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Princess Margaret Summer Rounds Series, Princess Margaret Hospital, Toronto Felicia Marie Knaul, PhD
Harvard Global Equity Initiative, Global Task Force on Expanded Access to Cancer Care and Control in LMICs Mexican Health Foundation Tmatelo a Pecho
From anecdote
to evidence
Juanita:
Advanced metastatic breast cancer is the result of a series of missed opportunities
From anecdote
to evidence
I: Much should be done II: Much could be done III: Much can be and is being done
Applies a diagonal approach to avoid the false dilemmas between disease silos -CD/NCD- that continue to plague global health
Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries
GTF.CCC
Members
C) Can be done
Myth 4: Impossible
19%
20%
0%
LMICs
High income
-31%
Facets
Men Women
% of population
40
Both sexes
20
Lower Upper High Low middle middle income Age-standardized prevalence of risk factor in adults aged 15+ years
Children
Leukaemia
All cancers LOW INCOME HIGH INCOME LOW INCOME HIGH INCOME
In Canada, almost 90% of children with leukemia survive. In the poorest countries only 10%.
Cancer especially in Stigma: women and children - adds a layer of discrimination onto ethnicity, poverty, and gender.
C) Can be done
Myth 4: Impossible
Women and mothers in LMICs face many risks through the life cycle Women 15-59, annual deaths
- 35% in 30 years
Mortality in childbirth Breast cancer Cervical cancer Diabetes
342,900
166,577
142,744
120,889
A Diagonal Strategy:
Delivery: Harness platforms by integrating breast and cervical cancer prevention, screening and survivorship care into MCH, SRH, HIV/AIDS, social welfare and antipoverty programs.
and Qiagen
C) Can be done
Myth 4: Impossible
Almost 80% of the DALYs lost worldwide to cancer are in LMICs, yet these countries have only a very small share of global resources for cancer ~ 5% or less.
1/3-1/2 of cancer deaths are avoidable: 2.4-3.7 million deaths - 80% in LIMCs
The costs to close the cancer divide may be less than many fear:
All but 3 of 29 LMIC priority cancer chemo and hormonal agents are off-patent: many < $100 / course Cost of drug treatment: cervical cancer + HL + ALL(kids) in LMICs / year of incident cases: $US 280 m Pain medication is cheap Prices drop: HPV 2011, $100/ to GAVI $5 & PAHO $14 Market potential is underutilized and undeveloped: purchasing is fragmented and procurement is unstable Delivery innovations are unexploited including health technology policy
Outcomes in MDR-TB patients in Lima, Peru receiving at least four months of therapy
Failed therapy Abandon 8%
therapy 2%
Died 8%
Cured 83%
Champions
Drew G. Faust
President of Harvard University 22+ year BC survivor
Embryonal Rhabdomyosarcoma
0
1965 1975 1985
1955
1995
2008
Source: Knaul et al., 2008. Reproductive Health Matters, and updated by Knaul, Arreola-Ornelas and Mndez based on WHO data, WHOSIS (1955-1978), and Ministry of Health in Mexico (1979-2006)
Mexico, Colombia, Dominican Republic, Peru China, India, Taiwan Rwanda, Kenya
Rich
~100%
89%
9%
1.5
5.1 millones
9.1 millones
146 113
2004
2005
2006
2007
2008
2009
2010
2012
2004
2005
2006
2007
2008
2009
2010
2011
2011
2012
Juanita:
Advanced metastatic breast cancer is the result of a series of missed opportunities
Be an optimist optimalist
Expanding access to cancer care and control in LMICs: Should, Could, and Can be done