Close the Care Gap

Cancers are a leading cause of death worldwide, causing 10.0 million deaths in 2019. We all have lost a family member or friend to cancer. In some families multiple members have succumbed to this dreaded disease. In 2022, there were an estimated 20 million new cancer cases. The estimated number of people who were alive within 5 years following a cancer diagnosis was 53.5 million. About 1 in 5 people develop cancer in their lifetime, approximately 1 in 9 men and 1 in 12 women die from the disease. World Cancer Day is an international day marked on 4 February to raise awareness of cancer and to encourage its prevention, detection, and treatment. This year’s theme is "Close the care gap". Everyone deserves access to cancer care. Cancer is a large group of diseases that can affect any organ or tissue of the body. It refers to the abnormal growth of cells that divide uncontrollably. Cancer has the ability to spread from one body part/ organ/ tissue to another. Cancer is the second most frequent cause of morbidity and mortality in the Americas, after cardiovascular disease, and an important basis of health inequalities. In the Americas, there are an estimated 4.2 million people were newly diagnosed and 1.4 million people died from the disease in 2022. Cancer diagnosis is very scary and costly to treat especially given that so many of us have no health insurance in the Americas. The Pan American Health Organization (PAHO) estimates that approximately, 54% of new cancer cases and 45.1% of cancer deaths occurred in people 69 years of age and younger, in the prime of their lives. The global World Health Organization (WHO) survey on Universal Health Coverage (UHC) and cancer shows that only 39% of participating countries covered the basics of cancer management as part of their financed core health services for all citizens, ‘health benefit packages’ (HBP). Only 28% of participating countries additionally covered care for people who require palliative care, including pain relief in general, and not just linked to cancer. Three major cancer types in 2022: lung, breast and colorectal cancers. Lung cancer was the most commonly occurring cancer worldwide with 2.5 million new cases accounting for 12.4% of the total new cases. Female breast cancer ranked second (2.3 million cases, 11.6%), followed by colorectal cancer (1.9 million cases, 9.6%), prostate cancer (1.5 million cases, 7.3%), and stomach cancer (970 000 cases, 4.9%). According to the WHO, lung cancer was the leading cause of cancer death (1.8 million deaths, 18.7% of the total cancer deaths) followed by colorectal cancer (900 000 deaths, 9.3%), liver cancer (760 000 deaths, 7.8%), breast cancer (670 000 deaths, 6.9%) and stomach cancer (660 000 deaths, 6.8%). Lung cancer’s re-emergence as the most common cancer is likely related to persistent tobacco use in Asia. The WHO argues that there were some differences by sex in incidence and mortality from the global total for both sexes. For women, the most commonly diagnosed cancer and leading cause of cancer death was breast cancer, whereas it was lung cancer for men. Breast cancer was the most common cancer in women in the vast majority of countries (157 of 185). For men, prostate and colorectal cancers were the second and third most commonly occurring cancers, while liver and colorectal cancers were the second and third most common causes of cancer death. For women, lung and colorectal cancer were second and third for both the number of new cases and of deaths. The WHO states that cervical cancer was the eighth most commonly occurring cancer globally and the ninth leading cause of cancer death, accounting for 661 044 new cases and 348 186 deaths. It is the most common cancer in women in 25 countries, many of which are in sub-Saharan Africa. Even while recognizing varying incidence levels, cervical cancer can be eliminated as a public health problem, through the scale-up of the WHO Cervical Cancer Elimination Initiative. Striking cancer inequity by Human Development Index (HDI). According to data from the ESMO the European Society for Medical Oncology the health burden of cancers is distributed unevenly across countries, with high-income countries facing a greater per-population burden in terms of disability-adjusted life-years than low- and middle-income countries (LMICs). Cancers impose a marked toll on the economy through reduced productivity, unemployment, labour losses, and capital investment reductions. Accordingly, investment in cancer screening, diagnosis, and treatment could yield substantial health and economic benefits, especially in LMICs, which have lower levels of cancer survival compared with high-income countries. Global estimates reveal striking inequities in the cancer burden according to human development index. This is particularly true for breast cancer. In countries with a very high HDI, 1 in 12 women will be diagnosed with breast cancer in their lifetime and 1 in 71 women die of it. By contrast, in countries with a low HDI; while only one in 27 women is diagnosed with breast cancer in their lifetime, one in 48 women will die from it. Projected cancer burden increase in 2050. The WHO indicates that over 35 million new cancer cases are predicted in 2050, a 77% increase from the estimated 20 million cases in 2022. The rapidly growing global cancer burden reflects both population ageing and growth, as well as changes to people’s exposure to risk factors, several of which are associated with socioeconomic development. Tobacco, alcohol and obesity are key factors behind the increasing incidence of cancer, with air pollution still a key driver of environmental risk factors. In terms of the absolute burden, high HDI countries are expected to experience the greatest absolute increase in incidence, with an additional 4.8 million new cases predicted in 2050 compared with 2022 estimates. Yet the proportional increase in incidence is most striking in low HDI countries (142% increases) and in medium HDI countries (99%). Likewise, cancer mortality in these countries is projected to almost double in 2050. Cancer can be prevented and controlled by implementing evidence-based strategies for cancer prevention, screening, early detection, treatment, and palliative care. The most common modifiable risk factors for cancer, which are shared with many other non-communicable diseases, are: tobacco use, low fruit and vegetable intake, harmful use of alcohol and lack of physical activity. On this World Cancer Day let us lobby our governments to invest more funds regarding the diagnosis and treatment of cancer. Alarmingly, the JAMA Oncology publication estimates that the total cost of cancer to the global economy will reach US$25.2 trillion dollars between 2020 and 2050. It is clear that the global community must unite both in terms of collective voices and resources in order to spread the message that early detection provides the best possible outcome for a diagnosis of cancer. The time to show more kindness and to be supportive to those who are going through their journey with cancer is now. It is possible to close the care gap regarding cancer. Wayne Campbell is an educator and social commentator with an interest in development policies as they affect culture and or gender issues. waykam@yahoo.com @WayneCamo © #WorldCancerDay