Abstract IA04: Developing a national plan for cancer prevention and control; balancing unmet needs and addressing global disparities
Authors: MOHAR ALEJANDRO , Reynoso Nancy , Meneses Abelardo 
Published: March 2017

Abstract
Later estimates calculate that more than 12 million people are diagnosed every year with cancer. If there is no a major shift in the prevalence of risk factors, it is expected that by the year 2030 there will be 20 million people diagnosed with cancer worldwide and 13 million deaths. For the Latin American and Caribbean region, around 1.7 million new cases and 1 million deaths will occur annually.
Of 590 million inhabitants in Latin America, more then 50% do not have health-care coverage. In addition, there is a high prevalence of risk factors associated with chronic diseases, which include an increase in sedentary lifestyles, overweight, obesity and diabetes mellitus, tobacco smoke, alcohol use, household air pollution, diets low in fruits and vegetables, and ageing. In contrast with the United States and Canada where tobacco smoke is the leading risk factor for cancer, in Latin America the leading risk factors are overweight and alcohol use.
However, these data are indirect since there are few epidemiological studies in the region that identify the prevalence and time-trend of these and other factors. It is known that only 8-10% of the Latin American population, is covered by population-based cancer registries; by contrast with 96% in the USA and Canada.
Within these limitations, it is estimated that the overall incidence of cancer is lower in Latin America (163/100,000) compared to the USA (300/100,000). However, the mortality rate is higher in Latin America, since the mortality/incidence ratio for Latin America is 0.59 compared with 0.35 in the USA or 0.43 for Western Europe. This higher mortality burden is associated with advanced stages of the disease at the time of diagnosis. In the USA, 60% of breast cancer cases are diagnosed in early stages, whereas in Brazil and Mexico only 20% and 10%, respectively, are diagnosed earlier. In Latin America breast and cervical cancer are the more common cancer types in women, in the USA are breast and colon cancer; in men, prostate, stomach and lung cancer are the more common malignancies in Latin America, whereas in the USA are prostate, lung and colorectal.
Within a setting off financial restrictions, a common characteristic of the oncological institutions in Latin America is that most of them are poorly equipped, highly concentrated in urban areas, limitations in human resources, low-income of the physicians and nurses, poor access to new drugs, and in most of them a fragmented or segmented health-care system. In addition, among these 33 states there is unbalance access to medical care with diversity in socioeconomic, geographic, environmental, cultural and ethnic factors that provide fewer services to the poor, thus promoting further inequity. For example, in Mexico and Perú there are a total of 269 medical oncologists in Mexico of whom 60% work in the three megacities of the country. In Perú, 85% of the 130 medical oncologists reside in Lima, the capital city. Finally, adequate medical infrastructure to undertake prevention, diagnostic and treatment of cancer is not available or not accessible in several regions of Latin America. Mammography is 4.7 per 100,000 inhabitants, radiotherapy units are available in 0.128 per 100,000 inhabitants; by comparison, USA has 1.2 radiotherapy units.
The health care investment in Latin America varies substantially between countries, on average the total health expenditure was 7.7% of GDP, by comparison in the USA in the same year it was 17.2%
Conclusions and challenges. There is an urgent need to increase efforts towards primary and secondary prevention of cancer in Latin America; particularly, to identify patients in early stages of the disease and offer prompt treatment to them. To accomplish a better cancer control it is necessary the development, implementation and evaluation of a comprehensive National Cancer Control Plan in this region, which includes the investment in population-based cancer registries.
However, this situation will not improve without adequate financial and better human resources. The economic burden of cancer in Latin America is estimated to be around US$4billion. Surprisingly, the mean medical expenditure per patient is $7.92, compared with $460 in the USA. In addition the estimated expenditure gap for cancer in this region is between 25-57%, compared with 11% in high-income countries.
They are several challenges ahead for Latin America. As a first step: restructure of health-care systems together with an increase in the financial resources to improve primary and secondary prevention together with cancer care. Also, to develop and optimize the oncology infrastructure, including the work-force. It is necessary an improvement and investment in clinical and epidemiological research according to the needs and capacity of these countries. Cancer in Latin America has become a mayor public health problem, that requires an urgent planning and directed interventions. Cancer control should be a national priority for Latin America.
Citation Format: ALEJANDRO MOHAR, Nancy Reynoso, Abelardo Meneses. Developing a national plan for cancer prevention and control; balancing unmet needs and addressing global disparities. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr IA04.