Rising cancer rates in low and middle income countries threaten economic stability

The rising cost of treating and caring for a growing number of cancer patients threatens economic development in low and middle income countries (LMICs), making prevention a key element of health care plans, according to a new commentary.

Authored by researchers from the International Agency for Research on Cancer (IARC), the American Cancer Society, and Imperial College of London, the commentary says in the absence of the implementation of prevention, LMICs will not have the resources to diagnose and treat all new cancer patients, and the economic burden will soon become unsustainable. The commentary appears in the Journal of the National Cancer Institute (JNCI).

The number of cancer cases every year worldwide, currently estimated to be more than 14 million, is projected to reach almost 22 million by 2030, with the proportion of newly diagnosed cases in low- and middle-income countries rising from the current 59% to almost 65%.

The chronic nature of cancer and its high cost of treatment mean LMICs can ill afford the diagnostic and therapeutic work-up required by the new wave of cancers linked with westernization that are now becoming evident. "Only rapid acceleration in the implementation of cancer control programs at the national and/or regional levels ... is likely to have a major impact in reducing the projected burden," write the authors.

The editorial points to three examples of effective cancer prevention campaigns in recent years.

In Taiwan, hepatitis B virus (HBV) vaccination started in 1984. Since then, liver cancer in children and young adults has decreased by as much as 80%.

Rwanda, in spite of its limited resources, reached 93% coverage of HPV vaccination of the target population in 2011 using free, school-based vaccination, community involvement, and a nationwide campaign. The vast majority of the rest of Africa has a complete lack of HPV vaccination.

In Brazil, smoking prevalence declined by 46% between 1989 and 2008, with much of the decline attributed to taxes and advertisement bans. Similarly, increased taxes and advertisement bans accounted for much of the relative decrease in smoking prevalence between 1991 and 2006 in Thailand.

The authors also say cancer prevention can be a good investment, writing: "The costs of cancer diagnosis and therapy are extremely high, while prevention leads to net savings."

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Article: Long-term Realism and Cost-effectiveness: Primary Prevention in Combatting Cancer and Associated Inequalities Worldwide, JNCI J Natl Cancer Inst (2015) 107 (12): djv273 doi: 10.1093/jnci/djv273 First published online September 30, 2015

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David Sampson