Equalizing the global fight against cancer
Informing someone that he or she has cancer is indescribably difficult. It is all the more heart-wrenching when we know that their disease possibly could have been detected and treated earlier, thus increasing their survival chances, or even prevented entirely.
Ten million people died prematurely from cancer in 2020. Half of those deaths could have been prevented by greater awareness of risk factors and early warning signs, earlier consultations, and easier and more timely access to health services and high-performance testing equipment. Moving swiftly toward universal health coverage can help to achieve this goal.
There are several reasons why we are not all equal before cancer. The “social determinants of health” — such as where we are born and grow up, where we currently live and work, and our income level — influence our perceptions and understanding of cancer and the risks that contribute to its development.
Crucially, these factors also help to determine the quality of care we can access, which depends on the robustness of our local health system, the number of available health facilities or specialized doctors, the ease of traveling to a facility and staying for care, and the cost of the care itself.
A range of personal, social, cultural and religious influences also play a role. Stigma and discrimination related to age, sexual orientation and/or ethnicity, for example, create real barriers that prevent people from receiving the level of healthcare they need.
Extending health coverage to everyone can help to overcome socioeconomic inequities in healthcare access, thereby preventing millions of cancer-related deaths. At the same time, resource-efficient measures that all countries can take to reduce the cancer burden — developed and implemented through national cancer control planning — can facilitate the move to universal health coverage. In this sense, cancer control and universal health coverage go hand in hand.
For example, most people do not think of cancers as being preventable through vaccination, because they are non-communicable diseases that arise due to changes or mutations in the body’s cells rather than from transmissible pathogens. But 70 percent of cervical cancer cases are caused by the human papillomavirus (HPV), which is contagious through sexual contact and can be contained, if not eliminated, through vaccination.
Furthermore, the earlier cervical cancer is detected, the higher the survival rate. The international community has thus committed to vaccinating 90 percent of girls aged 9 to 15 against HPV by 2030, and to screening 70 percent of women between the ages of 35 and 45 for cervical cancer. Achieving these targets would save millions of lives over the coming decades.
HPV is also responsible for causing several other genital cancers, as well as for the dramatic rise in oropharyngeal cancers (affecting the tonsils and the base of the tongue) in the West over the last decade.
Early detection is also vital to treating other cancers. The five-year survival rate for breast cancer can be above 90 percent in well-resourced countries such as the United States, where women have greater access to health information and services. But in countries where cancers are often detected later and are thus harder to treat, the five-year survival rates are much lower — 66 percent in India and 40 percent in South Africa, for example. Effective implementation of recommended screenings for prostate, colorectal and lung cancers, where early diagnosis can significantly increase survival rates, would save even more lives.
We have the technology to control cancer more effectively, but we must reach all populations everywhere. That means ensuring that everyone can receive an HPV vaccine, access screening programs, and benefit from essential cancer services such as early diagnosis, targeted treatment and palliative care.
Universal health coverage not only saves lives and upholds people’s fundamental right to health and human dignity, but also contributes to social political stability and yields valuable economic benefits. After all, the healthier a population is overall, the more resilient and productive it tends to be.
For example, in my home country, India, a majority of the population lacks health insurance. The federal government’s National Health Protection Scheme is a welcome first step toward making health services more accessible and affordable, particularly for the poor and in rural areas where such services are most needed.
The economic burden of moving toward universal health coverage and ensuring better health for all is not as heavy as might be expected. According to the World Health Organization, eliminating cervical cancer would cost an average of $0.40 per person per year in low-income settings, and $0.20 per person per year in lowermiddle-income countries. This pales in comparison with the human, social and economic costs of allowing people to die from a preventable disease.
The COVID-19 pandemic has highlighted the need for stronger health systems and universal health coverage in order to prevent further avoidable deaths. Taking the same approach to controlling cancer can help ensure that 5 million people a year do not die prematurely — and that no doctor needs to tell another cancer patient that their illness could have been prevented.