Progress in cancer control… unevenly shared

ICC marks this year its 90th year of existence. It was born out of the growing burden of cancer and the need for international collaboration and cooperation to respond to it more effectively. 

The intervening decades have seen significant progress in cancer care with the advent of surgery, radiotherapy and chemotherapy and screening. And the efficacy of these treatments – targeting and eliminating cancerous cells with increasingly less damage to healthy ones – has accelerated in the past 20 years.

More focused and less invasive radiation therapy, less toxic chemotherapy drugs, targeted therapies aimed at the genetic mutations that drive the growth of cancer, immunotherapy and now possibly mRNA vaccine technology to treat cancer, have led to better outcomes overall for people living with cancer – not only a greater chance of surviving the disease but also enhancing their quality of life.

There have also been incredible advances in prevention and early detection, with increasingly high performing screening technology – ultrasound, magnetic resonance imaging (MRI) and computerised tomography (CT) – and the effective use of artificial intelligence in diagnostics.

The ability to reach traditionally underserved populations in remote areas has also been enhanced with mobile screening units and at-home testing kits.

As a result, certain common cancers such as breast, cervical, colorectal can be detected increasingly early, sometimes at a pre-cancerous stage, further improving the chances of successful treatment. 

The vaccine against the human papillomavirus (HPV), which causes most cases of cervical cancer, has already largely contributed to a reduction of cervical cancer cases (by 87% since 2008 in the UK). Combined with innovative tools – such HPV DNA testing – for the screening or secondary prevention, and then treatment, of precancerous lesions, this offers the promise for the first time of eliminating a cancer. 

Finally, a better understanding of the disease has led to a greater recognition of the risk factors and how they can be addressed. In particular, governments are increasingly moving to expand policies that constrain the commercial interests that drive the marketing of carcinogenic products – notably tobacco, alcohol, and unhealthy foods – and limit the exposure of individuals to these products as well as environmental factors such as air pollution.

Indeed, prevention and early detection hold the key to further progress. As cancer is basically an uncontrolled growth of cells occurring within the human body, a strategy solely based on eradicating cancer seems unlikely to succeed. Today, it is rather one of “containment”: preventing as much as possible, and detecting, diagnosing and treating as early as possible. 

An inequitable success

Nixon declared ‘war on cancer’ just over 50 years ago, signing the National Cancer Act in 1971. While using ‘war’ metaphors has since been questioned, there is no doubt that these efforts are proving largely successful – at least, for most populations in high-income settings, where they are more widely available and accessible. The US has notably launched over 25 new programmes, policies and resources designed to address cancer under its Moonshot initiative.

In the US, for instance, mortality rates for all cancers combined have dropped 27% in the past 50 years, by as much as 70% for cervical and stomach cancer, and deaths from lung cancer were down 44% from a peak in 1993. In all European countries also, there has been a steady increase in five-year survival rates for the most common cancer types. Pancreatic, brain and oesophageal cancers remain the exceptions to this decline. 

There are significant disparities, however, even with such a high-income country: overall cancer mortality rates have actually increased in many parts of southern US states, notably due to “unequal dissemination of advances in cancer control like the availability of screening and therapeutic advances,” according to Dr Ahmedin Jemal, Senior Vice President, Surveillance and Health Equity Science at the American Cancer Society as quoted in a press release.

The barriers that prevent many people from access cancer services even when they are available are many – notably, due to socioeconomic status, race and ethnicity, gender norms and discrimination, geographical location, age, sexual orientation, and mental or physical disability. UICC has designed the 2022-2024 campaign for World Cancer Day around raising awareness about these barriers and mobilising action and suggesting ways to close this care gap.

Perhaps the starkest divide remains between high- and low-income regions, where many people lack access to even basic health services, including many essential cancer medicines, screening options and treatment such as radiotherapy.

There are progress, programmes and initiatives on which to build in order to mend this divide. The World Health Organization (WHO) has developed the Global Initiative for Cancer Registry Development, to assist countries in better understanding the nature of their cancer burden to inform public health policies. WHO has also launched costing tools, “best buys” and initiatives to tackle childhood cancer, eliminate cervical cancer and reduce breast cancer incidence and mortality.

Many non-governmental and other international organisations – including UICC – have also developed knowledge sharing programmes to help strengthen health systems and cancer care in low-income settings. In particular, UICC contributes to the SUCCESS project to expand secondary cervical cancer prevention in select low-income countries. And governments themselves are expanding health coverage and implementing national cancer control strategies. 

So while it is natural to be focused on all the work that still need to be done to reduce the number of lives lost to cancer around the world, it is important to look back at the advances made over the last decades, and feel hopeful for the coming decades.

A brief history of how cancer is understood and treated

The oldest description of tumours can be found in an Ancient Egyptian text and relates to ulcers in the breast that were removed by cauterisation. The disease was considered incurable. About 2,500 years ago, the ‘Father of Medicine’, Hippocrates, referred to such tumours as karkinos, which in Greek means ‘crab’, possibly because of how tumours splay out. The Roman physician, Celsus, in the 1st century translated the Greek term into ‘cancer’. 

Ever greater understanding of the disease and it pathology was made possible with autopsy findings and then the microscopic study of diseased tissues in the 19th century. Surgery was considered the first possible means to treat cancer in the 18th century by removing a tumour that had not spread to another part of the body. Treatment options expanded in the early 20th century with radiology and radiation therapy, thanks notably to the discoveries made by Marie Curie.

Chemotherapy was introduced in the mid-20th century and the discovery of the DNA double helix and subsequent mapping and sequencing of the human genome paved the way for genetic research, a greater understanding of how cancer develops and grows and, most recently, targeted gene therapies.

See cancer.org for more information