Download Global Efforts to Address the Rising Cancer Burden, Dr. Julie Gralow

Women’s Empowerment Cancer Advocacy
Network (WE CAN) Conference
Global Efforts to Address the
Rising Cancer Burden
Dar es Salaam, Tanzania, September 2014
Julie R. Gralow, M.D.
Jill Bennett Endowed Professor of Breast Cancer
Director, Breast Medical Oncology
Professor, Global Health
University of Washington School of Medicine
Fred Hutchinson Cancer Research Center
Seattle Cancer Care Alliance
MYTH
Cancer is a disease of
developed countries
FACT
Low and middle-income
countries now bear a majority
share of the burden of cancer
Globocan 2008
Cancer Incidence and Deaths
Less Developed versus More Developed
Countries
Cancer Incidence
Cancer Deaths
Less Developed
4.8 million; 64%
Less Developed
7.1 million; 56%
5.6 million; 44%
More Developed
2.7 million; 37%
More Developed
Percent of Worldwide Cancers
Diagnosed in Developing Countries
• 1970 – 15%
• 2008 – 56%
• 2030 – 70%
•Ferlay J, et al. GLOBOCAN 2008. Lyon: International Agency for Research on Cancer, 2010
•Beaulieu N, et al. Breakaway: the global burden of cancer—challenges and opportunities. A
report from the Economist Intelligence Unit, 2009.
Most Common Cancer Site in Females
Globally
Source: GLOBOCAN 2008
The Cancer Transition in Low and Middle
Income Countries (LMICs):
Breast and Cervical Cancer
LMICs account for
>90% of cervical
cancer deaths and
>60% of breast
cancer deaths.
Both diseases are
leading killers –
especially of
young women.
% Change in # of deaths
1980-2010
53%
High
income
19%
20%
0%
Source: Knaul, Arreola, Mendez. estimates based on IHME, 2011.
LMIC’s
-31%
Cancer Estimates for Africa
Ferlay et. al 2010 http://globocan.iarc.fr
• 2008:
–681,000 diagnosed
–512,400 deaths
• 2030 (projected):
–1.28 million diagnosed
–970,000 deaths
Cancer Care and Control: A Call to
Action
Farmer P et al, Lancet, August 2010
Global Task Force on Expanded Access
to Cancer Care and Control in Developing
Countries
• Task Force report available
as free pdf download:
http://gtfccc.harvard.edu
Global Task Force Report: Core Elements of
a Cancer Care and Control Strategy
• Many cancers are preventable through infection control
and lifestyle modifications
• Accurate cancer diagnosis is critical to determining an
appropriate and successful treatment plan
• Many cancers are highly treatable with affordable
therapies that result in the addition of many years of life
– Denial of therapy for diseases that are highly curable
with affordable drugs is unacceptable
• Palliation of pain and suffering from cancer is a basic
human right
• Reliable data is needed to understand the magnitude of
the cancer burden and the potential impact of
interventions
A Global Call to Action
UN High-level Meeting on Prevention & Control
of Non-Communicable Diseases (NCDs)
September 19-20, 2011
• Millennium Development Goals
expire 2015
• NCDs – cancer, cardiac,
respiratory, diabetes – a major
challenge to health and
development in 21st century
• NCDs a priority for UN
• Goal of 25% reduction in
preventable deaths due to
NCDs by 2025
WHO Global Monitoring
Framework for NCDs
• Provides a clear vision for action by 2025
• UN Member States formally adopted the global
monitoring framework as part of a comprehensive
"Omnibus" Resolution at the 66th World Health
Assembly in May 2013
– 9 global targets
– 25 indicators
Primary Target:
Global NCD Targets for 2025
Global NCD Targets for 2025
WHO Global Monitoring Framework for
NCDs:
Selected Cancer-related Metrics
• 80% availability of affordable basic technologies &
essential medicines required to treat major NCDs
• Access to palliative care assessed by morphine
equivalent consumption of strong opioid analgesics per
death from cancer
• Availability, if cost‐effective and affordable, of vaccines
against human papillomavirus (HPV)
• Vaccination coverage against HBV monitored by
number of 3rd doses of Hep‐B vaccine administered
• Proportion of women between 30-49 screened for
cervical cancer at least once
Global Alliance for Vaccines and
Immunization (GAVI) and HPV Vaccine
Pricing
• Effective May 2013, lowest income countries have
access to HPV vaccines for US $4.50 per dose
– Same vaccines costs > $100 in developed countries
– Previous lowest public sector price $13 per dose
• GAVI working mostly in Africa, preparing for
introducing the HPV vaccine through national roll out
or pilot projects
– Anticipated that > 30 million girls will be immunized
by 2020
UN High-level Meeting - Comprehensive
Review and Assessment of the Progress
Achieved in the Prevention and Control of
Non-Communicable Diseases (NCDs)
July 10-11, 2014
• WHO report: NCDs country profiles 2014
http://www.who.int/nmh/publications/ncd-profiles-2014/en/
US NCI Center for Global Health
Established November, 2011
http://www.cancer.gov/aboutnci/globalhealth
• Goals:
– Advance global cancer research, build expertise and
leverage resources across nations to address
challenges of cancer and reduce cancer deaths
worldwide
American Society of Clinical
Oncology (ASCO)
International
• Portfolio of education and research opportunities to
accelerate collaboration between members,
organizations, and countries
– Multidisciplinary Cancer Management Courses
– International Clinical Trials Workshops
– Palliative Care Courses
– Oncology for the Non-Oncologist Course
– International Development and
Education Awards (IDEA)
– International Innovation Grants
2007 Institute of Medicine Report
Cancer Control Opportunities in Lowand Middle-Income Countries
Sloan FA, et al, National Academies Press, 2007
• Patient advocacy has a key role to play in bringing the
public’s concerns about cancer to decision makers
• Summary recommendations: Advocacy
– Provide active support and assistance of cancer
advocacy in low- and middle-resource countries
– Suggested activities:
» Set up advocacy networks within countries, regions,
internationally
» Identify successful approaches to cancer advocacy
and replicate/adapt for use in other settings
» Provide hands-on training and technical assistance
Promotion of public advocacy for breast and
cervical cancer
Women’s Empowerment Cancer
Advocacy Network (WE CAN)
Goals:
• To combat breast and cervical cancer by building and
supporting advocacy groups with skills to address:
– inadequacy in information
– inequity in treatment and care
– injustice in breast nd cervical cancer early
detection, screening, treatment, and prevention
WE CAN Eastern Europe/Central Asia Breast
and Cervical Cancer Advocacy Conferences
Vilnius, Lithuania 2003
Kiev, Ukraine 2005
Minsk, Belarus 2007
Bishkek, Kyrgyzstan 2009
Vilnius, Lithuania 2011
Tbilisi, Georgia 2013
WE CAN East Africa Breast and Cervical
Cancer Advocacy Conferences
Kampala, Uganda September 2013
Dar es Salaam, Tanzania October 2014
The Power of Social Media:
Connecting Across Continents
• #WECAN14 Twitter chat tonight 6-7 pm with breast
cancer patient advocates in North America!
MYTH
It’s too expensive and there are too
many obstacles to prevent or treat
cancer in developing countries
FACT
Much can be done to prevent,
treat and palliate cancer even in
resource-constrained settings
The time has come to challenge
and disprove the assumption
that cancer cannot be
prevented, treated, or palliated
in developing countries