Cancer Care in Low-Resource Areas
CANCER PREVENTION AND
EARLY DETECTION
WORKSHOP SUMMARY
Erin Balogh, Margie Patlak, and Sharyl J. Nass, Rapporteurs
National Cancer Policy Forum
Board on Health Care Services
Institute of Medicine
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This project was supported by Contract No. HHSN261200900003C and Contract No. HHSN2632012000741 (Task Order No. HHSN26300052) between the National Academy of Sciences and the Centers for Disease Control and Prevention and the National Cancer Institute/National Institutes of Health, respectively, and by the American Association for Cancer Research, American Cancer Society, American Society for Radiation Oncology, American Society of Clinical Oncology, American Society of Hematology, Association of American Cancer Institutes, AstraZeneca, Bristol-Myers Squibb, Cancer Support Community, CEO Roundtable on Cancer, EMD Serono, Helsinn Healthcare SA, LIVESTRONG Foundation, National Comprehensive Cancer Network, Novartis Oncology, Oncology Nursing Society, and Pfizer Inc. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-39101-6
International Standard Book Number-10: 0-309-39101-6
Digital Object Identifier: 10.17226/21892
Additional copies of this workshop summary are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.
Copyright 2016 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2016. Cancer control in low-resource areas: Cancer prevention and early detection: Workshop summary. Washington, DC: The National Academies Press. doi: 10.17226/21892.
The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Ralph J. Cicerone is president.
The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president.
The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.
The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.
Learn more about the National Academies of Sciences, Engineering, and Medicine at www.national-academies.org.
This page intentionally left blank.
WORKSHOP PLANNING COMMITTEE1
GRETA MASSETTI (Co-Chair), Associate Director for Science, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention
KATHLEEN SCHEMELER (Co-Chair), Associate Professor, Department of Gynecologic Oncology, University of Texas MD Anderson Cancer Center
LUCILE ADAMS-CAMPBELL, Professor of Oncology, Associate Director for Minority Health and Health Disparities Research, Georgetown University Lombardi Cancer Center
AFSAN BHADELIA, Visiting Scientist, Department of Global Health and Population, Harvard School of Public Health
DEJANA BRAITHWAITE, Associate Professor in Residence, Department of Epidemiology & Biostatistics, University of California, San Francisco, School of Medicine
WENDY DEMARK-WAHNEFRIED, Professor and Webb Endowed Chair of Nutrition Sciences, Associate Director, Cancer Prevention and Control, University of Alabama at Birmingham Comprehensive Cancer Center
LORI HOFFMAN HŌGG, Veterans Health Administration National Oncology Clinical Advisor, Department of Veterans Affairs, Cancer Program Director, Albany Stratton Veterans Affairs Medical Center
SAMIR KHLEIF, Director, Georgia Cancer Center at Augusta University
FELICIA KNAUL, Professor, Department of Public Health Sciences, University of Miami; Senior Economist, Mexican Health Foundation; Founding President, Tomatelo a Pecho, A.C.; Honorary Research Professor of Medical Sciences, National Institute of Public Health, Mexico
DANIEL MASYS, Affiliate Professor, Biomedical and Health Informatics, Department of Medical Education and Biomedical Informatics, University of Washington School of Medicine
TASHA MOSES, Vice President, Strategic Management Services, LLC
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.
HEATHER WHITE, Technical Adviser, Noncommunicable Diseases, Sexual, Reproductive Health and Tuberculosis Department, Population Services International
Project Staff
SHARYL J. NASS, Director, National Cancer Policy Forum
ERIN BALOGH, Senior Program Officer
PATRICK ROSS, Research Assistant
CYNDI TRANG, Senior Program Assistant
NATIONAL CANCER POLICY FORUM1
MICHAEL CALIGIURI (Chair), Chief Executive Officer, James Cancer Hospital and Solove Research Institute; Director, Ohio State University Comprehensive Cancer Center
PATRICIA A. GANZ (Vice Chair), Distinguished Professor, University of California, Los Angeles, Fielding School of Public Health; Director, Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center
AMY P. ABERNETHY, Chief Medical Officer and Senior Vice President for Oncology, Flatiron Health; Professor, Division of Medical Oncology, Duke University School of Medicine; Director, Center for Learning Health Care, Duke Clinical Research Institute
LUCILE ADAMS-CAMPBELL, Professor of Oncology, Associate Director for Minority Health and Health Disparities Research, Georgetown University Lombardi Cancer Center
KENNETH ANDERSON, Kraft Family Professor of Medicine, American Cancer Society Clinical Research Director, Jerome Lipper Multiple Myeloma Center, Harvard Medical School, Dana-Farber Cancer Institute
MONICA BERTAGNOLLI, Richard and Wilson, MD Professor of Surgery, Harvard University Medical School; Associate Surgeon, Dana-Farber Cancer Institute; Alliance for Clinical Trials in Oncology, Brigham and Women’s Hospital
OTIS BRAWLEY, Chief Medical Officer, American Cancer Society
CARLTON BROWN, Director of Professional Services, Oregon Nurses Association
ROBERT W. CARLSON, Chief Executive Officer, National Comprehensive Cancer Network
GREGORY CURT, Executive Director, External Scientific and Clinical Relations, U.S. Medical Affairs, AstraZeneca
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.
