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Cancer Control Opportunities in Low- and Middle-Income Countries
(HPV) vaccine to prevent infection with the viral agents that cause cervical cancer
Expansion of global capacity to treat the highly curable cancers of children and young adults
HBV vaccines have been available for 20 years and are now inexpensive, but still not being used in areas with some of the highest liver cancer rates. The reasons are detailed in the first section of this chapter. This is the most straightforward and obvious cancer control intervention that requires added support from the global community. One vaccine for HPV just entered the market in 2006 and another is soon to follow. A global consortium has given this intervention high visibility, and it, too, deserves continued support toward implementation. In the meantime, advances in understanding the natural history of cervical cancer have led to approaches to screen for and treat precancerous changes in adult women who will not benefit from vaccines. These approaches have proven feasible in some low- and middle-income countries (LMCs), and should be expanded. The final opportunity is to expand the availability of treatment for highly curable cancers of children and young adults. The number of children with cancer is small, but the lives saved can be long and productive. Of all the interventions described, treating children with cancer will give immediate positive results, demonstrating the curability of cancer.
REDOUBLED EFFORTS TO INCREASE THE UPTAKEOF HEPATITIS B VACCINATION
Liver cancer—hepatocellular carcinoma (HCC)—is the cause of more than 500,000 deaths each year worldwide, making it the third most frequent cause of cancer deaths in LMCs. It is currently the most preventable cancer caused by an infectious agent, chronic infection with HBV. Chronic HBV also causes significant numbers of deaths from liver cirrhosis and liver failure (Lavanchy, 2004), and an estimated 40,000 worldwide die from acute hepatitis infection (Goldstein et al., 2005). The prevalence of HBV varies widely among regions. About 45 percent of the world’s population lives where HBV prevalence is high, with the highest endemicity being in Asia, sub-Saharan Africa, and the Pacific. Other areas where infection rates are high include the southern parts of Eastern and Central Europe, the Amazon basin, the Middle East, and the Indian subcontinent. About 350 million chronic carriers are alive today, of whom 15 to 40 percent will die as a result of HBV, many in middle age. HBV is the 10th leading cause of death worldwide, and HCC is the 5th leading cause of cancer deaths, of which about 80 percent occur in developing countries (Lavanchy, 2004).