cancer

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Another neglected disease: Cancer in the Developing World

IHME UW

Breast cancer rates worldwide, 1980-2010

Freelance (and former NPR) health journalist Joanne Silberner of Seattle is doing a series of reports on cancer in the developing world for a number of news organizations with funding from the Pulitzer Center for Crisis Reporting.

The gist of it is that cancer in poor countries is often a neglected disease. As Silberner says in announcing her reporting tour starting in Uganda, moving on to India and Haiti:

Worldwide, more people die from cancer than from HIV/AIDS, tuberculosis and malaria – combined. Yet until recently, cancer was almost ignored by the global health groups, charitable organizations and governments working to improve conditions in developing countries.

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More women in poor countries dying from breast cancer

www.joaquinjara.net

African woman by Joaquin Jara

The number of young women with breast cancer has more than doubled worldwide since 1980, say researchers at Seattle’s Institute for Health Metrics and Evaluation.

Most of this, say the University of Washington global health number crunchers, is in the developing world where women lack access to screening, prevention and treatment programs that have reduced the overall risk of breast cancer for women in the rich world.

“Women in high-income countries like the United States and the United Kingdom are benefiting from early cancer screenings, drug therapies, and vaccines,” said Dr. Rafael Lozano, a UW professor of global Health at IHME and co-author of the paper published today in The Lancet.

The findings are almost certainly going to be fodder for those advocating giving cancer more attention on the global health agenda at next week’s UN High-Level Meeting on Non-Communicable Diseases.

The study, which reviewed health data of 187 countries from 1980 to 2010, looked at both breast and cervical cancer death rates.

Over three decades, the researchers determined that breast cancer cases increased from 641,000 cases in 1980 to 1.6 million cases in 2010 (which far exceeds what would happen from population growth). Cervical cancer cases increased from 378,000 in 1980 to 425,000 in 2010, not as dramatically as breast cancer cases, and the cervical death rate (though 200,000) actually declined.

IHME UW

Breast cancer rates worldwide, 1980-2010

But it is the shift in the disease burden globally that is of perhaps more interest than the overall numbers. Continue reading

Is cancer care too expensive for poor countries?

Tom Paulson

No doctor, no medicine at clinic in rural Nigeria

There’s a big push going on right now to expand the scope of the global health agenda, to include many non-communicable diseases (NCDs) like cancer.

The American Society of Clinical Oncology (cancer docs) this week called upon President Barack Obama to push the United Nations to add cancer to the list of priority diseases in global health. The UN, which is holding a special high-level meeting on NCDs in September, seems likely to do so. The UN’s World Health Organization already resolved to do this last year.

Preventing cancer should definitely be on the agenda, as much of that is a matter of behavior change. But should cancer treatment be on the agenda? Continue reading

WHO says cell phones may cause cancer

Flickr, by liber

Yikes, put down that phone!

Yeah, they may. Or may not.

This is a perennial story and it never seems to make much progress toward resolution.

Today, a number of news agencies like Reuters, AP and the BBC are reporting that an expert panel convened by the World Health Organization has determined that cell phones may cause an increased risk of cancer. The Telegraph reported on this last week.

NPR’s Scott Hensley notes that the WHO finding is a “bit of a surprise” since only last year a WHO-sponsored study found just the opposite:

Only last year, a WHO-organized study of cellphone risks that was the largest conducted to date found scant evidence to support a link between cellphones and brain cancers.

But a group of 31 experts from 14 countries conducted a review of the scientific literature and determined that the evidence, though limited, could support a connection between cellphone use and two types of brain cancer — gliomas and acoustic neuromas. (A summary of the findings is described in this press release.)

Again, the conclusion that cell phones are “possibly carcinogenic” is hardly new. But the finding seems to be getting a lot of news attention even if it appears to offer no new information or any kind of useful risk assessment.

Here’s a story I did years ago featuring a UW professor, Henry Lai, who has been sounding these kinds of warnings for a decade — and claims to have been blackballed by industry for raising the question.

CNET has done a fairly thorough job looking at the history of, and evidence for, this hypothesis.

Putting Cancer on the Global Health Agenda

Most people who die from cancer, and most cancer cases, are in the developing world.

Cancer cell

Cancer cell              NCI

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.

Julie Gralow and kids in Kampala

by Julie Gralow

Gralow in Kampala, Uganda, where Fred Hutch also works on pediatric cancer

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. Continue reading