Thursday, May 2, 2013

The Specter of Rising Cancer Deaths in Latin America and Caribbean

Latin America and the Caribbean are the next hotspots of cancer-related deaths in the world and countries in this region are woefully ill-prepared to face this growing epidemic. A report by Latin American Cooperative Oncology Group (LACOG) presented at the LACOG Conference 2013 on April 26-27, 2013, at Sao Paulo, Brazil, put these facts in depressing hard numbers: currently 13 people of 22 diagnosed with cancer die in Latin America and the Caribbean in contrast to 13 of 37 in US or 13 of 30 in Europe. This translates to 59% of cancer patients dying of cancer in Latin America and the Caribbean compared to 35% in US or 43% in EU.

The scope of problem
  • It is estimated that by the year 2030, 1.7 million cancers will  be diagnosed in this part of the world. 
  • And, with current outcomes, 1 million of these will die of cancer.
  • Currently economic loses due to cancer have been pegged at $4 billion annually which includes treatment, medication, loss of business and productivity.
  • This part of the world is rapidly graying. . . by 2020, there will be over 100 million 60 year or older people. These "ticking time bombs" are the next wave of cancer in Latin America.

Reasons for poor cancer outcomes in Latin America and the Caribbean
  • Currently 70% of people are diagnosed at late "incurable" stage.
  • There is a culture of "silence", cancer is "stigmatized" and patients are often left to "fate".
  • Access to health care is an issue particularly for the poor, rural and indigenous population. Overall, more than half of the population in the region lacks health insurance.
  • Except for Chile and Uruguay, public health systems are weak. And, llimited governmental resources are currently directed towards public health problems of the third world, such as infectious diseases and infant mortality, and chronic diseases as cancer are not high priority.
  • The infrastructure for cancer screening programs, public educational programs, national cancer registries or guidelines are no fully developed.

What is being done

Several people in public life, including those who ultimately succumbed to cancer took the issue of "sitgma" head-on. 

One tragic story is that of 28 year old Eva Ekvall, 2000 Miss Venezuela and 2001 Miss Universe third runner-up, who succumbed to her two year-long battle with breast cancer on December 10, 2011.  

Two years before her death, she wrote a book, Fuera de Foco (Out of Focus), about her struggle with advanced breast cancer, posed with her bald pictures shocking to the country obsessed with female beauty--she became one of the greatest breast cancer advocates in Venezuela.  She had dismissed a lump discovered during pregnancy of her daughter as expected hormonal change in spite of the family history, and she remained bitter about it!  Her advocacy led to increased awareness about breast cancer, breaking the taboo and significantly increasing breast cancer screenings in Venezuela. 

In addition, there are initiatives at national level
  • Some countries, such as, Mexico and Brazil, have better national conversation and awareness programs, at least in urban areas.
  • American Cancer Society (ACS) has been collaborating with scholars from at least 12 countries from Latin America since 2002, and there are several ACS-sponsored programs throughout his region (see here).
  • United States–Latin America Cancer Research Network (US-LA CRN)
  • In 2009, NCI formally launched the United States–Latin America Cancer Research Network (US-LA CRN) with institutions in five Latin American countries.

    Sources and further readings

    You can read the detailed report "Planning cancer control in Latin America and the CaribbeanProf Paul E Goss and his colleagues in the April 2013 issue of the Lancet Oncology (April 2013).
    Summary: Non-communicable diseases, including cancer, are overtaking infectious disease as the leading health-care threat in middle-income and low-income countries. Latin American and Caribbean countries are struggling to respond to increasing morbidity and death from advanced disease. Health ministries and health-care systems in these countries face many challenges caring for patients with advanced cancer: inadequate funding; inequitable distribution of resources and services; inadequate numbers, training, and distribution of health-care personnel and equipment; lack of adequate care for many populations based on socioeconomic, geographic, ethnic, and other factors; and current systems geared toward the needs of wealthy, urban minorities at a cost to the entire population. This burgeoning cancer problem threatens to cause widespread suffering and economic peril to the countries of Latin America. Prompt and deliberate actions must be taken to avoid this scenario. Increasing efforts towards prevention of cancer and avoidance of advanced, stage IV disease will reduce suffering and mortality and will make overall cancer care more affordable. We hope the findings of our Commission and our recommendations will inspire Latin American stakeholders to redouble their efforts to address this increasing cancer burden and to prevent it from worsening and threatening their societies.

    BBC News. 25 April 2013. [Link


    Goss, P., Lee, B., Badovinac-Crnjevic, T., Strasser-Weippl, K., Chavarri-Guerra, Y., Louis, J., Villarreal-Garza, C., Unger-Saldaña, K., Ferreyra, M., Debiasi, M., Liedke, P., Touya, D., Werutsky, G., Higgins, M., Fan, L., Vasconcelos, C., Cazap, E., Vallejos, C., Mohar, A., Knaul, F., Arreola, H., Batura, R., Luciani, S., Sullivan, R., Finkelstein, D., Simon, S., Barrios, C., Kightlinger, R., Gelrud, A., Bychkovsky, V., Lopes, G., Stefani, S., Blaya, M., Souza, F., Santos, F., Kaemmerer, A., de Azambuja, E., Zorilla, A., Murillo, R., Jeronimo, J., Tsu, V., Carvalho, A., Gil, C., Sternberg, C., Dueñas-Gonzalez, A., Sgroi, D., Cuello, M., Fresco, R., Reis, R., Masera, G., Gabús, R., Ribeiro, R., Knust, R., Ismael, G., Rosenblatt, E., Roth, B., Villa, L., Solares, A., Leon, M., Torres-Vigil, I., Covarrubias-Gomez, A., Hernández, A., Bertolino, M., Schwartsmann, G., Santillana, S., Esteva, F., Fein, L., Mano, M., Gomez, H., Hurlbert, M., Durstine, A., & Azenha, G. (2013). Planning cancer control in Latin America and the Caribbean The Lancet Oncology, 14 (5), 391-436 DOI: 10.1016/S1470-2045(13)70048-2

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