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We must do more to prevent deaths from breast and cervical cancer: Dr. Ophira Ginsburg

December 2016

Efforts to reduce preventable deaths from women’s cancers in low- and middle-income countries are inadequate, say scientists in a series of papers published in the Lancet.

Two thirds of breast cancer deaths and 9 out of 10 deaths from cervical cancer occur in low- and middle income countries. There are effective options to improve screening and treatment for these cancers, but often they are not available in the countries that need them most, the authors write.

Dr. Ophira Ginsburg
Dr. Ophira Ginsburg

Dr. Ophira Ginsburg, a scientist at Women’s College Hospital and medical officer at the World Health Organization (WHO), led the commissioned series. “There is a widespread misconception that breast and cervical cancers are too difficult and expensive to prevent and treat, particularly in resource-poor countries where the burden of these diseases is highest. But nothing could be further from the truth,” Dr. Ginsburg says. She adds that countries could introduce a cancer control program for as little as $1.72 per person.

Cervical cancer, for example, is almost entirely preventable with programs that vaccinate girls against human papillomavirus (HPV) and screen for pre-cancers. Vaccination and screening are cost-effective and they do not require oncologists or specialized health centres.

Estimates suggest that universal HPV vaccination of all 12-year-old girls using existing national immunization or child health programs could prevent 690,000 cases and 420,000 deaths worldwide over their lifetime. Most of these prevented cases would be in low- and middle-income countries. Visual inspection with acetic acid to screen for cervical cancer is another promising approach.

While mammography and late treatment of breast cancer are likely unaffordable, clinical breast examination screening and breast awareness campaigns are likely to be cost-effective in diagnosing early stage breast cancer, which could help promote early treatment.

Unless the international community takes action, the number of women diagnosed with breast cancer worldwide could almost double from 1.7 million to 3.2 million by 2030, according to new estimates published in the series. The authors predict the number of cervical cancer cases will rise by at least 25 per cent by 2030, to more than 700,000.

Low- and middle-income countries receive only 5 per cent of global funding for cancer, which exacerbates the issue. The authors call for political commitment, financial investment and a focus on health systems. They also call for greater efforts to reduce poverty, elevate the status of women, and address social and cultural attitudes that prevent many women from accessing screening and seeking out care early enough. Support in all of these areas is essential to achieve the goal of immunizing 70 per cent of girls between 9 and 13 years old against HPV and giving all women with breast cancer access to early diagnosis and treatment.

The Lancet series launched at the 2016 World Cancer Congress in Paris on November 2. The congress has a special focus on women and health.

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