(formerly IRIN News) Journalism from the heart of crises

The true burden of cancer

A healthworker in rural Pakistan helps spread awareness of breast cancer
Breast Cancer Care

Breast cancer continues to be misunderstood, under-diagnosed and fatal, particularly in developing countries, say researchers, despite more than one million official annual diagnoses and almost half a million recorded deaths annually.

Even with growing efforts from donors and health agencies to draw more attention to chronic non-communicable diseases, awareness about cancer still lags, said Sara Stulac, clinical director in Rwanda for the US-headquartered Partners in Health NGO.

"Just bringing up the fact that there are children suffering from cancer in Rwanda, the reaction I often get is 'Oh, cancer - Africa - I never thought about that'."

"We're victims of our own success, which is very good news," Harvard University's director of Global Equity Initiative, Felicia Knaul, told IRIN, referring to declining numbers of deaths from some communicable diseases in developing countries.

The downside of that success is, "You go on to live through other risks and get other diseases", she added.

The World Health Organization's (WHO) International Agency on Research on Cancer estimated in 2008 that breast cancer was the most frequently officially diagnosed cancer among women, with an estimated 1.38 million cases.

It was also the most frequently reported cause of death by cancer for women.

Eighty percent of up to 3.7 million of deaths by cancer - all types - are reported in developing countries, according to recent research Knaul co-authored with the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries at Harvard University.

Costly care

Women who reached Rwinkwavu Hospital in Kayonza District in eastern Rwanda, where Stulac works, may have already unsuccessfully sought care elsewhere - often at informal or ill-equipped health centres, she added.

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As a result, they frequently arrive at hospital with advanced stages of breast cancer that are harder, more expensive and more painful to cure, said Stulac.

An estimated 70-80 percent of breast cancer cases are diagnosed at late stages in lower- and middle-income countries, according to Knaul.

But even with early diagnosis, breast cancer can mean a painful and debilitating death in cash-strapped countries where specialists are few and costs are high, said Stulac.

"Over the course of just seeking a diagnosis, [patients] have depleted their family's resources."

Cancer prevention and awareness campaigns are infrequent in low-income countries. And when cancer is diagnosed, treatment options can often include palliative care, which is scarce, expensive and stigmatized, according to 2011 oncology research

The Vienna-based International Narcotics Control Board says 90 percent of the world's opiate supply for pain relief is consumed in the most developed countries, leaving little for poorer countries. 

Gathering data

Knaul urged combating disease with data. "We have to help women to diagnose more, even when we don't have good access to treatment because that's how we'll get to know that the disease exists."

Since 1980, breast cancer cases globally have risen annually by 3.1 percent on average, according to recent reports, and continued rises are predicted by WHO.

As a complex group of diseases for which there are few national registries, and ones that lack access to diagnostics and treatment, cancer's true burden remains unknown in many developing countries.

"We need to research at a very basic level of understanding what the disease looks like. We need better data," said Stulac.

Knaul's report called for public health systems to boost cancer detection alongside anti-poverty, maternal and child health, sexual and reproductive health and HIV/AIDS programming.

Breast cancer clinical trials in lower and middle-income countries can help boost tracking and prevention - sorely lacking and almost non-existent in some places, said Ismail Jatoi, chief of surgical oncology at the US-based Texas University Health Science Centre.

"Conducting trials in these countries is a way of setting up infrastructure within [health] centres that are conducting trials."

While an estimated eight out of 10 cancer cases worldwide are diagnosed in poorer countries, research there only attracts 5 percent of global cancer funding, according to the Global Task Force on Expanded Access to Cancer Care and Control.

"When research and science have helped us come up with newer and better medications, one of our goals should be to advocate for bringing those medications not just [to] rich people, but [to] poor people as well," said Stulac.


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