Action instead of reaction: the Latin American cancer control scorecard
Held in room Castillo A5, level B
Breakfast organised by:
Cancer and its control in Latin America present often stark contrasts. Rapid change next to stubborn stasis, and substantial progress in some areas intermingled with still unmet, pressing needs in others. It is also an issue with growing political salience within the region: past success in the control of communicable diseases has increased the relative profile of non-communicable ones.
The disparity between countryside and city begins with screening. A Mexican study, for example, found low frequency of mammography and follow-up of abnormal findings in a poor rural area, largely because of lack of medical facilities. Meanwhile, in Brazil, cervical-cancer screening appears to be performed less frequently in rural provinces than more urbanised ones. At an extreme, one study calculated that, between 1987 and 2008, the odds of a woman living in rural Ecuador having a Pap smear done were only about one-half those of one living in a city. Quality is also a big issue. In Brazil 10% of Pap smears are unreadable; in rural Amazonas state this figure rises to 60%.
The Economist Intelligence Unit (EIU) proposed this year a major tool for stakeholders seeking to understand this field: the Latin America Cancer Control Scorecard (LACCS). LACCS relies on significant desk research to rank the 12 study countries on their performance in different areas of direct relevance to cancer control access. In addition to the scorecard, this report also draws on its own, separate substantial research as well as 19 interviews with experts on cancer in the region or worldwide.
The LACCS tracks six domains: cancer plan, monitor performance, medicines availability, radiotherapy availability, prevention and early detection, and finance. It was not designed to measure the level of inequality or its impact. Raw scores for each domain have been normalised to a scale of 1-5 to enable comparisons across domains.
Overlapping Latin America’s socio-economic disparities in cancer control are geographic ones. On average in the EIU study, 22% of the population live in rural areas. These typically are economically worse off than cities: for study countries where data are available, on average 20% of the urban population live in poverty; in rural ones it is 33%. Not surprisingly, the former also have better healthcare and access to cancer treatment.
In Peru, meanwhile, 85% of oncologists live in the capital, while some of the country’s states have none. In Colombia, meanwhile, over 60% of oncologists live in the four largest cities.
Linear accelerators are typically much more concentrated in national capitals or other major cities that their populations would warrant. Argentina, with its provincially run healthcare, is the only one to have escaped this problem.
Following the different domains proposed by the LACCS, the round table will cover the lessons learned in each of the areas of the cancer control efforts throughout the Latin America region and emphasize the critical role of the cities.
Mrs Irene Mia, Global Editorial Director, the Economist Intelligence Unit, UK
Dr. Felicia Knaul, Past Board Member UICC and President, Union Against Cancer of Women (ULACCAM), USA
Dr. Alejandro Mohar, Head of Epidemiology Unit, National Cancer Institute, Mexico
Dr. Gilberto Lopes, Medical Director for International Programs, Associate Director for Global Health, University of Miami, Miller School of Medicine, USA