Cancer, Silent but Intense, Threatens Systems

The worthy efforts in recent years to increase attention on HIV/AIDS, tuberculosis, malaria and other communicable diseases have helped the world respond more effectively to the threat these diseases pose in low- and middle-income countries. But at the same time in these countries, a silent pandemic of cancer and other noncommunicable diseases (NCDs) has been spreading and now threatens to overwhelm health systems and undermine social structures.
NCDs, which include cancer, cardiovascular disease, diabetes and chronic obstructive lung disease, claim more than 35 million lives each year, accounting for 60 percent of all deaths worldwide. According to the World Health Organization, mortality rates are higher for noncommunicable diseases than for communicable disease among men and women age 15 to 59 in all regions of the world save Africa.  Now, more than ever, the world must take steps to balance the global response to both communicable and noncommunicable diseases, especially in low- and middle-income countries where the burden of NCDs is already great and the level of unnecessary suffering profound.
Frightening Threshold
In 2008, cancer accounted for 7.6 million deaths globally, more than AIDS, malaria and tuberculosis combined. We have reached the point where cancer is set to become the leading cause of death in the world, followed by heart disease and then stroke. This threshold has been approaching for years, yet has largely gone unnoticed.  Cancer and other NCDs are rarely addressed in major policy forums, such as meetings of the G8 and G7, and have only recently been incorporated into discussions at the World Economic Forum. 
Perhaps most strikingly, NCDs are not specifically referenced in the United Nation’s landmark Millennium Development Goals (MDGs), which are designed to reduce “income poverty, hunger, disease, lack of adequate shelter and exclusion.” Expanding the Millennium Development Goals to specifically address cancer and other noncommunicable diseases and setting firm targets (or indicators) for controlling these diseases are important steps toward more fully addressing the world’s leading causes of death and disability.
All Income Groups, Ages Touched
The impact of NCDs can be felt throughout the world and cuts across all income groups and ages. In absolute numbers, the vast majority of NCD deaths – more than 80 percent – occur in low- and middle-income countries, where population sizes are high, access to high quality health care is often limited, and health promotion programs are rare. Cancer alone claims more than 5.3 million deaths annually in low- and middle-income counties – more than 70 percent of all cancer deaths worldwide. According to the World Health Organization, adults are especially vulnerable to NCDs. “People in these countries tend to develop disease at younger ages, suffer longer – often with preventable complications – and die sooner than those in high income countries.”

Link to Infectious Diseases
Although NCDs are often associated with unhealthy lifestyle behaviors, such as tobacco use and poor diet, a significant number of NCDs are closely connected to infectious agents. Cervical cancer, which is the second most common cancer among women worldwide, is caused by human papillomavirus. Despite the fact that most cases of cervical cancer could be prevented or effectively treated, approximately 273,000 women die from the disease each year. The vast majority of these deaths – more than 80 percent – are among women in low- and middle-income countries. Most women in these nations do not have access to care that can prevent the onset of this disease or detect it early. 
Overall, infection-related cancers account for approximately 26 percent of all cancer cases in low- and middle-income countries compared to 8 percent in economically developed countries. These and other disparities must be addressed.
Balancing Priorities
Efforts to control noncommunicable diseases should not come at the expense of other global health initiatives. Too often calls for disease-specific interventions force decision makers into a zero-sum approach to resource allocation. In reality, a higher overall level of funding – even in hard economic times – is needed to effectively address major disease issues globally. We must identify new resources for combating NCDs and, over time, build a more balanced public health portfolio that includes health promotion and policy reform along with prevention and treatment. The cost to address noncommunicable diseases will not be insignificant, but it pales in comparison to the very real costs –economic and human – of doing nothing.

John R. Seffrin, PhD, is chief executive officer of the American Cancer Society. David Hill, PhD, is president of the International Union Against Cancer. Werner Burkart, PhD, is deputy director general of the International Atomic Energy Authority. Ian Magrath, MB, BS, FRCP, FRCPath, is president of the International Network for Cancer Treatment and Research. Rajendra A Badwe, MD, MBBS is director of the Tata Memorial Centre. Twalib Ngoma, MD, is president of the African Organisation for Research and Training in Cancer at the Ocean Road Cancer Institute. Alejandro Mohar, MD is director general of the Mexican National Cancer Institute. Nathan Grey, MPH, is the national vice president for international affairs at the American Cancer Society.