CommentaryGlobal Health

Cancer in global health: How do prevention and early detection strategies relate?

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Science Translational Medicine  11 Mar 2015:
Vol. 7, Issue 278, pp. 278cm1
DOI: 10.1126/scitranslmed.3008853

Tables

  • Table 1. Incidence, prevention potential, screening effectiveness, and mortality-to-incidence ratio differences for the 10 most frequent cancers around the globe.

    Data are from (6). The PAFs were calculated in LMICs when available (9, 24, 27). Screening percentages reflect estimated mortality decline with effective screening based on published screening trial statistics (18, 25, 28, 29). Screening modalities exist for each of the listed cancer subtypes but may not be cost-effective or efficacious in many circumstances. The MIR reflects the effectiveness of current diagnosis and treatment in very high human development regions as defined by the International Agency for Research on Cancer (6, 24). Differences in MIR between HICs and LMICs provide a gross index of potential improvement with investment in early detection and treatment resources. Health policy priority is determined via a comparison of PAF (which could be addressed with maximal prevention investment) versus screening availability with associated mortality reduction versus potential improvements in MIR. These generalized policy recommendations are subject to interpretation and could be altered depending on an individual country’s situation and specific resource constraints.

    Cancer typeRelative incidence in LMICs (%)Prevention potential (PAF) (%)Screening effectiveness (estimated mortality benefit, %)MIR in HICs (%)Difference in MIR between HICs and LMICs (%)Health policy priority
    Breast15.621Yes (20–40)2228Early detection and treatment
    Prostate5.10No* (0–30)1864Treatment
    Lung4.174Unknown (0–20)827Prevention
    Colorectum4.213-15Yes (12–32)4234Early detection and treatment
    Cervix uteri11.795–100Yes (20–70)4219Prevention > early detection
    Stomach3.769No†5638Prevention > treatment
    Liver5.381No*869Prevention
    Corpus uteri1.337No*1920Prevention > treatment
    Ovary2.212No*679Additional research
    Esophagus4.946–58No*8111Prevention

    *Screening for esophageal, uterine, ovarian, and prostate cancers is advised only for high-risk patient cohorts. †Gastric screening may be indicated in countries that have a particularly high gastric cancer burden (for example, in Japan).

    • Table 2. Prevention program types.

      The estimated PAF provides an indirect measure of the potential impact for a given prevention program. HPV, human papilloma virus; HCC, hepatocellular carcinoma.

      EtiologyCarcinogenic risk factor (associated PAF)Overall PAF (%)Risk reduction programsKey multisectoral partnersEstimated cost-effectiveness
      Infectious etiologiesHPV (cervical cancer 90–100%)*
      Hepatitis B and C (HCC 77%)*
      H. pylori (gastric cancer 75%)*
      18VaccinationsHealth care workers
      Pharmaceutical companies
      Legislative bodies
      Very cost-effective
      Behavioral factorsTobacco (30%)†
      Obesity (20%)†
      Diet (5%)†
      Alcohol (4%)†
      66Tobacco cessation
      Exercise programs
      Public education and outreach
      General population (health literacy)
      Legislative bodies
      Health care workers
      Very cost-effective
      Environmental factorsAir pollution
      Aflatoxins
      4Environmental regulationsLegislative bodies
      Business sector
      Potentially cost-effective
      Clinical interventionsChemoprevention (such as tamoxifen, aspirin, celecoxib, or finasteride)
      Surgical procedures (such as prophylactic mastectomy or prophylactic oophorectomy)
      N/AInsurance coverage for correctly selected individuals at elevated riskHealth care workers
      Pharmaceutical companies
      General population
      Cost-effective

      *Percentage reflects PAF for a single cancer type (for example, 90 to 100% of cervical cancer can be avoided with universal vaccination). †Percentage reflects PAF for multiple cancer types (for example, reducing obesity can decrease incidence of up to 20% of cancers).

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