He and some 70 colleagues coauthored the report that found that although the cancer incidence in Latin America is estimated to be 163 cases per 100,000 people, which is substantially lower than in the United States and Europe, the mortality rate in Latin America (13 deaths for every 22 cases) is nearly double that in the U.S. (13 deaths for every 37 cases) and Europe (13 deaths for every 30 cases).
The reasons for the high mortality are similar to those of other areas of the world that have been more focused on dealing with infectious diseases than with non-communicable diseases such as cancer.
But as deaths from infectious diseases decline, more people are living longer and are at greater risk for cancer. And with about 320 million people—constituting nearly half of Latin America's population—with inadequate or no health insurance, access to care for the poor, rural, and indigenous communities has meant that more people are being diagnosed with cancer at later, less treatable stages.
Goss and his colleagues noted that cancer control in the region should focus on:
- Health inequities;
- Rethinking health infrastructure and access to drugs and medical devices;
- Increasing government spending on health;
- Encouraging people to adopt healthier lifestyles including reducing risk factors such as smoking, indoor pollution from burning solid fuel, obesity, and alcohol consumption.
They also noted that it is more expensive to admit patients with advanced cancer for end-of-life treatment in hospitals and that shifting to effective palliative care programs will help “free resources for investment in prevention strategies.”
Other recommendations included improving medical education, increasing the number of cancer specialists, and stemming the “brain drain” of cancer professionals leaving the region.
Goss said that he sees cancer control as dealing with both discovery and delivery, and that there is a big difference between doing nothing and doing something.
He said that Latin America offers an opportunity to make a difference through collaboration among its many nations sharing common cultures and languages—Spanish and Portuguese—and, although it is lagging behind some more developed nations, the region does have a health infrastructure, and many individual nations have successful cancer control programs that can serve as models for the others.
“I was invited by The Lancet Oncology to start this commission at Harvard Medical School in 2012 and we kept adding experts from Latin America. This is a unique report because it is so comprehensive and has a unified platform for data,” he said, adding that tiny changes in national policies can have significant impact in large populations, and that his group would continue its work.
This commission, he noted, follows one established by Lancet Oncology a few years ago to look at delivering affordable cancer care in high-income countries (2011;12:933-980), which was the first commission to be created since the one that addressed London's sewerage system in 1864.© 2013 Lippincott Williams & Wilkins, Inc.
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