One in five people will possibly be diagnosed with cancer in our lifetime. What determines whether that diagnosis is survivable, per the World Health Organization (WHO)’s new Global Status Report on Cancer released this week, is geography and income. Five-year survival exceeds 85% in high-income countries and falls below 30% in low-income ones. The clearest evidence of the divide comes from new WHO estimates for breast and childhood cancer survival. For breast cancer, five-year survival is 87% in wealthy nations
One in five people will possibly be diagnosed with cancer in our lifetime. What determines whether that diagnosis is survivable, per the World Health Organization (WHO)’s new Global Status Report on Cancer released this week, is geography and income. Five-year survival exceeds 85% in high-income countries and falls below 30% in low-income ones. The clearest evidence of the divide comes from new WHO estimates for breast and childhood cancer survival. For breast cancer, five-year survival is 87% in wealthy nations against 42% in poor ones — a difference not of tumours but of systems.
This is not a knowledge problem. WHO all but admits it: The science exists, the plans exist; the money and the delivery mechanism do not. National cancer control plans exist in 82% of countries, up from half in 2010. But fewer than four in 10 include cancer care in universal health coverage, and only 12 are on track to meet WHO’s 2030 mortality-reduction target; 48 are moving backwards. Essential cancer medicines are stocked in 9% to 54% of low- and lower-middle-income hospitals, against 68% to 94% in wealthy ones. HPV vaccination — the strongest protection against cervical cancer — has been folded into 85% of national immunisation programmes; only 31% of girls have actually received it. In India, a national cancer control programme has been running since 1975 and survival has slowly improved, but the programme is yet to get basics in order. According to the last national health survey, fewer than 2% of women aged 30-49 had ever been screened for cervical cancer, fewer than 1% for breast. What failures such as these translate to is this: At least 45% of patients face financial hardship from a diagnosis; treatment abandonment reaches 90% in some settings. This is not because modern medicine has failed, but because a diagnosis in most of the world still means a choice between treatment and solvency.
Cancer cases are projected to nearly double by 2050. Whether that surge is met or merely counted depends entirely on whether commitment turns into capability. The choice, as WHO frames it, is ours to make.
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