WHO’s new guide for cancer focuses on early detection and treatment

Aarti Dhar, CNS Correspondent, India
(First published in theIndiasaga.com)
Latest cancer data released by the World Health Organisation (WHO) says that 8.8 million people died from cancer in 2015, with about 70% of deaths occurring in low and middle-income countries. One thing common in these deaths is that the disease was diagnosed too late, making the chances of survival slim. Even in countries with optimal health systems and services, many cancer cases are diagnosed at an advanced stage, when they are harder to treat successfully.

This year on World Cancer Day – observed every year on February 4, the WHO released new guidelines, which aim to improve the chances of survival for people   living with cancer by ensuring that health services can focus on diagnosing and treating the disease early enough. “Diagnosing cancer in late stages, and the inability to provide treatment, condemns many people to unnecessary suffering and early death,” says Dr Etienne Krug, Director of WHO’s Department for the Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention. “By taking the steps to implement WHO’s new guidance, healthcare planners can improve early diagnosis of cancer and ensure prompt treatment, especially for breast, cervical and colorectal cancers. This will result in more people surviving cancer. It will also be less expensive to treat and cure cancer patients.” All countries can take steps to improve early diagnosis of cancer, according to WHO’s new guide to early diagnosis of cancer. The three main steps for early diagnosis are (i) improving awareness of different cancer symptoms and encouraging people to seek care when these arise; (ii) investing in strengthening and equipping health services and training health workers so that they can conduct accurate and timely diagnosis; and (iii) ensuring that people living with cancer can access safe and effective treatment, including pain relief, without incurring prohibitive personal or financial hardships.

Challenges are clearly greater in low and middle-income countries, which have less resources and abilities to provide access to effective diagnostic services, including imaging, laboratory tests and pathology – all key to helping detect cancers and plan treatment. Countries also currently have different capacities to refer cancer patients to the appropriate level of care. Detecting cancer early also greatly reduces cancer’s financial impact: not only is the cost of treatment much less in cancer’s early stages, but people can also continue to work and support their families if they can access effective treatment in time. In 2010, the total annual economic cost of cancer through healthcare expenditure and loss of productivity was estimated at US$ 1.16 trillion. Strategies to improve early diagnosis can be readily built into health systems at a low cost. In turn, effective early diagnosis can help detect cancer in patients at an early stage, enabling treatment that is generally more effective, less complex and less expensive. For example, studies in high-income countries have shown that treatment for cancer patients who have been diagnosed early are 2 to 4 times less expensive compared to treating people diagnosed with cancer at more advanced stages. 

Sustainable Development Goal (SDG) 3 aims to ensure healthy lives and promote well-being for all at all ages. Countries have agreed to achieve the  target of reducing premature deaths from cancers and other noncommunicable diseases (NCDs) by one-third by 2030. They have also agreed to achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all. At the same time, efforts to meet other SDG targets, such as improving environmental health and reducing social inequalities can also help reduce the cancer burden. Cancer is now responsible for almost one in six deaths globally. More than 14 million people develop cancer every year, and this figure is projected to rise to over 21 million by 2030. Figures compiled by Central Bureau of Health Intelligence suggest India had 11.48 lakh cases of cancer in 2016— up from 10.57 lakh in 2012. Progress on strengthening early cancer diagnosis and providing basic treatment for all can help India and other countries meet national targets tied to the SDGs. Most people diagnosed with cancer live in low- and middle-income countries, where two thirds of all cancer deaths occur. Less than 30% of low-income countries have generally accessible diagnosis and treatment services, and referral systems for suspected cancer are often unavailable resulting in delayed and fragmented care. The situation for pathology services is even more challenging: in 2015, only about 35% of low-income countries reported that pathology services were generally available in the public sector, compared to more than 95% of high-income countries.

Comprehensive cancer control consists of prevention, early diagnosis and screening, treatment, palliative care, and survivorship care. All should be part of strong national cancer control plans. WHO has produced comprehensive cancer control guidance to help governments develop and implement such plans to protect people from the onset of cancer and to treat those needing care. Cancers, along with diabetes, cardiovascular and chronic lung diseases, are also known as NCDs, which were responsible for 40 million (70%) of the world’s 56 million deaths in 2015. More than 40% of the people who died from a NCD were under 70 years of age. Tobacco control is a cost-effective and evidence-based cancer prevention strategy. Over 20% cancer deaths are caused by tobacco use. Tobacco not only dangerously elevates lung cancer but also impacts 14 kinds of cancers. Tobacco is a leading common risk factor for major NCDs annually with most deaths in low and middle income countries, says Anne Jones, senior tobacco control expert with the International Union Against TB and Lung Disease (The Union). According to Dr. Navneet Singh, Secretary of Indian Society for the Study of Lung Cancer, and Associate Professor at the Department of Pulmonary Medicine, PGIMER, nearly 85% of lung cancer patients present themselves in Stage 3B and 4 of the disease at the time of diagnosis. Cure at that point of time is not possible. He says lung cancer in developing countries is either declining or has plateaued but in India it is increasing with indoor pollution, and passive smoking being major reasons, particularly among women.

Aarti Dhar, Citizen News Service - CNS
February 7, 2017