Tackling cancer among poor doesn’t have to cost dear
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The growing burden of cancer in developing countries could be reduced without expensive drugs and equipment, scientists said Monday, but it requires a global effort similar to the fight against HIV/AIDS.
In a study in The Lancet, scientists from the United States, who have formed a Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries (GTF.CCC), said cancer is now a leading cause of death in poor nations but is often neglected in health authorities’ prevention and treatment plans.
While only about 5 percent of global resources for cancer are spent in developing countries, the burden of the disease is far greater there than in rich nations, with up to 80 percent of cancer deaths each year occurring in poorer nations.
“Cancer is no longer primarily the burden of high-income countries,” the scientists, led by Felicia Knaul of the Harvard Global Equity Initiative, write in the study. “The time has come to challenge and disprove the widespread assumption that cancer will remain untreated in poor countries.”
They said many cancers that make up the greatest burden in low- and middle-income countries, such as breast cancer, could be treated with drugs that are off-patent and can be manufactured generically at affordable prices.
They cited the breast cancer drug tamoxifen as one example and said that in Malawi, Cameroon and Ghana the total cost of generic chemotherapy drugs with a 50 percent cure rate for a type of cancer called Burkitt’s lymphoma could be as low as $50 per patient.
“These drugs should be a focus of cancer treatment programs, rather than expensive on-patent drugs,” they write.
According to GTF.CCC, rates of cancer in low- and middle-income countries have increased dramatically from 1970, when they accounted for 15 percent of newly reported cancers, to 2008 when that figure rose to 56 percent. The proportion is expected to rise to 70 percent in 2030.
More efforts against smoking, a major risk factor for many cancers that threatens to cause a surge in cancer deaths in Africa in the next decade, would be one relatively cheap way of making an impact, they said, as would increasing awareness about the importance of early cancer detection and screening.
Another intervention with huge potential, they said, would be vaccination against human papillomavirus (HPV), to help prevent cervical cancer, and against hepatitis B virus (HBV), to help prevent liver cancer.
GlaxoSmithKline and Merck & Co make vaccines against HPV and many drugmakers have HBV vaccines but these are often too expensive to be included in the health programs of low- and middle-income countries, the scientists said.
The group criticized what it described as “the public health community’s assumption” that cancer could not be treated in poor countries and compared it to “similarly unfounded arguments from more than a decade ago” about treatment for HIV and AIDS.
Major advances in prevention, health services and efforts to bring down drug prices have dramatically increased the number of people in poor countries who have access to HIV treatment.
Knaul’s team said like HIV and AIDS, cancer was now “an urgent health and ethical priority” in developing countries.
SOURCE: The Lancet, Online First, August 16, 2010.
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