Description of the population: People living in absolute poverty
are defined by the World Bank as living on less than $1.25 per day in developing
countries. In addition to economic indicators, poverty may be defined as lacking
basic human services such as employment opportunities, safe drinking water, and
basic sanitation services and access to food, health, education, and shelter.
Incidence, death, and survival statistics: According to the World
Health Organization, globally, the six leading causes of cancer death are lung
cancer, liver cancer, stomach cancer, colorectal cancer, breast cancer, and
esophagal cancer. According to data from the International Agency for Research on
Cancer, in 2008, approximately two-thirds of cancer deaths occurred in low- and
middle-income countries, where survival rates for cancer are much lower than in
high-income countries, largely due to delays in diagnosis and treatment.
Approximately 20 percent of all malignancies worldwide are caused by infectious
agents such as hepatitis B and hepatitis C viruses (HBV and HCV, which
cause liver cancer), human papillomaviruses (HPV, which
causes cervical cancer), and
Helicobacter pylori
(H. pylori, the bacterial agent that causes stomach cancer)
and are preventable with safe health and behavioral practices. The rates of these
viral infections are higher in low- and middle-income countries than in
high-income countries.
Breast and cervical cancer rates are steady or decreasing in some developed
countries such as the United States, possibly because of early detection, proper
and timely treatment, and vaccination; however, the trend is different in many
developing countries. For example, Pakistan is continuing to see an increase in
cancer prevalence among women. It has the highest prevalence of breast cancer of
any Asian country, accounting for about 25 percent of all malignant tumors among
Pakistani women. Malaysia also experiences high rates of breast cancer, and 50 to
60 percent of breast cancers were diagnosed late, in Stages III and IV,
contributing to low survival rates for breast cancer among Malaysian women.
Cervical cancer, which is preventable through HPV
vaccination, routine screenings, and safe sex practices, is
highly endemic in Central America, Southeast Africa, and India. Approximately 80
percent of all cervical cancer deaths occur in developing countries, where
prevention, detection, and treatment strategies are minimal or absent.
Risk statistics: Socioeconomic status, tobacco use,
poor nutrition or diet, physical inactivity, and prohibitively expensive health
care are major risk factors for cancer globally. Environmental factors, such as
exposure to pollution, also are risk factors.
The main difference between cancer in developing and developed countries is
that developing countries are experiencing cancers largely associated with
behavior and environment (cervical, liver, and stomach); these cancers are more
often detected in early stages and successfully treated in developed countries. In
developed countries, cancers that are preventable through diet and nutrition,
physical activity, and avoiding tobacco use are endemic. For example,
obesity is a leading cause of death in high- to
middle-income countries, and obesity is associated with breast and colon
cancers.
Developing countries often lack a stable health care system to screen for and
treat cancer. If treatment is available, it is often geographically distant or not
affordable except by the affluent members of the society. For example, Pakistan
has numerous medical facilities that diagnose and treat cancer. However, a
majority of Pakistani cancer patients are unable to afford treatment even if the
facilities are in their area. Diagnostics are not typically available to
socioeconomically disadvantaged groups, while higher-income groups benefit greatly
from screening and physical examinations. Poor health education is a contributing
risk factor for cancer.
Cultural barriers: Financial barriers are not the only reason that
people in developing countries do not get cancer screening and treatment. Culture
also plays a major role in preventing the early detection and proper treatment of
cancer. One large cultural barrier that is often noted in many low-income
countries is the role of traditional medicine. Often physicians in developing
countries who were trained in and practice Western medicine incorporate
traditional beliefs into their practices. In India, Pakistan, and Malaysia,
traditional beliefs have been noted to interfere with the timely diagnosis of
cancer. Social stigmas such as the fear that cancer is contagious and that
patients will be abandoned by their spouses and communities also inhibit timely
diagnosis and treatment for cancer in developing countries.
Perspective and prospects: Poverty is the greatest barrier to
early diagnosis and proper treatment for cancer globally. The poor suffer greater
mortality from cancer, particularly in developing countries. Financial and
cultural barriers prevent socioeconomically disadvantaged people from seeking
early diagnosis and treatment for the disease.
Areas to be addressed in solving this problem include improvement of health education, integration of the socioeconomically disadvantaged into health care systems, and the removal of cultural barriers to prevention and timely diagnosis.
Primarily, health education needs to be emphasized. Safe-sex
practices can greatly reduce the incidence of cervical and
liver cancers by lowering the spread of HPV and hepatitis B and C. Better
sanitation may reduce the incidence of H. pylori and reduce
stomach cancers resulting from this bacterial agent. Additionally, the dangers of
tobacco use need to be emphasized to reduce global lung cancer rates. Proper
health education may also help reduce the social stigmas and cultural barriers
attached to cancer and enable more timely diagnosis.
Even if people become educated regarding their health, the medical system needs
to be in place and capable of adequately treating cancer. However, because
developing countries are often dealing with a high prevalence of infectious
diseases, they often give a lower priority to the prevention of chronic diseases.
The vaccination of people in developing countries against HPV and hepatitis B
could help control the increase in the rates of cervical cancer and liver cancer,
respectively.
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