Abstract SY03-01: Government and civil society efforts in global cancer control
Authors: Ginsburg Ophira 
Published: August 2018

Abstract
Cancer kills more than 8 million men, women, and children each year (1). Most people who will develop and die from cancer live in low- and middle-income countries (LMIC), and the number of new cases is expected to increase by 70% over the next two decades to 22 million each year by 2030 (1). Advanced stage at presentation and diagnosis, due to multifactorial causes that influence patient and provider delays, are common in most settings within LMIC. Limited access to affordable high-quality cancer surgery, pathology, essential cancer medicines, and radiotherapy are all factors that influence poorer survival in many countries (2,3). The WHO 2015 country capacity survey for noncommunicable diseases (4) reported that while 90% of high-income countries had treatment services widely available, this was as low as 30% in low-income countries, where only 35% report pathology services as “generally available” in the public sector. Access to palliative care is also woefully inadequate, particularly outside of hospital settings with limited access to oral morphine and hospice care. Compounding global cancer disparities is the general lack of high-quality data that are necessary to inform population-level prevention and individual (precision) treatment strategies, as well as to advise governments on the most appropriate allocation of resources towards national cancer control. These stark inequities present not only a moral and ethical imperative, but also an economic one. The total cost of cancer in 2010 was estimated at approximately US$ 1.16 trillion, representing approximately 1.8% of global GDP (5). So, what can we do as individuals, academic and professional societies, nations, and multinational agencies? The good news is that we can do a great deal to help, but we will achieve greater impact, faster, if we harness our efforts in strategic, collective, and collaborative fashion.
According to the World Health Organization and the International Agency for Research on Cancer (1,2), approximately one third of cancer deaths are attributable to five behavioral and dietary risks: tobacco use, alcohol, overweight and obesity, lack of physical activity, and a diet poor in fruit and vegetables. Tobacco alone is responsible for approximately 22% of all cancer deaths worldwide. Although highly effective vaccines are widely available against hepatitis B and HPV (notwithstanding recent shortages in the latter), infectious agents account for 25% of cancer cases in LMIC (6). However, public health efforts and policy initiatives to reduce tobacco use and alcohol consumption, and to improve access to affordable fresh fruits and vegetables, along with nationwide immunization against hepatitis B and HPV, can go a long way to stem this tide. The World Health Organization, IARC, and International Atomic Energy Agency (IAEA) have an important role to play in global cancer control, providing technical support and guidance for countries confronting the growing cancer burden (7). With its headquarters in Geneva, as well as 6 regional offices and more than 150 country offices, WHO is arguably uniquely positioned to help guide countries in the prevention and management of disease, and to navigate an increasingly complex, interconnected, global health landscape. Recent examples of WHO and partner agencies' cancer control efforts include the following (7):
1. In 2015, with support from the Union for International Cancer Control (UICC), WHO released an updated Model List of Essential Medicines with an additional 16 new cancer medicines (8).
2. UNAIDS in partnership with WHO, the UN Interagency Task Force on NCDs, and the Global Coalition on Women and AIDS launched a new guide, “HIV, HPV, and Cervical Cancer: Leveraging Synergies to Save Women's Lives” at the 2016 International AIDS Conference in Durban, South Africa. This document highlights the need for more attention and better integration of health services for women living with HIV/AIDS who are at increased risk to develop cervical cancer, an AIDS-defining illness (9).
3. On World Cancer Day 2016, former United National Secretary General Ban Ki Moon called for “the elimination of cervical cancer” as a public health concern (10), and on 2017 World Cancer Day the WHO Director General launched the “WHO Guide to Cancer Early Diagnosis” (11) to provide health policy-makers, planners, and managers with guidance to facilitate timely and equitable access to cancer care. At the 2017 World Health Assembly, WHO member states passed a new “Cancer Resolution” (12) that includes a call for member states to “promote cancer research to improve the evidence base for cancer prevention and control, including research on health outcomes, quality of life and cost-effectiveness” and “to continue fostering partnerships between government and civil society, building on the contribution of health-related nongovernmental organizations and patient organizations, to support, as appropriate, the provision of services for the prevention and control, treatment and care of cancer, including palliative care.” In this context, the U.S. National Cancer Institute Center for Global Health, ASCO, AACR, NCCN, and many other national and international academic institutes and civil society organizations are rising to the global cancer challenge, leading the research, development, and dissemination of evidence-informed, resource-tailored guidance in cancer care and control.
References:
1. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11. Lyon, France: International Agency for Research on Cancer; 2013.
2. World Health Organization 2017. http://www.who.int/mediacentre/factsheets/fs297/en/
3. Allemani C, Weir HK, Carreira H, et al... and the CONCORD Working Group. Global surveillance of cancer survival 1995-2009: Analysis of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet 2015;385: 977-1010.
4. Assessing national capacity for the prevention and control of noncommunicable diseases: Report of the 2015 global survey. World Health Organization 2015. http://apps.who.int/iris/bitstream/10665/246223/1/9789241565363-eng.pdf?ua=1
5. Stewart BW, Wild CP, editors. World Cancer Report 2014. Lyon: International Agency for Research on Cancer; 2014.
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7. Al-Sukhun S, de Lima Lopes G, Gospodarowicz M, Ginsburg O, Yu PP. Global Health Initiatives of the International Oncology Community. ASCO Annual Meeting 2017 Educational Book.
8. WHO Model List of Essential Medicines. http://www.who.int/medicines/publications/essentialmedicines/en/
9. HPV, HIV and cervical cancer: Leveraging synergies to save women's lives. UNAIDS 2016.
10. UN Secretary-General message on World Cancer Day Feb 4, 2016. https://www.un.org/sg/en/content/sg/statement/2016-02-04/secretary-generals-message-world-cancer-day-scroll-down-french .
11. WHO Guide to Cancer Early Diagnosis. World Health Organization 2017. http://www.who.int/cancer/publications/cancer_early_diagnosis/en/
12. Cancer Prevention and Control in the Context of an Integrated Approach. Seventieth World Health Assembly WHO70.12, Mar 31st 2017. http://apps.who.int/medicinedocs/documents/s23233en/s23233en.pdf
Citation Format: Ophira Ginsburg. Government and civil society efforts in global cancer control [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr SY03-01.