Disparities in cancer survival

In my last post I published some good news about cancer survival rates, so I thought it was important to highlight a big problem with our recent success against this disease. This issue is flagged up in a study published at the end of January.

It addresses the fact that the gains we have made in cancer diagnosis and treatment are very unevenly spread around the world. To analyze this is greater detail, the scientists studied the differences in survival in different countries, and the results are somewhat predictable.

If, for example, you are an Australian or American with breast cancer, you have a 90% chance of surviving. If you are Indian however, you only have a 66% chance.

If a child is diagnosed with acute lymphoblastic leukaemia in Finland, they have a 95% chance of beating the disease; in Ecuador, the rate is only 50%.

So, over the period of this study (2000 to 2014) roughly 200,000 Indian women died from breast cancer who wouldn’t have died if they were living in the US. Almost 1,000 Ecuadorian children died from acute lymphoblastic leukaemia who wouldn’t have if they were in Finland. The same pattern is seen for all cancers, so it is clear that millions are dying from cancer in less developed countries who would not be if they were born somewhere else.

This is even more staggering when you realise that this study did not even include countries at the bottom end of the global poverty index. This excluded nearly one third of the global population, as the records and reporting from these areas is just too unreliable to use.

It is clear from the numbers that if you are from a less well-off country, you are far more likely to die after being diagnosed with cancer. This isn’t entirely surprising, as the detection and treatment of the disease changes quickly and can prohibitively expensive.

Unfortunately, it is also likely get worse in the coming years. Due to a lack of tobacco regulation in poorer countries, lung cancer is set to increase. The WHO has pointed out that smoking still appears to be increasing in Middle Eastern and African regions, and it is known that the tobacco industry has actively been targeting young people in these countries.

Additionally, as our treatments for cancer get more sophisticated, they also get more expensive, something I have written about in the past. When combined with less well supported health systems, and other more pressing public health issues, the picture looks bleak for cancer patients in many low- and middle-income countries.

Of course, there are plenty of other public health improvements that can be made around the world that would have a bigger impact on people’s lives than providing better access to cancer treatments. Access to clean water, anti-malarial programs, and HIV and TB treatment programs would be far wiser investments than cancer therapeutics. However, as we in cancer research congratulate ourselves on our successes, it is always worth keeping in mind just how unevenly that success is distributed.

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