Prevention, Early Detection Could Avert a Major Surge in Cancer Deaths in the Americas

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The toll of cancer and other chronic diseases is high and rapidly growing. Experts at the Pan American Health Organization (PAHO) said that countries in Latin America and the Caribbean urgently need to take preventive measures to help curb increasing rates of cancer in the region. Speaking on the occasion of World Cancer Day 2007, February 4, they said countries need to actively promote healthy lifestyles, including increased physical activity, healthier diets and avoidance of tobacco products.

The cost of not acting

Chronic diseases such as cancer, diabetes and heart disease are already the main causes of death and early disability in most countries of Latin America and the Caribbean. Cancer alone accounts for more deaths in the PAHO region than AIDS, malaria and tuberculosis combined.

The World Health Organization (WHO) estimates that if no measures are taken, the cancer death toll worldwide could reach 9 million by 2015. WHO estimates that 60 percent of all cancer deaths in 2005 were in developing countries. In Latin America and the Caribbean, there were an estimated 479,000 cancer deaths in 2002, a 33 percent increase over 1990. Many of these deaths were avoidable, since many cancers are preventable or curable if caught early.

According to WHO, more than 40 percent of all cancers are associated with preventable risk factors. One in three cancers could be cured if detected early and treated adequately. Nearly all pain associated with cancer could be eliminated if current knowledge about pain control and palliative care were applied.

Cancer affects people of all ages; in developing countries people with cancer tend to die younger and suffer longer. Prostate, lung and stomach cancers cause the greatest number of cancer deaths among men in Latin America and the Caribbean, while cancer deaths in women in the region are primarily the result of cervical, breast and lung cancers.

Worldwide, more than 160,000 children are diagnosed with cancer each year, and an estimated 90,000 will eventually die from the disease. Most childhood cancers can be cured if treatments are readily available. However, in developing countries, where effective treatment is often not available, half of all children diagnosed with cancer will eventually die.

In September 2006, PAHO's Directing Council approved a new "Regional Strategy and Plan of Action on an Integrated Approach to Prevention and Control of Chronic Diseases including Diet, Physical Activity and Health." Cancer is one of the four major diseases targeted in the plan, and PAHO is developing an implementation strategy for cancer prevention and control. These activities will complement past PAHO initiatives to battle cancer, including partnerships to prevent cervical cancer in Peru and related efforts in Panama and El Salvador.

Prevention is critical

According to Dr. James Hospedales, interim chief of PAHO's Chronic Diseases Unit, the costs associated with chronic diseases such as cancer are high and rapidly increasing.

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"The tsunami of cancer and other chronic diseases is not something that is going to happen; it is already here. The impact of this killer wave has arrived," he said.

Prevention is one of the main lines of action in WHO's global strategy against these diseases, he noted, adding that prevention must be promoted at all levels of society. To be really effective, public health strategies must include actions in areas such as taxation and regulation of advertising.

Because the single most important risk factor for cancer is smoking, Hospedales said that it is critically important for countries to implement and enforce tobacco control legislation consistent with the WHO Framework Convention on Tobacco Control (FCTC).

"Countries that have not yet signed on to the FCTC should do so. In those that have signed, in-country implementation needs to take place. As a first step, governments should immediately mandate that all government workplaces be smoke free. As employers, governments have particular responsibility for the health of their staff."

The main organizer of World Cancer Day, the International Union Against Cancer (UICC), said that in low- and middle-income countries, 80-90 percent of cancer patients, at the time of diagnosis, are already suffering from advanced and incurable cancers. Screening, early detection and lifestyle changes are critical, UICC said, if this trend is to be reversed.

Cancer in women

Latin America and the Caribbean have some of the highest rates of death from cervical cancer in the world, with an estimated 37,600 cervical cancer deaths each year. Cervical cancer is the leading cause of cancer deaths among women in the Caribbean and Central America and the second-leading cause of death for women in South America. Thousands of these deaths could be prevented through a combination of routine screening to facilitate timely detection and appropriate diagnosis, treatment and follow-up. Unlike high-income countries, which have successfully reduced cervical cancer deaths, low- and middle-income countries continue to struggle with limited resources and the challenges of providing screening services and ensuring adequate follow-up.

PAHO/WHO has been working in partnership with the global Alliance for Cervical Cancer Prevention (ACCP) and local partners to influence health policies, assess screening and treatment technologies in low-resource settings, develop approaches to improving services, and test strategies to encourage women to get screened. PAHO conducted research on methods to improve cervical cancer screening and found that alternative methods for screening are safe, feasible and affordable. A second phase of this project is under way in Peru.

In addition, PAHO is working to promote the adoption in its member countries of the newly available vaccine against the human papillomavirus (HPV), which causes cervical cancer. Last November, PAHO was awarded the "Women in Government Presidential Leadership Award for Commitment to the Elimination of Cervical Cancer" for its work in this area.

PAHO is also partnering in a new initiative coordinated by the Programme of Action for Cancer Therapy, created by the International Atomic Energy Agency (IAEA) recognizing that only a broad alliance can effectively battle the cancer epidemic in the developing world. As part of this alliance, PAHO is working with several partners to reduce cancer deaths in Nicaragua and to improve conditions for the thousands of Nicaraguans currently living with cancer.

PAHO has also been collaborating with the Breast Health Global Initiative and is sponsoring the publication of its "Guidelines for International Breast Health and Cancer Control" in Spanish. Ms. Silvana Luciani, PAHO project manager for noncommunicable diseases, said: "We are delighted to partner with the BHGI to expand the dissemination of these guidelines. The aim is to make these breast cancer guidelines available in Spanish to foster better decision-making for high-quality care in breast cancer programs throughout Latin America."

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