Most people who die from cancer, and most cancer cases, are in the developing world.
Yet cancer is seldom included in any discussion about global health.
Some powerful people — from the high-profile health activist Dr. Paul Farmer to the even more high-profile Lance Armstrong (not to mention CNN’s Dr. Sanjay Gupta) — want to change that. They present their case for making cancer a global health priority in an article published online Monday in The Lancet and, more generally, on their web site.
“When you look at the cancer numbers, the global burden of disease, it’s surprising to see how little cancer gets mentioned when people talk about global health,” said Dr. Julie Gralow, a member of this gang of advocates, clinical researcher at Fred Hutchinson Cancer Research Center and director of breast medical oncology at the Seattle Cancer Care Alliance.
Almost two-thirds of the 7.6 million cancer deaths that occur every year take place in low- and middle-income countries.
Gralow, a renowned breast cancer specialist already active in efforts to improve cancer care and prevention worldwide, got pulled into this specific cause because of a patient — a health policy expert named Felicia Knaul who came to Seattle when her prominent husband, Dr. Julio Frenk, joined the Bill & Melinda Gates Foundation to work on global health issues.
The couple’s personal battle with cancer led them to rally others on this mission to put cancer on the global health agenda. Gralow, as Knaul’s physician and already an advocate for cancer care and prevention globally, was a natural ally.
So why wasn’t cancer already a priority?
To begin with, Gralow said, cancer treatment is viewed by many as too expensive or complex to apply in poor countries. Given that the global health agenda is already straining to achieve simpler, cheaper tasks — vaccinating kids, preventing maternal deaths, providing clean water and nutrition — many have argued that it would be unreasonable to add cancer to this agenda.
“But for breast cancer (a big killer), the drug that has saved the most lives, tamoxifen, is now dirt cheap,” Gralow said. Many experts once argued that AIDS care was too expensive and complex to carry out in poor countries, she said, but now the limiting factor is just money and political will.
Paul Farmer, long an advocate for equity in health, said in a statement accompanying the Lancet paper that making cancer care and prevention a priority in global health can serve as a means to strengthen health systems:
“The provision of adequate health care in settings of poverty is by definition difficult, but the past two decades have taught us that setting our standards high can help bring new resources to bear on old problems,” said Farmer, co-founder of Partners In Health.