Latin America is facing an alarming increase in cancer rates, and unless urgent action is taken to prevent cancers, improve health-care systems and facilities, access to vital medical care, and treatment of poor people, the region threatens to be overwhelmed by the burgeoning epidemic, say the authors of a major new report on cancer control in the region, published in The Lancet Oncology, and launched at the Latin American Cooperative Oncology Group (LACOG) 2013 conference in São Paulo, Brazil.
The overall incidence of cancer in Latin America is estimated to be 163 cases per 100 000 people, a substantially lower rate than in the USA or Europe. However, the proportion of people who die from cancer in Latin America is almost twice that in the USA, with around 13 deaths for every 22 cases of cancer in Latin America, compared to around 13 deaths for every 37 cases of cancer the US, and approximately 13 deaths for every 30 cases of cancer in Europe.
Researchers estimate that by 2030, 1.7 million cases of cancer will be diagnosed in Latin America and the Caribbean, with more than 1 million deaths from cancer predicted to occur annually. The total cost of cancer to Latin American countries – including not just the cost of treatment and medicine, but the cost to businesses and the economy of lives prematurely cut short by cancer – currently stands at around US$4 billion per year, and these costs will rise substantially if governments do not take co-ordinated action now to arrest the growing impact of cancer in the region.
The authors state that the main reason why the mortality burden of cancer in Latin America is so much greater than in other regions is because too many people are not diagnosed with cancer until the disease is at a late stage, when it is consequently much harder to treat and more likely to kill. Furthermore, many people across the region – especially those in poor, rural, or indigenous communities – have little or no access to cancer services, a problem exacerbated by low, and highly inequitable, health investment in most Latin American countries. Over half (320 million people) of the population in Latin America have inadequate or no health insurance, and the authors say that this situation will have to change if the region is to avoid devastating loss of human life in future years.
Paul Goss, Professor of medicine at Harvard Medical School, in Boston, MA, USA, and a well-known international cancer researcher, led a group of cancer experts, predominantly from Latin America, to produce the report. According to Professor Goss, "Latin American countries have focused their health investment on prevention and treatment of infectious diseases, whereas spending on non-communicable diseases, such as cancer, has not kept pace. However, cancers are diseases of ageing people, and researchers estimate that by 2020 more than 100 million people in Latin America will be over 60 years of age. More widespread adoption of lifestyles similar to those in developed countries will lead to a rapidly growing number of patients with cancer, a cost burden for which Latin American countries are not prepared."
While acknowledging that many countries in Latin America have been successful in improving some aspects of cancer care in recent years, the authors identify a number of key issues which will need to be addressed across the region if cancer is to be controlled in the coming decades. These include addressing health inequities, rethinking health infrastructure and access to drugs and medical devices, and increasing levels of governmental spending on health.
Furthermore, efforts across the region to improve primary prevention – encouraging people to adopt healthier lifestyles to reduce their risk of cancer – will need to be intensified. The leading risk factors for cancer in Latin America are smoking, house smoke (ie, indoor air pollution, typically from burning solid fuel), obesity, and alcohol and the authors point out that governments can make a real impact on cancer rates, at relatively low cost, by implementing public health programmes and other measures to encourage people to give up smoking, avoid cooking smoke, reduce their alcohol intake, and adopt healthy diets and exercise. Reacting to patients with advanced cancer, most countries admit patients to hospital for their end-of-life care. This is costly and increasingly unaffordable and shifting to effective palliative care programmes will free resources for investment in prevention strategies.
Medical education also needs to be improved. Not only are an insufficient number of cancer specialists being trained in Latin America, but training for different specialty areas of cancer medicine – for example, palliative care, and children's cancer – is under-resourced and inadequate in many countries. Added to this, a number of Latin American countries are experiencing so-called "brain-drain", whereby trained doctors and nurses leave the continent to seek opportunities abroad.
"Cancer control in Latin America has arisen in a piece-meal, largely reactive manner to serve educated and wealthy urban constituents, whereas poorer populations have been neglected. Countries of Latin America are currently overwhelmed by the challenge of cancer control, and now this burden is poised to increase substantially," says Professor Goss. He adds that, "Failure to act promptly will have dire human and economic consequences. This burgeoning cancer problem threatens to cause widespread suffering and economic peril to the countries of Latin America. The region is poorly equipped to deal with the alarming rise in cancer incidence and disproportionately high mortality rates compared with other world regions, underscoring the magnitude of the cancer-control problem."