Surviving Cancer: Does Where You Live Make A Difference?

James Stark, MD, of Stark Oncology

James Stark, MD, of Stark Oncology

From all the publicity given to new cancer diagnostic tools and new therapies, one could reasonably conclude that we are winning the fight against cancer.
In fact, this is partially correct.

The National Cancer Institute (a branch of the National Institutes of Health in Bethesda, Maryland) and the Centers for Disease Control in Atlanta track cancer survivors.  In 1971, with a US population of slightly over 207 million, there were 3 million cancer survivors.  In 2001, with a population over 285 million there were 9.8 million cancer survivors.   By 2007 that number had increased to 11.7 million (total 301 million).

By arithmetic alone we seem to be doing much better, as the graph below expresses:

Morbidity and Mortality Weekly Report Vol. 60, No. 9, 2011 (click graph to enlarge)

If you lived in the third world during this same period of time, the numbers were very different.  Dr. Paul Farmer and colleagues from the Harvard School of Public Health and the Harvard Global Equity Initiative have studied mortality trends in the developing world for many years.  Traditionally their focus has been on malnutrition and infectious diseases.  Recently they have tackled the problem of cancer treatment and survivorship.  In 2008 they estimated that 56% of the new cancer cases occurred in the developing world.  In areas where resources are scarce and constrained by poverty how did those people fare?   By their estimates overall mortality from cancer was 46% in highly developed countries and 75% in the least developed.  The graph below illustrates the point: disease by disease: mortality falls with increased income.

The Lancet Vol.376, October 2, 2010, pp. 1186-93 (click graph to enlarge)

They estimate that current resources to combat cancer are not likely to improve soon despite efforts by such organizations as the Gates and Clinton Foundations.   These countries lack the resources to build modern surgical suites, purchase anti-cancer drugs, and attract oncologists.  International aid foundations have not targeted cancer as a disease worthy of consideration.

What can be done about this?  Farmer recommends that efforts be trained on prevention; specifically: smoking cessation and immunization against Hepatitis B and Human Papilloma Virus (HPV).  Two years ago, Harvard Medical School, where Farmer serves as Professor, set up an initiative to attack cancer in the developing world.  They proposed a multi-pronged approach including immunizations as above as well as the development of new models of care delivery using local partners to improve access to care.  As yet no one can assess the progress they are making.

The disparities in cancer survival mirror those of health care in general.  The difference is the rapid devastation wrought by a late diagnosis and lack of therapy.

+ Read more articles about Cancer Care
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