International Leaders Stress Prevention to Avert ‘Untenable’ Rise in Worldwide Cancer Cases

Cancer leaders and government representatives from 50 countries warned at the World Cancer Leaders' Summit in Montral that greater emphasis must be placed on prevention to stem the tide of rising cancer incidence. If worldwide action is not taken, cancer incidence will likely increase by 70 percent in middle-income countries and 82 percent in lower-income countries by 2030, speakers said. If it occurs unabated, this rising incidence will have a dire effect on worldwide economic productivity, they noted. The summit was held in conjunction with the World Cancer Congress. At the meeting, American Cancer Society CEO John Seffrin, PhD, pledged $2 million over the next three years to fight cancer globally in its collaboration with the Union for International Cancer Control (UICC), which convenes the World Cancer Congress. Seffrin, who was President of the UICC from 2002 to 2006, decried a setback in the United States just before the meeting: a federal court decision banning from cigarette packs large graphic warning labels and the toll-free phone number that helps smokers break the habit (1–800-Quit-Now).Image“The court's rejection of the number represents a huge missed opportunity, because callers to quitlines are twice as likely to stop smoking as those who don't seek this assistance,” he said in an ACS statement. Lessons Learned During a Congress webcast, those participating in the World Cancer Leaders' Summit said that much has been learned from developed countries that can help developing countries cope with this rising cancer incidence. Prof. Prabhat Jha, MD, DPhil, Executive Director of the Centre for Global Health Research in Toronto, said lessons learned in the developed world on reducing cancer incidence—such as the value of screenings and early detection—“are important globally.” Some of the lessons learned can be applied to specific age groups. Prof. Jha noted that in India, for example, cancer “is not an old person's disease,” with the heaviest incidence occurring in people age 30 to 69. In addition, education—or the lack thereof—plays a major role in cancer incidence in India. The death rates are twice as high in illiterate people as in literate people, he said. “Tobacco taxes are the single most important strategy” to reduce cancer deaths. He noted that while some cite high tobacco taxes as an undue burden on the poor, “tobacco taxes are not anti-poor; they can be pro-poor,” because they discourage tobacco purchase. “The biggest cost of tobacco is the premature mortality that arises from it.” Economic Toll The economic toll of smoking deaths in this century is estimated to rise to $1 billion, compared with $100 million in the last century, he added. “It just swamps any other costs.” And while tobacco taxes will likely not play a role in the upcoming US presidential election, he said, whoever is elected President of the United States should continue raising tobacco taxes to cut down on smoking-related cancer deaths. Canada is hoping to enlarge the pictorial warnings on cigarette packages that already exist, said Douglas Bettcher, MD, PhD, Director of the Tobacco Free Initiative of the World Health Organization. He noted that tobacco companies are fighting this effort. He praised Australia, which has adopted an unappetizing, “drab brownish-green” packaging for cigarette packs. Worldwide, Bettcher said, WHO strongly advises countries to adopt plain cigarette packaging devoid of seductive branded company logos and symbols. “The world cannot afford to have inaction on cancer,” he warned. “Most premature deaths from cancer are preventable,” said Oleg Chestnov, MD, WHO's Assistant Director General for Non-Communicable Diseases and Mental Health. To reduce mounting cancer incidence, all countries need national cancer control plans and need to take action based on those plans. Said UICC President-Elect Mary Gospodarowicz, MD, Medical Director of the Cancer Program at Princess Margaret Hospital in Toronto and a specialist in radiation therapy: “UICC is very much behind national cancer control plans. She urged government leaders in countries that don't have such plans to establish and implement them, and noted that UICC has a tool available to help countries without such plans develop them. She too stressed that the cost of inaction against cancer “greatly outweighs the cost of action.” More Emphasis on Prevention “We really need to put a lot more emphasis on prevention,” emphasized Christopher Wild, PhD, Director of the International Agency for Research on Cancer, in agreeing with the other speakers. Today, he said, “We put most of our money into treatment,” which he called “a mismatch” in terms of stemming the rising tide of cancer incidence. “We can't treat our way out of cancer, particularly in the developing countries,” he warned. Wild cited the importance of public health officials tailoring national cancer control plans to their own countries' specific needs. “We have to encourage countries to look at their own particular patterns of cancer,” he said. For example, the human papillomavirus vaccine could be an important part of a national cancer control plan in countries that have high rates of cervical cancer. And while cancers due to infection are still a problem in many developing countries, the rates of breast, colorectal, and prostate cancers are increasing in those countries as they adopt a more westernized diet and lifestyle. Wild also noted that in some countries—Africa, for example—it may not be feasible to offer mammography screening everywhere. Therefore, he said, techniques such as clinical breast exams may have to be widely used. Today, less than 50 percent of countries have cancer registries, according to WHO data. India is one large country that is making progress on cancer registries, Wild noted. And in Canada, there have been major strides with provinces to expand existing cancer registries to include staging, said Heather Bryant, MD, PhD, Vice-President for Cancer Programs, Clinical and Population Health, of the Canadian Partnership Against Cancer. As of 2010, Canadian cancer registries now include staging for breast, colorectal, lung, and prostate cancers, she said. Bryant also noted that Canada has adopted screening for psychosocial distress when cancer patients first presents, and she cited the need to get prevention into evidence-based practice, and practice into prevention. Global Cancer Research Efforts As for global cancer research efforts, Wild said these should: Gather reliable statistics on cancer incidence and mortality; Investigate the causes of cancers whose causes are currently unknown; Evaluate preventive strategies to see whether they work in practice (adapted to the needs of each country); and Assess barriers to implementing prevention in practice (for example, factors that stop men from coming in for colorectal cancer screening). ACS Commits $2 Million to Global Cancer FightImageDuring the meeting, the American Cancer Society announced that it was committing two million dollars towards fighting cancer internationally. The investment, with the oversight of the UICC, will be directed towards three priority areas: Improving access to pain relief worldwide through the Global Access to Pain Relief Initiative (a joint program of UICC and ACS); Supporting the work of the NCD Alliance—a network of 2,000 civil society organizations in 170 countries—to make non-communicable diseases a priority on the global health and development agenda; and Supporting the development of cancer leaders to build cancer control capacity worldwide.

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