The burden of cancer

Recently, The Economist Intelligence Unit, published a special report titled “The Global Burden of Cancer - Challenges and Opportunities”.

The numbers are breathtaking: Cancer is the second leading cause of death and disability in the world, trailing only heart disease. Based on the most current data available, cancer accounts for one out of every eight deaths annually, and more people die from cancer every year around the world, than from AIDS, malaria and tuberculosis combined. According to a review of the National Cancer Institute in the United States, in that country, one out of every two men and one out of every three women will experience some type of cancer in the course of their lives.

Several years ago, cancer was a disease of high income countries of the developed world, but today more cancers arise and more deaths occur in lower income and middle income countries of the developing world, than in high income countries.

According to the World Health Organization, cancer is one of the leading causes of death in the world: 7.6 million people in the year 2005. It is estimated that if nothing is done to change it, about 84 million more people will die in the next 10 years. More than 70 percent of these deaths will occur in low income and middle income countries.

In Panama, cancer is the second leading cause of death behind all the cardiovascular diseases (stroke, myocardial infarction, diabetes).

If you separate these diseases, cancer is the first cause of death, with a rate of 74 per 100,000 habitants in the year 2008. The main localizations were breast and cervix cancer for women, and prostate cancer for men.

Last year the National Institute of Oncology attended approximately 12,000 patients with a budget of $28 million. It is estimated that about 5,000 new cases of cancer will be seen this year.

According to the World Health Organization, about 40 percent of the cancer cases are preventable. As I have discussed in previous articles, smoking accounts for several cancers, also excessive alcohol ingestion seems to play a goal in cancer development.

Obesity, high fat food ingestion, and sedentary life seem to influence cancer development. There are viruses associated with cancer etiology, like Hepatitis B and C that can produce hepatocarcinoma, the human papilloma virus has been associated to development of cervical cancer in women, and also of penis in men. All of these associated cancer could be prevented.

The World Health Assembly on May 2005 adopted resolution WHA 58.22 on cancer prevention and control, and urged member states to intensify actions against cancer by developing and reinforcing cancer control programs. Other agencies, like the International Atomic Energy Agency (IAEA) and the International Union Againts Cancer (UICC) provide funds to support prevention and control cancer programs.

The components of a cancer control program are prevention, early detection, treatment and palliative care.

Prevention: of cancer, specially when integrated with prevention of chronic diseases, offers the greatest public health potential and the most cost effective method of cancer control. The hepatitis B immunization, papilloma virus immunization, anti-tobacco laws, promotion of healthy lifestyles are examples of these actions.

Early detection: detects the disease at an early stage, when it has more potential for cure (like in cervical and breast cancer). Screening programs and awareness of early signs and symptoms are included here. It is estimated that there are interventions to detect about one third of the cases.

Treatment: aims to cure the disease prolong life and improve the quality of remaining life after the diagnosis of cancer is obtained. Follows evidence based medicine.

Palliative Care: meets the needs of all patients requiring relief from symptoms and of psychosocial and supportive care, particularly those with advanced stages or terminal disease. Cancer and its management have physical, emotional, spiritual, social and economic consequences for patients and their families. A good palliative service can improve their quality of life.

The Ministry of Health of Panama has initiated planning to develop a Program for the Control of Chronic Diseases and Cancer. In the meantime, remember:

About 80 percent of the cardiovascular diseases, including stroke, diabetes and coronary artery disease, and about 30-40 percent of cancers could be prevented by controlling the common risk factors, with healthy lifestyles (diet and exercise), non-smoking, and avoiding excessive alcohol intake.