and to take appropriate and feasible next steps in cancer control. Steps taken now—particularly in prevention—will be rewarded by curbing the growth in cancer rates. Steps taken toward establishing effective cancer diagnosis and treatment (i.e., cancer management), even if modest, can act as a nucleus from which development can grow.

“Low- and middle-income countries” include a wide range of nations vastly different in available resources, in rates of economic growth, in political and social conditions, and in the history and current status of health care services and infrastructure. They range from the low-income countries (defined by the World Bank as having a per capita gross national income—GNI—of less than $825 in 2004) where cancer control activity is minimal or nonexistent, to the upper middle-income countries (defined as having a GNI per capita of $3,256–$10,065) where most of the population may have access to at least some cancer services (Figure S-1).

This report does not suggest a single prescription for these diverse countries, nor does it envision “comprehensive” cancer control being possible without significant improvements in health care systems. Rather, it recognizes certain global priorities and approaches that are feasible at low resource levels, in the context of national cancer control planning. However, without assistance from the broader global health community—the same span of public- and private-sector agencies and organizations involved in traditional developing country health issues such as infant mortality, child and maternal health, tropical infectious diseases, and HIV/AIDS—it is unlikely that countries will be able to make substantial progress in cancer control. Thus, the recommendations in this report are aimed equally at LMCs and the global health and international development communities.

CANCER IN LOW- AND MIDDLE-INCOME COUNTRIES

Cancer is common everywhere. However, the mix of cancers that occurs varies around the world, driven largely by environment, geography, and standard of living. Cancer is also regarded differently in different settings: as a preventable and often curable disease in high-income countries; but as a painful death sentence in many LMCs.

The rise in cigarette smoking has made lung cancer the most common cancer, and cause of death from cancer in LMCs, just as it is in high-income countries in men and overall. Breast cancer is the most common cancer in women in both LMCs and high-income countries. Among men in LMCs, cancers of the stomach and liver are next most common and among women, cancers of the cervix and stomach.

Most cases of stomach and liver cancers, and nearly all cases of cervical cancer are caused by infectious agents: the bacterium Helicobacter pylori, hepatitis B and C viruses, and human papillomaviruses, respectively. In



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