Cancer in developing countries

4 February was World Cancer Day, and to mark the occasion, the American Cancer Society (ACS) released a report titled ‘Global Cancer Facts and Figures’. The report noted that changing lifestyles linked to economic growth in developing countries are driving up the global incidence of several cancers. The WHO estimates that 84 million people will die of cancer between 2005 and 2015 without intervention, and there is an increasingly larger incidence of reported cancers in developing countries. Estimates vary: according to a recent article in the Lancet, in 1970, approximately 15% of newly reported cancers were in developing countries, increasing to 56% in 2008, and is estimated to rise to 70% by 2030; while Dr Margaret Chan, Director-General of the WHO has stated that around 70% of cancer deaths occur in developing countries.

Despite the discrepancies amongst estimates, the general prediction is that the cancer incidence is on the rise in developing countries. However, such a trend may not be detrimental to the health of populations in developing regions. As noted in the ACS report, the shift in the global burden of cancer from economically developed countries to economically developing countries is ‘simply due to the growth and aging of the population, as well as reductions in childhood mortality and deaths from infectious diseases in developing countries’. Economic development is imperative to improving health as it is a foundation stone in countering curable infectious diseases such as cholera and malaria through the improvement of basic infrastructure, hygiene and sanitation. The predicted increase in cancer deaths may arguably reflect the epidemiological transition countries experience as they develop into advanced economies where ‘degenerative and man-made diseases displace pandemics of infection as the primary causes of morbidity and mortality’. Populations with increasing life expectancies and lower mortality from infectious diseases would necessarily mean that people would be dying from other ailments, and such a shift is reflected in the increasing incidence of cancer and other chronic diseases.

On the other hand, the ACS report also argued that economic growth could be detrimental to health and could worsen the burden of cancer due to the  ‘adoption of unhealthy lifestyles and behaviors related to economic development, such as smoking, poor diet, and physical inactivity’. Inasmuch as economic development may bring about such lifestyles, the key word here is ‘adoption’. It reflects an active choice in which people have the option of assuming such routines in their everyday lives. However, without economic development and the accompanying infrastructure, adequate sanitation and medical services, many people in developing regions have little say in the matter, subject to the vicissitudes of life and prone to contracting fatal yet easily curable infectious diseases.

Cancer is an increasingly important health priority, but the growing incidence in developing countries may not necessarily be negative. However, it is vital for governments, international organisations and NGOs to address the underlying factors of disparities in cancer survival rates between developing and developed countries, which reflect varied access to health services and differences in the strengths of health systems.