WILLIAM S. DALTON, Chief Executive Officer, M2Gen Personalized Medicine Institute, H. Lee Moffitt Cancer Center; Chair, American Association for Cancer Research Science Policy & Legislative Affairs Committee
WENDY DEMARK-WAHNEFRIED, Professor and Webb Endowed Chair of Nutrition Sciences, Associate Director for Cancer Prevention and Control, University of Alabama at Birmingham Comprehensive Cancer Center
JAMES DOROSHOW, Deputy Director for Clinical and Translational Research, National Cancer Institute
JOHN FRIEND II, Senior Vice President, Helsinn Therapeutics
LORI HOFFMAN HŌGG, Veterans Health Administration National Oncology Clinical Advisor, Department of Veterans Affairs, Cancer Program Director, Albany Stratton Veterans Affairs Medical Center
LINDA HOUSE, President, Cancer Support Community
HEDVIG HRICAK, Chair, Department of Radiology, Memorial Sloan Kettering Cancer Center
SAMIR N. KHLEIF, Director, Georgia Cancer Center at Augusta University
RONALD M. KLINE, Medical Officer, Patient Care Models Group, Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services
LEE M. KRUG, Disease Area Head, Immuno-Oncology, Bristol-Myers Squibb
RICHARD A. LARSON, Hematology/Oncology Director, Hematologic Malignancies Clinical Research Program, University of Chicago
MICHELLE M. LE BEAU, Arthur and Marian Edelstein Professor of Medicine, Director, University of Chicago Comprehensive Cancer Center
GRETA MASSETTI, Associate Director for Science, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention
DANIEL R. MASYS, Affiliate Professor, Biomedical and Health Informatics, Department of Medical Education and Biomedical Informatics, University of Washington School of Medicine
MARTIN J. MURPHY, Chief Executive Officer, CEO Roundtable on Cancer
LOYCE PACE, Health Policy Director, LIVESTRONG Foundation
RICHARD PAZDUR, Director, Office of Oncology and Hematology Products, Food and Drug Administration
STEVEN PIANTADOSI, Phase One Foundation Endowed Chair and Director, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center
JENNIFER A. PIETENPOL, Director, Vanderbilt-Ingraham Cancer Center, Benjamin F. Byrd, Jr., Professor of Oncology, Professor of Biochemistry, Vanderbilt University
MACE L. ROTHENBERG, Chief Medical Officer & Senior Vice President, Clinical Development & Medical Affairs, Pfizer Oncology, Pfizer Inc.
RICHARD SCHILSKY, Chief Medical Officer, American Society of Clinical Oncology
DEBORAH SCHRAG, Chief, Division of Population Sciences, Professor of Medicine, Department of Medical Oncology, Harvard Medical School, Dana-Farber Cancer Institute
YA-CHEN TINA SHIH, Professor of Health Economics, Chief, Section of Cancer Economics and Policy, Department of Health Services Research, University of Texas MD Anderson Cancer Center
ELLEN V. SIGAL, Chair and Founder, Friends of Cancer Research
RALPH WEICHSELBAUM, Daniel K. Ludwig Professor and Chair, Department of Radiation Oncology, Director, Ludwig Center for Metastasis Research, The University of Chicago Medical Center
GEORGE J. WEINER, President, Association of American Cancer Institutes, C.E. Block Chair of Cancer Research, Professor of Internal Medicine, Director, Holden Comprehensive Cancer Center, University of Iowa
RICHARD WOODMAN, Senior Vice President, Head North America Oncology Clinical Development & Medical Affairs, Novartis Pharmaceuticals Corporation
WENDY WOODWARD, Associate Professor and the Section Chief of Clinical Breast Radiation, Department of Radiation Oncology, University of Texas MD Anderson Cancer Center
National Cancer Policy Forum Staff
SHARYL J. NASS, Forum Director and Director, Board on Health Care Services
ERIN BALOGH, Senior Program Officer
PATRICK ROSS, Research Assistant
CYNDI TRANG, Senior Program Assistant
PATRICK BURKE, Financial Associate
Reviewers
This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary:
DOYIN OLUWOLE, Global Health Innovations and Action Foundation
NEAL A. PALAFOX, University of Hawaii
ELISEO PEREZ-STABLE, National Institute on Minority Health and Health Disparities
REBECCA RICHARDS-KORTUM, Rice University
Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this report was overseen by VIVIAN W. PINN. She was responsible for making certain that an
independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the rapporteurs and the institution.
