use through reduction in demand and supply. Health ministries should see tobacco control as a broad effort to tackle not only cancer but also other non-communicable diseases, such as cardiovascular diseases and chronic respiratory diseases.

Additionally, synergies between efforts to control cancer and existing health initiatives should be sought.

For example, GLOBOCAN 2008 shows that cervical and liver cancers are much more common in developing regions than in developed regions. Most liver cancers can be prevented by simple childhood immunization against hepatitis B, and cervical cancer can be prevented by vaccination of adolescent girls against the human papillomavirus (HPV). Such vaccines could be incorporated into established vaccination programmes.

Cost, however, is an issue. The HPV vaccine and most life-saving cancer drugs remain prohibitively expensive for developing countries. To this end, the work of the Global Task Force on Expanded Cancer Care and Control in the Developing World, launched in November last year, will be crucial.

The Task Force aims to design and implement global and regional initiatives for the financing and procurement of affordable cancer drugs, vaccines, and services. Innovative financing mechanisms, such as those created to procure antiretroviral and antimalarial drugs for developing nations, should be developed for anticancer vaccines and treatments.

Furthermore, the staggering imbalance in the distribution of resources needs to be rectified. Only 5% of global cancer resources are currently spent in developing countries, which account for almost 80% of disability adjusted life years lost in the world to this disease.

There is hope for improved resources for non-communicable diseases, including cancer. Thanks to a concerted effort by WHO and partners, the huge burden of chronic diseases in developing countries is starting to get the attention it deserves on the global health stage.

This visibility was marked by the recent passing of a UN resolution to tackle non-communicable diseases. But much remains to be done. The data from GLOBOCAN 2008 should provide the first steps on what is likely to be a long road to improving cancer control and care in developing nations.


  • Health-e News

    Health-e News is South Africa's dedicated health news service and home to OurHealth citizen journalism. Follow us on Twitter @HealtheNews

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