Building capacity for cancer control in developing countries: the need for a paradigm shift.

摘要

In 2005, according to WHO, cancer, which is ranked second to cardiovascular diseases for mortality, accounted for 7.6 million of the 58 million deaths worldwide, with 70% of cancer deaths in developing countries. By 2020, demographic changes alone will result in an increase in the global cancer burden by at least 50% compared with 2000. The bulk of this burden will occur in low-income and middle-income countries, where more than 150 million new cases will have arisen in just two decades-the equivalent, in terms of mortality, of an influenza pandemic like that of 1918 occurring every 2-3 years. Yet already, cancer services in low-income and most middle-income countries are overwhelmed. Most patients who reach a facility capable of providing care have advanced disease, an unknown fraction are never diagnosed, and many receive minimum or no treatment, not even palliative care. Primary prevention, through risk-factor control, is very important, but its effect will be limited to particular cancers and, however successful, benefits will accrue too late to have a substantial effect on the anticipated cancer deaths in the next 15-20 years. Earlier detection of cancer through education programmes and screening for selected cancers would be of more immediate value, but national mortality will only be reduced if high population coverage is achieved and there is a link to effective treatment. Ensuring that patients with cancer are promptly and appropriately treated will need teams of well-trained doctors, nurses, and other health professionals who have access to required resources and who use treatment plans based on relevant evidence.