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Institute of Medicine (US) Committee on Cancer Control in Low- and Middle-Income Countries; Sloan FA, Gelband H, editors. Cancer Control Opportunities in Low- and Middle-Income Countries. Washington (DC): National Academies Press (US); 2007.

Cover of Cancer Control Opportunities in Low- and Middle-Income Countries

Cancer Control Opportunities in Low- and Middle-Income Countries.

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In high-income countries, cancer has received considerable public attention because it is one of the major causes of mortality, morbidity, and disease burden. In middle- and particularly in low-income countries, cancer has received less public attention because other diseases, especially infectious diseases, have historically been far more pressing. Although less prominent in relative terms, as this report documents, cancer is a major burden in low- and middle-income countries (LMCs) today.

In the future, it is inevitable that cancer will be a more important issue in LMCs. As the competing risk of infectious disease declines, major chronic diseases, including cancer, will move to the forefront as contributors to poor health. Furthermore, to the extent that LMCs adopt the health behaviors of populations in high-income countries, the incidence of chronic diseases such as cancer will increase.

If cancer is to be an even greater health problem in the future, given other pressing social priorities, why should LMCs be concerned about it now? First, it is already a greater burden than is widely appreciated. Second, establishing capacity for cancer prevention, diagnosis, and treatment in a country takes time. Third, some cancers can be prevented, and the latency period from the cause to the development of cancer can be several decades. Tobacco use is a case in point. The vast majority of tobacco use is initiated before age 21. Yet most of the deleterious effects of such use occur after age 50. A message of this report is that countries can implement effective policies for reducing tobacco use in their countries, and they can do this rather inexpensively.

This report is about “opportunities.” The committee’s concept of opportunity is broad, ranging from data collection and planning to resource-level-appropriate interventions. We did not use cost-effectiveness or cost-benefit analysis to rank individual projects. There is likely to be important variation in benefits relative to costs between low- and middle-income countries, and within countries in each category.

The concept of “resource-level-appropriateness” is central to this report. For the lowest income countries, where most people first present to the health care system with late-stage cancers, cure is usually impossible. Yet much more can be done than at present to promote palliative therapies to improve the quality of life of those who have incurable cancers, particularly near the end of life. At the other end of the spectrum is cancer prevention, which includes educating the public about what they can do to avoid cancer. Some approaches to prevention identified in the report are not costly and are within the ability of lower income countries to finance, sometimes with external assistance.

Investments in cancer diagnosis and treatment should vary depending on resources available in the country. A temptation that high-income countries should resist is focusing on exporting the latest, most expensive technologies that may (or may not!) be appropriate for wealthy countries, but for which alternatives exist that may be preferred in low-, and in some cases, middle-income countries. Partnerships are needed between high-income and other countries in developing resource-appropriate strategies. These partnerships may be government to government, but there is great potential for private partnerships, involving, for example, academic health centers in high-income countries and delivery sites in low- or middle-income countries. The report describes such opportunities. We hope it will prove a valuable resource, not only for the report’s sponsors—the National Cancer Institute and the American Cancer Society—for considering how best to use existing knowledge to develop strategies for cancer control that recognize differences among countries in both resources and health care services delivery.

Frank A. Sloan

J. Alexander McMahon Professor of Health Policy and Management and Professor of Economics

Duke University

Copyright © 2007, National Academy of Sciences.
Bookshelf ID: NBK54032


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