The Breast Health Global Initiative contributes to The National Academies Institute of Medicine Publication Cancer Control Opportunities in Low- and Middle-Income Countries

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More Resources Needed to Curb Cancer Burden in Low- and Middle-Income Countries; Groups in U.S. and Other Countries Should Partner with Cancer Centers in These Nations

Every year, roughly 4 million people in low- and middle-income countries die from cancer – 1 million more than die from AIDS in these nations – yet this health burden is largely unrecognized and unaddressed. These countries, along with the global health and development community, should direct resources to expanding the capacity to prevent and manage cancer, both to curb its growing toll and to provide better care for those affected, says a new report from The Institute of Medicine, Cancer Control Opportunities in Low- and Middle-Income Countries. BHGI Chair and Director, Benjamin O. Anderson, MD, contributed to a chapter in this report on "Defining Resource-Level Appropriate Cancer Control."

This chapter draws heavily on the experience of the Breast Health Global Initiative (BHGI), described in the report as a first-of-its-kind international collaboration that has developed resource-level specific guidelines for breast cancer and that, at press time remained the only available model. The BHGI Guidelines for aspects of breast cancer from early detection through palliation lay out the best care that can be given at four levels of resources, defined as "basic," "limited," "enhanced," and "maximal." A separate set of guidelines was developed for health care systems and public policy. The BHGI history, process, and results model an approach that could be used as the basis for work by other groups on other cancer types.

Cancer is generally low on or absent from the health agenda of the world's low- and middle-income countries, which range from the poorest nations in Africa and Southeast Asia to countries such as Brazil and India that have growing middle and upper classes. The report acknowledges that significant resources must be directed to basic public health problems in these nations, such as infectious diseases and malnutrition, but notes that cancer is growing as a share of these countries' overall disease burden.

Though the IOM report is not intended to be a "how-to" manual, it does identify a series of feasible and affordable next steps that these countries can take to lessen cancer's toll. For countries with minimally developed cancer control programs, this could mean establishing programs to reduce smoking and providing palliative care for those dying from cancer, for example. Where few or no cancer management services exist, a core of cancer expertise and limited cancer management services could be developed, to be expanded as resources permit, the report says. Where services are already available but resources are stretched or inadequate, the emphasis first should be on ensuring that the most appropriate and cost-effective measures are provided in well-equipped medical institutions and that treatments with little chance of success are discouraged.

Without assistance from the global health and development community, however, low- and middle-income countries will find it difficult to make substantial progress in controlling cancer, the report says. The report calls for the global health community to raise the priority level of cancer. Public- and private-sector organizations should provide information and policy guidance on cancer control and help fund cancer-control projects in low- and middle-income nations. Partnerships between cancer centers in these nations and established medical institutions in the United States and other countries offer a way to exchange information, provide training, and engage in other activities to help new and developing cancer centers improve, the report says. The international oncology community also should help develop cancer advocacy in the target countries.

The report was sponsored by the National Cancer Institute and the American Cancer Society. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.

Copies of Cancer Control Opportunities in Low- and Middle-Income Countries are available from the National Academies Press; tel. (202) 334-3313 or 1-(800) 624-6242 or on the Internet at www.nap.edu.