Local and global pressures for change

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Published: 10 Oct 2017
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Dr Christopher Wild - International Agency for Research on Cancer, Lyon, France

Dr Wild speaks with ecancer at the RSM meeting on cancer control about the health burden of ageing and shifting populations around the globe, especially in low and middle-income countries in which changing lifestyles are leading to increased cancer incidence.

Noting that 'no country can afford to treat its way out', he describes how prevention and early detection of disease are essential components in cancer control alongside adequate treatment.

In tackling societal interventions to reduce disease risk, including taxes and vaccination campaigns, Dr Wild encourages commitment to local, low-cost health policy changes.

It’s been a very interesting conference so far because it’s looking at the situation with cancer on a global scale. What we see from that is really this developing burden of cancer, the total number of cases increasing, particularly in the low and middle income countries. Of course these are the countries in which that capacity to respond to this increasing burden is least well developed and that’s going to put a huge burden on the health services in the future.

Can shifting populations between high and low income countries have an effect?

What we’re seeing actually is this change in risk factors, so things which cause cancer are becoming more common in the population. For example, in many populations still the tobacco use is increasing; we’re getting more people overweight and obese doing less physical activity. So there are a number of risk factors which are becoming more prevalent and that’s leading to a change in the incidence of a number of cancers but also a major effect of just population aging. As cancer is a disease of old age, predominantly at least, then as people are living longer, surviving into their old age, then that’s when the cancer rates start to go up. So we have this combination of a demographic change linked to a change in the risk factors for cancer which are leading to the large projected increases in cancer burden which we’ve been speaking about today.

How much of a balance is there between education, prevention and treatment?

What we’ve seen, really across the world, is that no country can afford to treat its way out of the cancer problem, even the wealthiest countries. We have not only the growth in cancer numbers, just the number of patients to deal with, but the costs of cancer treatment are spiralling out of control and they’re certainly not accessible to many of the low and middle income countries. So those circumstances of increased burden and increased cost of treatment make it impossible to treat your way out of the problem. What we have to do is have a better balance, a more integrated approach to prevention, early detection and treatment. So not to neglect at all the treatment area but to place more emphasis on prevention and early detection. When we think of that prevention it’s not only the responsibility on the individual to modify their behaviour, their lifestyle, but also a responsibility on government to introduce policies that have a positive effect on cancer control.

Do you see an increasing role for doctors within the world of politics?

First and foremost we need some good solid research data to evaluate the sorts of policies that might be considered, for example taxation, as you’ve mentioned, on sugary drinks or on alcohol, as we’ve seen has been effective on tobacco. So we need the information, the research data to evaluate such interventions and then we need to be presenting this kind of information to the policy makers to support them in their decision making. I think this conference is very interesting because it’s bringing people from different disciplines but also different parts of the world. What we’re seeing is some very interesting examples from different populations, different perspectives on cancer control measures, that can really inform us about our own particular challenges, the countries that we live in ourselves.

What is your take home message?

The important message is that we have a lot of knowledge already about the causes of cancer and we also have some very effective interventions. We have excellent vaccines against hepatitis B virus and human papilloma virus, both of which are associated with some of the most common cancers in the developing world – liver cancer and cervical cancer. We have very good ways to curb tobacco use through the application of the WHO Framework Convention on Tobacco Control. We have also opportunities to detect cancers early, such as cervical cancer and breast cancer, colorectal cancer. So there are a lot of tools, evidence based, that can be applied effectively if there’s a commitment there and the resources at national level. So whilst we can debate the value of new treatments and whether the cost of those treatments is really justified, particularly for a low and middle income country, we shouldn’t be distracted too much from the things that we can do already at relatively low cost which are known to be effective. I think some of that debate is what’s been interesting about today’s session.