By Sarbani Chakraborty
Here is what we know today: cancer is the second leading cause of death worldwide, claiming nearly 10 million lives in 2018 alone. On top of that, population growth and ageing will contribute significantly to the rise of cancer incidence globally in the years ahead. Population ageing will lead to an estimated 63% rise in cancer cases between 2018 and 2040.
In my many years working with various ministries of finance and health to tackle global health problems, I’ve noticed a sense of fatalism when it comes to cancer. The public-sector mindset can be that it is simply too hard to deal with such a complex and prevalent disease. This cancer fatalism permeates governments, and even patients and their families. Preparing countries to better battle cancer will reduce this fatalism and turn what is inevitably a challenge for health systems into a surmountable reality.
We can ensure – indeed, we have a responsibility to ensure – that our health systems are adequately prepared to tackle the disease and reduce mortality in the years ahead. This is especially critical for low- and middle-income countries, which are experiencing fast growth in cancer incidence but whose health systems are stretched, due to a rising triple-threat of non-communicable diseases (NCDs), communicable diseases and a vast mental health burden.
Equipping health systems to take on cancer
Cancer is a complex issue that breeds distinct, country-specific challenges and opportunities. But while countries need to adopt tailored local approaches to address the epidemic, there are several key pillars that can bolster our collective ability to outpace the looming cancer threat.
Prevent the preventable
While most cancers are not preventable, cost-effective interventions exist to prevent the 30-50% of cancers which we can avoid.
Eradicate tobacco usage
A global best buy for cancer prevention seems obvious: stopping tobacco use. Tobacco is the single most important risk factor for cancer and still accounts for 22% of cancer-related deaths globally. Tackling tobacco usage not only reduces the risk for various types of cancers – it also helps to boost overall health and life expectancy. The key to eradicating tobacco use is often a combination of good policy-making and effective implementation.
There are also several types of cancers which can be prevented through simple and cost-effective immunization. Around 25% of cancers in lower- and middle-income countries are attributed to carcinogenic infections, such as human papillomavirus (HPV) and hepatitis B, which are preventable through vaccines. The HPV vaccine has the potential to reduce global cervical cancer incidence by 90%, while hepatitis B immunization has been shown to reduce the risk of liver cancer. In fact, Australia made headlines last year for being on track to be the first country to eradicate cervical cancer, thanks to its publicly funded school HPV vaccination programs.
Lead healthy lifestyles
Healthy lifestyle choices reduce cancer risk too. Our increasingly sedentary lifestyles, unhealthy diets and alcohol use raise the risk not only for cancer, but also for NCDs such as diabetes and cardiovascular diseases. By promoting healthier lifestyles, we reduce the overall disease burden and free up healthcare resources to treat other diseases and the cancers that are not preventable.
Strengthen primary care
Besides implementing the prevention basics, strong delivery systems are essential for effective cancer control. Strengthening early intervention capabilities by investing in primary care services manages the cancer burden with a (relatively) low price tag. Early cancer detection falls largely in the hands of primary care providers, making it an essential part of cancer preparation. According to one study, 85% of cancer cases are detected during a consultation with a primary care clinician. By detecting cancers early, patients have a better chance of fighting and surviving the disease, reducing fatalities and unnecessary human suffering.
Integrate primary, secondary and tertiary services
Of course, because we cannot prevent more than half of all cancers, screening and diagnosis in secondary care represent critical components in the next phase of cancer control. Early screenings such as mammography and bowel cancer screening help ensure cancers are diagnosed and tackled in the early stages, so that patients have better survival outcomes.
Finally, without effective treatment facilities, secondary cost-saving interventions such as screening and early diagnosis lose their value. Around the world, even in countries with strong cancer control platforms, there’s a need to increase the number of skilled healthcare personnel and further integrate primary care systems with oncology units.
A sound investment
Developing and maintaining this type of effective healthcare infrastructure across primary, secondary and tertiary care does require large investment. However, this investment provides priceless long-term benefits, including improved quality of life for millions of patients around the world. In fact, I would argue that health systems that are able to adequately tackle cancer are better equipped to tackle the majority of chronic diseases.
Developing countries may make different choices to more effectively use limited resources. For example, even though Thailand lacks specialized cancer manpower, it is doing relatively well in cancer control. This boils down to its strategic focus on all aspects of cancer prevention, including the rollout of vaccination campaigns, implementation of a framework against tobacco use and investments in disease surveillance tools and cancer research. Another great example is Rwanda, which has made a deliberate choice to integrate cancer care into its aspirations for universal health coverage.
Make good policies and ensure they are implemented
Last week in Singapore, the Economist Intelligence Unit released findings from its new Cancer Preparedness Around the World report and Index of Cancer Preparedness (which was commissioned by Pfizer, Novartis and my employer, Roche). These tools are the first attempt to measure countries’ preparedness to reduce premature deaths from cancer, increase cancer survival rates and improve quality of life for patients and survivors.
One key callout of the report is the importance of effective policy implementation on cancer control. This can be done by having an actionable and realistic National Cancer Control Plan (NCCP) to help countries decide on the best approach to the local cancer problems through coordinated efforts between stakeholders.
However, in many cases, the report found that NCCPs were more aspirational than operational, with lofty ambitions not matched by reality and budgets. In some cases, the right policies were in place, but not effectively implemented. Spain, for example, has strong tobacco control policies, but more than a quarter of Spanish adults smoke, and that rate is rising.
To be effective, NCCPs must focus on the specific cancer needs of the population covered, have realistic goals and budgets, and engage all relevant stakeholders. Early data indicates the effectiveness of a strong and well-implemented NCCP in reducing cancer mortality.
The key: cross-sector collaboration
The task ahead is not an easy one, and the public sector cannot tackle the cancer challenge alone. The full cancer ecosystem, including civil society and the private sector, should be part of the solution. This is why I’m proud Roche contributes to the ongoing policy dialogue and public-private partnerships. Through this important cross-sector dialogue on access to healthcare, and through our contribution to the Union for International Cancer Control’s City Cancer Challenge 2025, we are working with city governments and other stakeholders to raise the visibility and commitment to improve cancer care at city level.
The continuing rise of cancer is inevitable. However, if we embrace the key pillars of preparedness and work together in close collaboration, we can offset its impact on millions of people around the world.
This article has been written by Sarbani Chakraborty, Lead, Health Systems Capacity , Roche.
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