How can we really close the gaps in women's cancers in the Asia-Pacific?

We know that tools exist to eliminate cervical cancer as a public health problem and to reduce the incidence of breast cancer; these are clearly outlined in the WHO’s Global strategy to accelerate the elimination of cervical cancer and the WHO Global breast cancer initiative.

So why is it that in the Asia-Pacific region in particular, we’re not seeing a decrease in incidence and mortality? On the contrary, cancers affecting women are becoming more common and more impactful. Over half of the global incidence of cervical cancer in 2020 was in Asia, which also had the highest death rate. For breast cancer, deaths disproportionately occur in low and middle-income countries and continue to rise.[1]

That’s the question we wanted to answer when Economist Impact, supported by Roche and the APAC Women’s Cancer Coalition, began research for our report on women’s cancers in the region. And not only that, we wanted to identify where countries should focus to start tackling the gaps that are being seen in breast and cervical cancer in the region, and recommend some country-specific, actionable opportunities for improvement.

Our new report, Impact and opportunity: the case for investing in women’s cancers in Asia Pacific, does just that, focussing on India, Indonesia, Malaysia, the Philippines, Thailand and Vietnam.

But first, the problem: We found that in the region, both diseases are often diagnosed too late, leading to direct and indirect healthcare costs, higher burdens for patients, and higher mortality rates. This is partly because of sub-optimal primary and secondary prevention and screening, and a large and concerning variation in practices; particularly when it comes to organised, population-based screening, HPV DNA testing for cervical cancer, and mammography for breast cancer. HPV vaccination rates are low, with some countries not having national-level vaccination yet. And once a diagnosis of cancer is made, patients still face huge challenges to accessing the care and treatment they need.

In our paper, we use a comparative scorecard model to assess policies and programmes on particular dimensions, with the hope of inspiring progress for individual countries. When you can see where the gaps are, it’s easier to visualise where the opportunities for improvement might be.

Our report includes recommendations that are clear, actionable, and rooted in evidence - we think that these recommendations could help countries develop a roadmap for what’s possible and achievable, especially if there is the right political will and leadership in place.

Key recommendations:

1. Countries must demonstrate greater political will and leadership, and implement and update national elimination plans and strategies to align with WHO targets for cervical and breast cancer
2. Enhance performance tracking by building immunisation, screening and patient outcome registries for cervical and breast cancer
3. Focus on primary prevention by rolling out national immunisation programmes (HPV immunisation for cervical cancer) and secondary prevention by rolling out organised population-based national screening programmes (for both cervical and breast cancer)
4. Referral and treatment pathways for patients should be clear and well-defined
5. Governments should prioritise women’s cancers as key policy areas to achieve national targets for immunisation, screening and treatment
6. Governments and global funding bodies should devise and implement effective and sustainable funding models
7. Services and programmes should be patient-centric and tailored to the needs of affected populations in different settings
8. Consider integrated, holistic approaches to tackle resource and capacity challenge

This is an exciting time for women’s cancers, with a lot of opportunities and momentum thanks to the WHO global targets. If the targets for cervical cancer are met, by 2030 we could save 300,000 women’s lives, over 14 million by 2070, and over 62 million by 2120.  For breast cancer, achieving the WHO targets for reducing incidence would save 2.5m lives by 2040.  This is an incredible amount of women’s lives saved. The APAC region needs to rise to the challenge and commit to taking the necessary steps to achieve a future free from cervical cancer, and a reduction in breast cancer incidence - we know it’s not out of reach. 

_____________________________