Innovation and inclusive healthcare are the dual pillars of modern cancer control

In the past two decades, the rate of newly diagnosed cases of cancer in the United States has dropped by 10%. The rate of mortality has dropped by more than 25%. In fact, since 2015, the number of deaths because of cancer has decreased every year by about 2.1%.

Technological advancements have been pivotal to this success.

Ever higher-performing imaging machines and routine screening programs have enabled oncologists to detect cancers at increasingly early stages, or even pre-cancerous conditions, when they are easier to treat successfully and less invasively.

Targeted radiotherapy, improved surgical tools and protocols, immunotherapy, new chemotherapy medicines, as well as affordable biosimilars and generic medicines, have made interventions and treatments more effective with fewer side effects.

Innovations in the area of in vitro diagnostics for early detection also have been game-changers.

These diagnostic tests have not only facilitated early interventions for cancers such as breast and colon, improving survival rates, but have also contributed to the burgeoning field of personalized medicine. This targeted approach to treatment maximizes efficacy while minimizing side effects, creating a more patient-centric healthcare model.

EARLY DETECTION

And looking ahead, the promise of diagnosis assisted by artificial intelligence mRNA-based therapeutic vaccines and multi-cancer early detection — the ability to detect at an early stage several cancers with a single blood test — raise the prospect that we may one day manage cancer the way we manage high blood pressure, as a possibly chronic but non-fatal condition that does not impact our quality of lives too adversely.

In terms of prevention, a better understanding of the risk factors has led governments to take action to reduce tobacco use and exposure to air pollution, warning citizens against the dangers of alcohol consumption and unhealthy foods, and encouraging them to lead more active lifestyles.

Vaccination against the human papillomavirus (HPV), where widely implemented, has cut cervical cancer cases by nearly 90%.

There is, however, much work still to be done. In the United States, there were an estimated 1.9 million newly diagnosed cases of cancer and more than 600,000 people who died of the disease in 2022.

And while cancer is a disease that can affect anyone, it doesn’t affect everyone equally.

There are fewer cases of breast cancer in Black women, for instance; however, they are 40% more likely to die from this disease than non-Hispanic white women. And, overall, breast cancer accounts for nearly a quarter of all cancer deaths in the United States, though survival rates can be higher than 90% when it is detected and treated early.

The same applies to other common cancers such as colorectal, cervical and prostate cancers. However, many barriers prevent a person from accessing reliable information about cancer and effective prevention, treatment, and supportive care services.

These include inadequate insurance coverage, low pay, lack of paid leave from work for medical care, discrimination and assumptions based on age, ethnicity, gender, sexual orientation or disability.

Low-quality education, lack of access to healthy and affordable foods, lack of accessible, affordable and reliable transportation, and a lack of safe, stable and affordable housing are further examples of barriers to care that create significant disparities in how people are treated and may survive the same disease, as well as their quality of life.

Policymakers need to work toward greater universal health coverage, focusing on closing insurance gaps for all populations. There should be more qualified health centers accessible to those living far from urban centers, as well as tailored screening guidelines to account for higher risks among different ethnic groups.

PUT PATIENTS FIRST

Health policies and care should be centered on the patient, as each individual has a different medical history, different health situation and different needs and objectives.

Equally vital is investing in social determinants such as clean water and air, education and affordable housing.

Clinical trials need diverse participation to avoid skewed data that can widen disparities further. Collaboration between the private sector, non-profits and government bodies can improve access to quality care.

Technology also holds the potential to democratize healthcare access. For example, telementoring programs, such as Project ECHO (Extension for Community

Healthcare Outcomes), build workforce capacity in areas that lack oncologists and other cancer-care providers.

However, technology can also exacerbate existing inequities. Innovations should be accessible across all communities, emphasizing low-cost solutions, such as mobile health — but careful planning is needed to ensure implementation is inclusive.

New digital technologies such as telehealth, mobile apps, electronic medical records, and mobile screening tools require access to broadband internet, appropriate devices (smartphones, computers, etc.), along with basic digital literacy skills to use the devices.

An intentional, intersectional approach, recognizing people’s complex identities, is necessary to offer everyone a fair and just opportunity for better health outcomes.

Gilberto Lopes is a medical oncologist and division chief at the Sylvester Comprehensive Cancer Center, University of

Miami. He holds key roles in international cancer organizations, including the Union International for Cancer Control board of directors.