February 2nd, 2015 1:28 pm ET -
I’m 30 years old and have already had cancer three times. If I lived in a developing country I likely would have died from my testicular cancer, or from my melanoma, or almost surely from my recurrence of melanoma that spread to the liver and brain. Fortunately for me, I have the opportunity to access an extraordinarily high level of care that has kept me alive and hopefully will continue to do so. Unfortunately for billions of people around the world, the same cancers that are largely preventable or treatable in countries with access to good-quality care can still be devastatingly deadly for them. Even in 2015, whether you survive cancer still depends very much on where you live.
As a public health advisor in CDC’s Office of International Cancer Control, for the past four years I’ve been working to develop programs that increase access to cancer prevention and treatment services in low- and middle-income countries. While traveling for my job I’ve often reflected on my ongoing personal experience with cancer and how different things would be for me if I had been born somewhere without access to good-quality cancer care. I feel a powerful connection to the cancer survivors and public health professionals I meet. My experiences have given me a unique perspective on cancer disparities that exist between countries and the importance of international collaboration to address them.
One area where health disparities are apparent is in the availability of specialized cancer care. I’ve always had access to the care I need, but sometimes I wait at the clinic for what seems like a long time to see my oncologist. Once I waited for four hours and even wondered if I should take my business elsewhere. It wasn’t until I traveled to Vietnam, where I met patients at the main cancer hospitals who had been waiting for hours and even days in crowded waiting rooms, stairwells, and outside in the smothering heat and humidity, that I realized how trivial the concerns about my wait time actually were.
In Vietnam and many other countries, wait times are a symptom of much larger health systems challenges. Many countries lack sufficient cancer treatment and prevention services, while some countries have no specialized cancer care at all. Even if treatment is available, it may be too expensive for most people, or they may have to travel for days to arrive at a cancer center, making it less likely that patients will receive the care they need to survive.
I recently met an elderly woman in Guatemala City who had melanoma and had traveled a long way from her rural village to receive treatment. She spoke only her indigenous language, and because of the distance, nobody had been able to travel with her. After meeting her, I felt especially fortunate to have had my family by my side throughout my treatment.
The overwhelming support I’ve received from my family, friends, colleagues, and even strangers has been an absolutely critical part of my care. I can’t express how comforting it is to know that so many people would do anything they could to help me. Never have I felt embarrassed or ashamed about having cancer; rather, I’ve been encouraged to share my experience to help others who are going through similar things and to raise awareness about melanoma prevention.
Sadly, due to the stigma around cancer that still exists in many countries, cancer patients are often discouraged from speaking openly about their disease, even among close family and friends. This can be detrimental to the psychological well-being of cancer patients and interfere with their ability to get the medical care they need. A friend of mine, Carolyn Taylor, a cancer survivor and photographer who founded the nonprofit organization Global Focus on Cancer, tells the story of a woman she met at a hospital in India who was waiting to receive treatment for breast cancer. As this woman cautiously opened up, she told Carolyn that the only other person who knew she had cancer was her husband, who had asked her not to speak to anyone else about it since it could be seen as a source of shame for the family. Unfortunately, stories like this are not uncommon, especially in places with lower levels of awareness about cancer.
Cancer is scary for anyone, but especially for those who think there’s no way to survive it. After spending a few days visiting the top cancer hospitals in Vietnam, I asked two Vietnamese women, both highly educated physicians who had been with me throughout the trip, where they would go to for treatment if they learned they had breast cancer. I was surprised when they both responded that they probably wouldn’t go anywhere. Perhaps they truly believed cancer was incurable, or maybe they felt like it wasn’t worth the pain and discomfort to get care at one of the overcrowded hospitals we’d visited where patients often slept on the floor or shared beds with as many as three other people, but the fact that they had no hope of being cured strikes me, a cancer survivor and public health professional, as an important indicator that we need to do something about this.
A Global Response
It’s past time to stop ignoring the impact of cancer on poverty and health systems while expecting impressive results from economic development and global health programs. They are inextricably linked and need to be tackled together to have the desired outcome. Reducing the cancer burden worldwide contributes significantly to the success of other global health and development efforts.
The growing cancer burden places an enormous load on already strained health systems, making it more difficult for countries to manage other health challenges. Since a health system strong enough to prevent and control cancer is also better equipped to deal with other important causes of death and disability, such as Ebola and AIDS, strengthening country health systems to control cancer also contributes to building a safer world.
If the global cancer crisis is not addressed now, it will become even more difficult and costly to deal with in the future after millions of lives have been avoidably lost. Fortunately, technology already exists that can prevent millions of cancer deaths every year. Low-cost yet effective approaches to cancer prevention and treatment are already being implemented in many countries throughout the world, but the work is obviously far from finished.