In poor and middle-income countries, a lethal malady once prominent mainly in affluent parts of the globe is raising its ugly head. Cancer incidence rates are increasing at double that of the rest of the world. Especially alarming are the fatality data. As Jason Gale reports in the December issue of Bloomberg Markets magazine, while developing countries account for about half of new cancer cases, they have about 70 per cent of cancer deaths.
Lack of access to the latest diagnostic technology and chemotherapy is partly to blame. Also culpable, however, are cultural factors: In countries where people are not yet familiar with it, cancer still carries mystery and stigma. A woman in India who feels a lump in her breast, the Markets article illustrates, often tries to ignore it, fearing it will bring shame to her entire family and not realizing that the longer she delays seeking help, the more likely it is that the tumor will kill her.
This issue, at least, can be addressed with relative haste. The ultimate goal is to make state-of-the-art diagnostic equipment and advanced cancer treatments available to everyone who needs them. But in the meantime, poor countries can build up their health systems and engage in the public education necessary to get people to seek whatever rudimentary care is available — be it manual exams, biopsies, surgery or chemotherapy.
Such progress can in itself improve cancer survival rates significantly — as the U.S. experience illustrates. For decades before the mid-1970s, when mammography came into wide use, U.S. breast cancer mortality rates steadily declined, thanks to increasing access to routine checkups. At the same time, the American Cancer Society promoted self-examination, and people generally became more comfortable talking about breast cancer.
The same progress should be possible now in countries that are new to cancer treatment.
The first step is to get people talking to one another — and, especially, relating stories of survival. A 2007 survey of more than 4,500 people in 10 countries by the Livestrong Foundation of Austin, Texas, found that cancer carries stigma because people think that it is untreatable and incurable, that victims bring it on themselves, and that it will ostracize them even from their families. The foundation has had success in combating such myths through public education efforts in Mexico and South Africa that are aimed at helping cancer survivors tell their stories publicly.
Of course, such publicity relies on people having access to health-care providers who know what cancer is and can refer patients to regional treatment centers. In many poor countries, this health-care infrastructure is still lacking. One of the benefits of increasing awareness of cancer, perhaps, could be greater demand for — and availability of — basic health care.