Global Cancer: The Current Reality and the Future Need for Action

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The estimated number of cancer cases worldwide in 2008 was 12.7 million, with 7.6 million deaths. By 2030, it is estimated that there will be 22 million newly diagnosed cancer cases and 12 million deaths, shocking to contemplate in dollars and human suffering. Although this impending disaster has been discussed over the past several years at oncology conferences, the traction needed to address the global cancer burden has been slow.

According to the editors, Kenneth D. Miller, MD, and Miklos Simon, MD, the purpose of their new two-volume book called Global Perspectives on Cancer: Incidence, Care, and Experience is to help improve the state of global cancer. Every addition to that cause is worthwhile, and this book certainly should be read by doctors and policy makers who fathom the global cancer crisis and have the moxie to address it.

Past ASCO President Sandra M. Swain, MD, opens the book with a crisp foreword that identifies the editors’ goals. And they are ambitious. Tackling a book of such vast scope has the potential for disharmony and excess. To the editors’ credit, they have constructed a linear and accessible format that is tailor made for public health professionals as well as oncologists and others in the medical trade who ponder the big picture and want to be informed.

“Cancer is more than just a global health problem but also is the cause of deep suffering for individuals, their families, and communities…. Unfortunately, there are significant disparities in the incidence and mortality rates for all cancers and in the accessibility and availability of cancer care,” write the editors in the introduction. That’s the problem in a nutshell, and over the course of two volumes, comprising about 700 pages, they explicate the issue and lay out a way forward.

Cultural Barriers to Cancer Care

Volume one—essentially an issue-based treatment of global cancer challenges—delves into many of the cultural barriers that thwart the delivery of cancer care, especially in low-income regions. In chapter 3, medical oncologist Antonella Surbone, MD, reviews the cultural attitudes about cancer, which is the right way to begin a book on global health.

That said, unraveling a potpourri of language, customs, religiosity, biases, and socioeconomic disparities presents quite a challenge. Dr. Surbone wisely sections her chapter into three key elements: truth-telling and decision-making, palliative and end-of-life care and survivorship care, and acquisition and practice of cultural competence to overcome cultural differences and address disparities in access to cancer care.

Overcoming roadblocks is essential to deliver palliative and end-of-life care in low-resource regions such as sub-Saharan Africa, where the majority of cancer patients present with advanced disease.

Book One also delivers fine chapters on psychosocial oncology, the oncology nurse, ethics, as well as breast cancer and viable treatment modalities. However, the meat of Book One is its middle section on transmissible agents, human immunodeficiency virus, and cancer. The frontlines of cancer care in middle- to low-income regions begin with knowledge of disease transmission and how to prevent it, a theme woven skillfully throughout the book.

A Readable Format

The editors use a sound strategy of introducing each chapter in this solid section, with first epidemiology and etiology, then running down the pathogenesis, and clinical manifestations through diagnosis and treatment. This book is not a clinical tome; it’s a diagrammatic exposition of the worldwide scourge of cancer, and the editors have smartly constructed a readable format that delivers the salient information needed to understand and address the problem. Their restraint—not easy when dealing with a subject of such magnitude—is one of the strong points of the Global Perspectives on Cancer. Moreover, the modular layout makes it easy to highlight areas of special interest.

One Shortcoming

Book One has only one shortcoming: Chapter 12, “Palliative Care for Oncology Patients in the 21st Century.” This issue drills to the marrow of disparities of care in economically challenged regions of the world. It also is a sociopolitical drama that speaks to the unrelenting suffering of millions of late-stage cancer patients who have little to no access to morphine. The World Health Organization declared access to morphine a human right; Kathy Foley, MD, has publically stated that not providing morphine to cancer patients in severe pain should be classified as torture. The authors of this brief chapter should have given the reader a tad more, both in substance and well-reasoned passion.

Focus on Types of Cancer

Book Two is structured into two parts: Types of Cancer and Cancers by Country or Region. The editors chose to repeat Sandra Swain’s foreword from Book One, but perhaps bringing a new voice in—one from the developing world—might have added a zesty opening for Book Two. That small complaint aside, Book Two is content-rich, covering the spectrum of the global cancer from an historical context, epidemiology, diagnoses, staging, genomic insights, trending outlooks, and much more.

Chapter one, “Head and Neck Cancer,” which focuses on squamous cell carcinoma of the head and neck, opens with some sobering data: Squamous cell carcinoma of the head and neck kills about 273,000 people each year. Tobacco and alcohol are the leading factors in developing squamous cell carcinoma of the head and neck, and the World Health Organization estimates that there are currently 1 billion smokers worldwide, 80% of whom live in low- to middle-income countries.

As the editors have made clear, the oncology community is an international network, and together we need to face the impending crisis of the untenable global cancer burden.

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The follow-up to largely preventable cancers is Chapter 3: “Lung Cancer: Challenges and Progress.” The lead sentence is a grim reminder of what readers of The ASCO Post already know: “Leading both global incidence and mortality rates, lung cancer is the most common form of cancer in the world today and has been since 1985.” The contributors of this chapter give a concise overall picture of the devastation caused by tobacco use and then lay out a four-stage call to action, which is informed by research, public action, and governmental policy. Another take-away is the subtle yet deadly shift in tobacco consumption to the developing world, populations that have the least resources to deal with the scourge of tobacco.

Part one is a thorough examination of 13 cancers, and with each cancer site, the editors address the etiology, treatment options, and (when feasible) screening and prevention strategies. Once again, causal factors from infections to viruses are fully clarified, driving home the vital issue of prevention. The figures, nicely displayed throughout, dramatize the wildly divergent incidence and mortality rates of various cancer sites across the globe. Those interested in epidemiology will appreciate how the editors constructed compact sections of hard data without bogging down their message.

And while reading these cancer-site chapters, it becomes clear just how many lives could be saved by simple prevention methodologies. For instance, cervical cancer, now tamed in the industrialized world by Pap smears and the human papillomavirus vaccine, is a major killer of women in the developing world.

In the gastric cancer section, the editors have included a patient’s story: A 26-year-old woman with a family history of gastric cancer presenting with occasional dysphagia. This glimpse into her family pedigree speaks volumes about the advances we’ve made in separating out the hundreds of types of malignancies and their associated risk factors. However, this case history will leave readers wanting more, but, for some reason, the editors of other chapters chose not to include case histories.

Around-the-World Tour of Cancer

Book Two is an around-the-world tour of cancer and how the disease impacts different population groups. Most of the chapters begin with a public health perspective, a short overview of the country or region’s cancer status. It is deeply disturbing to read about the poor conditions of the health-care infrastructure in much of the developing world. In Book Two, the editors wisely added future directions at the conclusion of most chapters. Even those oncologists who are well versed in global cancer issues will come away with a better understanding of the challenges that lie ahead.

Before putting pen to paper, every author or editor should ask two questions: What is the purpose of the book, and who is the audience? The purpose of Global Perspectives on Cancer is to illuminate the challenges and progress in cancer care across the nations of the world. The audience for this book consists of health-care professionals who want a full understanding of the big picture of cancer.

As the editors have made clear, the oncology community is an international network, and together we need to face the impending crisis of the untenable global cancer burden. This eye-opening book is highly recommended for The ASCO Post readership. ■