Acknowledgments
Support from the many annual sponsors of the National Cancer Policy Forum is crucial to the work of the Forum. Federal sponsors include the Centers for Disease Control and Prevention and the National Cancer Institute/National Institutes of Health. Non-federal sponsors include the American Association for Cancer Research, American Cancer Society, American Society for Radiation Oncology, American Society of Clinical Oncology, American Society of Hematology, Association of American Cancer Institutes, AstraZeneca, Bristol-Myers Squibb, Cancer Support Community, CEO Roundtable on Cancer, EMD Serono, Helsinn Healthcare SA, LIVESTRONG Foundation, National Comprehensive Cancer Network, Novartis Oncology, Oncology Nursing Society, and Pfizer Inc.
The Forum wishes to express its gratitude to the expert speakers whose presentations helped examine the issues of cancer prevention and early detection in low-resource areas. The Forum also wishes to thank the members of the planning committee for their work in developing an excellent workshop agenda.
This page intentionally left blank.
Contents
Differences in Cancer Burdens Among Low- and High-Resource Countries
Differences in Cancer Burdens in the United States
Potential Impact of Prevention
SOCIOCULTURAL CHALLENGES IN LOW-RESOURCE AREAS
Lack of Education, Cancer Myths, and Stigma
Language Barriers and Lack of Trust
The Built Environment and Geographic Challenges
Challenges in Obtaining a Healthy Diet
Challenges in Providing Women’s Health Care
CANCER PREVENTION EFFORTS IN LOW-RESOURCE AREAS
Boxes, Figures, and Tables
BOXES
1 Suggestions Made by Individual Workshop Participants
2 Anti-Tobacco Efforts in Guam and the Philippines
3 Cervical Cancer Vaccine Program in Botswana
5 Cervical Cancer Prevention and Treatment in Zambia
6 African Research Group for Oncology
FIGURES
1 The cancer survival gap for various cancers
2 Age-adjusted annual death rates from cancer in the United States, 2012
3A Smoking prevalence among adult men aged 15 and older, 2013
3B Estimate of current adult smokers in the United States by quartile ranking
4 Cervical cancer death rates by state economic areas (SEAs), 2008-2012
5 Death and disability due to noncommunicable disease outnumber those due to infectious disease
7 Estimated cumulative tobacco deaths from 1950 to 2050 with different intervention strategies
8 The affordability of cervical cancer programs, total and per capita, in African countries
9 The availability of pathologists is limited in many parts of Africa
10 Global status of cancer registration and vital registration
TABLES
Acronyms and Abbreviations
| ARGO | African Research Group for Oncology |
| CBE | Clinical Breast Exam |
| c-CARE | Cancer Community Awareness Access Research and Education |
| CDC | Centers for Disease Control and Prevention |
| DALY | disability-adjusted life year |
| ECHO | Extension for Community Healthcare Outcomes |
| FCTC | Framework Convention on Tobacco Control |
| FETP | Field Epidemiology Training Program |
| HDI | Human Development Index |
| HPV | human papillomavirus |
| IARC | International Agency for Research on Cancer |
| IOM | Institute of Medicine |
| NCD | noncommunicable disease |
| NCI | National Cancer Institute |
| NCPF | National Cancer Policy Forum |
| NIH | National Institutes of Health |
| PLANET | Plan, Link, Act, Network with Evidence-based Tools |
| USAID | U.S. Agency for International Development |
| VIA | Visual Inspection with Acetic Acid |
| WHO | World Health Organization |
