By Hannah Vanbenschoten
For Sara Stulac, a pediatric doctor from Rwanda, treating a young girl with a tumor the size of a cauliflower on her face was not what she expected her first experience with a patient to look like. In 2005, when the young girl came to Dr. Stulac, it was clear an oncologist was needed; unfortunately, Rwanda did not have one. The girl’s father had tried traditional healing remedies and local doctors, but the tumor grew to the point where Dr. Stulac needed to recruit satellite help from an American oncologist in order to save the girl’s life.
Besides the happy ending, which is a rarity, this is not an uncommon story in the developing world. The World Health Organization reports that approximately 55% of new cancer cases occur in the developing world, a figure that is projected to grow to 60% by 2020 and 70% by 2050. These high rates of chronic illnesses in the developing world is an ironic effect of relative success in preventing and treating infectious diseases such as Tuberculosis, Malaria, and HIV. As the prevalence of these transmissible diseases — ones that typically hinder the chances of child survival beyond age 5 — decreases, the likelihood of an individual developing a noncommunicable disease with a later onset grows drastically.
According to a review by the Harvard School of Public Health, “the increasing incidence of lung, breast, and colorectal cancer is largely the result of demographic lifestyle changes, including longer life expectancy and accelerated urbanization, which in turn leads to reproductive patterns and lifestyles associated with several forms of cancer.” Some of these lifestyle changes include tobacco use, high calorie intake, alcohol consumption, low prevalence of breastfeeding, and pregnancy at older ages. Not only do developing nations still suffer health problems typically associated with poverty, such as infections, undernutrition, and high maternal death rates, they now face a new issue of high rates of chronic illnesses.
There is an alarming lack of awareness within developing nations about the increasing presence of cancer. Screening procedures for early detection of cancer is often considered too expensive and difficult to implement in health clinics serving low income areas. An ethical dilemma surrounds detecting cancer in these areas exists as well, as some medical professionals would argue that there is little to no effective means for treating cancer, so why trouble a patient with early detection if their prognosis will be dim regardless. Experts also point out the ever present and pressing issue of communicable diseases in developing countries and question the merits of even addressing cancer at all in the face of other health concerns.
Though the treatment of cancer is a massive conundrum, even in middle to high income countries, the reality is that early detection of some forms of cancer, specifically those that primarily affect women, such as breast and cervical cancer, leads to a very high success rate using relatively cost effective procedures. According to the National Breast Cancer Foundation, Stage I breast cancer can be easily treated with surgery and/or radiation with a 98% success rate. Similarly, Stage 0 and I cervical cancer has a relatively high survival rate of 93%. In spite of these promising figures in the way of treatment, cultural resistance and stigmas prevent early detection and the provision of treatment in many developing areas. In some cultures, it is common for women with breast cancer to be considered of “diminished femininity.” On the same note, an immense lack of consideration for female reproductive health is a significant barrier to preventing and addressing cervical cancer.
Simple solutions are present to prevent and treat these types of cancers in poor nations. For example, doctors estimate that roughly 80% of liver cancers and 70% of cervical cancers could be prevented by immunizing against hepatitis B and human papillomavirus. Fortunately, some recent efforts have increased awareness and financial support for combating cancer in developing nations. A breakthrough in this front includes a $50 million grant from the Bill & Melinda Gates Foundation to create the Alliance for Cervical Cancer Prevention. While this is a step in the right direction, a significantly larger focus on cancer in the developing world needs to be established in the global health community. Four-fifths of avoidable cancer deaths are in low- and middle-income countries. Targeted financial and knowledge based reform directly addressing cancer must be implemented in developing countries — it is no longer adequate to concentrate primarily on communicable disease alone.
Frenk, Julio. “Cancer Is on the Rise in Developing Countries.” Harvard School of Public Health. Harvard School of Public Health, 15 Sept. 2009. Web. 27 Feb. 2016.
“Stages 0 & 1.” The National Breast Cancer Foundation. National Cancer Institute, n.d. Web. 27 Feb. 2016.
“Worse than AIDS.” The Economist. The Economist Newspaper, 01 Mar. 2014. Web. 27 Feb. 2016.