How to close the global cancer divide

“The tragedy of global breast cancer is not that we don’t know what to do — it is that we don’t know how to get it done.” So writes Dr Benjamin O. Anderson, MD, former chair and director of the Breast Health Global Initiative.

He is referring to the cancer divide between rich and poor nations. According to a 2013 study endorsed by the World Health Organisation (WHO), “despite the common misconception that breast cancer is primarily a problem of high-income countries, in 2010 the majority of the world’s 425,000 deaths from breast cancer occurred in developing countries”.

Breast cancer, in fact, was the dominant cause of cancer-related death for women of less-developed regions, according to WHO’s latest data (324,000 deaths in 2012). While incidence is higher in developed countries — sometimes by up to a factor of 4 — mortality rates in low to middle income countries (LMICs) are much higher, explaining the higher death burden.

The authors of the WHO study blame this cancer divide between rich and poor countries in part on “gender-related social and economic factors”. Women in the developing world, for example, traditionally have had less access to healthcare services than do men. They also often lack awareness of the symptoms of breast cancer. Only 28% of Brazilians were aware of the link between breast cancer and dense breast tissue, for example, according to a recent survey done by MillardBrown for GE Healthcare. Thus, they seek help too late, with many of them presenting with tumours that often can be felt or even seen through the skin.

Another reason for the divide is money. Advanced-stage cancers require resource-intensive treatments like radiation, chemotherapy (which can require long travel from home) and surgery. Early detection also often involves expensive equipment such as mammography machines, which can cost upwards of $100,000. In 2012, for example, Mexico only had 9.1 such machines per million people—six times fewer than Korea.

Ultrasound devices, while considered less effective than mammograms in detecting breast cancer, are less expensive as well as easier to transport and use. Lower-cost solutions are also in development. Researchers at Harvard University, for example, are developing a portable “paper machine” that could test a sample of blood for pathogens and possibly breast cancer for less than $2.

Obtaining affordable screening equipment is only part of the equation. Reducing societal and cultural taboos around the disease is equally essential to convincing women to attend screenings or to perform self-exams. As Dr Anderson points out in an interview with the American Society of Clinical Oncology, “In some sub-Saharan African countries, it is common that a husband would divorce a wife with cancer, stripping her of any claim to her home or marital property. This is a huge disincentive toward early breast cancer detection”.

One possible way to address this challenge is via awareness campaigns, which have proved effective in destigmatising cancer in Western societies — although their impact in terms of health is less clear.

Another option might be to create synergies between maternal health, cancer screening and preventive education. According to the UN, for example, the number of women receiving prenatal care in developing countries has increased from 65% in 1990 to 83% in 2012.

Integrating self-exam education and low-tech breast exams into current pre- and post-natal visits may help to increase awareness among women about other aspects of their health. In that case, knowledge may actually be power.

This post first appeared on GE LookAhead. Publication does not imply endorsement of views by the World Economic Forum.

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Author: Holly Hickman writes for GE Look Ahead.