The World Cancer Declaration outlines nine targets to considerably reduce the number of premature deaths from cancer and improve quality of life and cancer survival rates. Originally launched at the UICC World Cancer Congress in 2006, the World Cancer Declaration was renewed in 2013 to be more closely aligned with developments in the fight against NCDs, in particular WHO’s Global Action Plan for the Prevention and Control of Non-Communicable Diseases (NCDs).
In the Comment “The World Cancer Declaration: time to consolidate wins and work towards 2025”, published this month in The Lancet Oncology, a group of leading cancer experts led by Dr Sonali Johnson, Head of Knowledge, Advocacy and Policy at UICC, confirms that, overall, the global community has made measurable progress towards achieving several targets outlined in the World Cancer Declaration. Several important areas such as prevention, early detection and treatment show mixed results, while challenges remain particularly in providing equal access to quality care to all populations.
An area where there has been significant advance is in the development and implementation of national cancer control plans (NCCP), which represent the cornerstone of an effective response to cancer in terms of prevention, detection and treatment. The number of countries with NCCPs worldwide has increased from 66% in 2013 to 81% in 2017; more plans, however, need to address country-specific issues with a more targeted allocation of resources.
“It is truly encouraging to see a widespread increase in political will to better monitor cancer, establish population-based registries and implement effective policies. Almost all countries, some 95%, have created a health department dedicated to NCDs. These are essential steps towards improving both the coverage and quality of cancer care and developing a strong health response to cancer.”
– Sonali Johnson, Head of Knowledge, Advocacy and Policy, UICC; co-author of “The World Cancer Declaration: time to consolidate wins and work towards 2025”
In terms of prevention, success in reducing the prevalence of key risk factors for cancers has been unequal. More and more countries are aligning their tobacco policies with the WHO Framework Convention on Tobacco Control, while the implementation of national campaigns to vaccinate against the hepatitis B virus and human papillomavirus promises to reduce the incidence respectively of liver cancer and cervical cancer. However, air pollution continues to contribute to over 350,000 preventable deaths from lung cancer, while according to The Lancet article, “alcohol use is growing in some regions, obesity rates in children are rising alarmingly and more than 80% of adolescents (aged 11-17) did not reach WHO’s global recommendations for physical activity.”
There are encouraging signs, however, that health promotion messages on cancer are getting through. For example, the UICC 2020 public opinion survey found a high degree of awareness of at least one main cancer risk factor. Many governments have initiated public awareness campaigns in collaboration with civil society.
Early detection is another key factor in reducing the cancer burden, an area where progress is also mixed. Effective diagnosis requires high-performing screening technology, which is not widely available, as well as access to a health provider, the recognition by primary care physicians of early cancer symptoms and prompt referral to specialised cancer services, which must also be accessible.
While incidence rates for most cancers are generally rising worldwide, in large part due to ageing populations, survival rates have noticeably improved for many cancers. The drop in premature death from cancer has, however mainly been observed in high-income countries. Furthermore, service disruptions due to COVID-19 risk further exacerbating disparities in terms of cancer-related mortality between low- and high-resourced regions, as emphasised in The Lancet comment.
This inequity between populations in survival rates is paralleled by a lack of equal access to cancer prevention programmes, services for early detection and diagnosis, treatment modalities and palliative care. This last aspect of cancer care is sadly one of the more neglected, according to the article, with only half of all countries including palliative care in their NCD policies and with almost 85% of the world’s population unable to access opioid medications for pain control.
“We have seen that collaboration between governments, health agencies and civil society is key to developing a comprehensive and holistic approach to cancer control. We must take account of what people living with cancer tell us, and make every effort to expand access to quality care to everyone who needs it. And, we must do more together to reduce premature mortality, to achieve universal health coverage inclusive of cancer services, and to build back better after the COVID-19 pandemic that has threatened our progress.”
– Bente Mikkelsen, Director, Department for Non-Communicable Diseases, WHO; co-author of “The World Cancer Declaration: time to consolidate wins and work towards 2025”
Sonali Johnson, Head of Knowledge, Advocacy and Policy, UICC
Zuzanna Tittenbrun, Global Resources Manager, UICC
Yannick Romero, Knowledge and Advocacy Manager, UICC
Julie Torode, Director of Special Projects, UICC
Silvina Frech, Head of Sustainability · City Cancer Challenge Foundation
May Adbel-Wahab, Director, Division of Human Health (NAHU), International Atomic Energy Agency (IAEA)
Lisa Stevens, Director, Programme of Action for Cancer Therapy, IAEA
Arsen Juric, Programme of Action for Cancer Therapy, IAEA
Freddie Bray, Head of Cancer Surveillance, International Agency for Research on Cancer (IARC)
Marion Piñeros, Section of Cancer Surveillance, IARC
James Cleary, Professor of Medicine and Walther Senior Chair of Supportive Oncology, Indiana University School of Medicine and Indiana University Simon Cancer Center
Elizabeth Mattfeld, Program Officer, United Nations Office on Drugs and Crime (UNODC)
Bente Mikkelsen, Director, Department for Non-Communicable Diseases, WHO
André Ilbawi, Technical Officer, Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, WHO