Closing the Cancer Divide: A Blueprint to Expand Access in Low and Middle Income Countries

Low and middle income countries (LMICs) share a common, emerging, and largely unrecognized challenge: the burden of increasingly prevalent chronic and non-communicable diseases. This emerging challenge compounds the difficulty of responding to the backlog of disease and illness associated with poverty and “underdevelopment” often associated with preventable infections and reproductive health problems. Cancer – itself a complex set of devastating diseases – epitomizes the complexities and inequities of the epidemiological challenge faced by LMICs. Cancer is also a challenge to economic and human development, as it is both a cause and an effect of poverty. The long-term disability and ongoing health care costs of cancer impoverish families and health systems, and contribute to social exclusion. At the same time, poverty, lack of access to education and health care, and discrimination expose populations to additional risks for presenting and dying from many cancers. There are glaring disparities between rich and poor in incidence and death from preventable cancers and death from treatable cancers, as well as in the pain, suffering, and stigma associated with the disease. These disparities constitute a cancer divide and demonstrate that increasing access to cancer care and control is also an issue of equity. Yet, many believe – and these myths persist – that meeting the challenge of cancer in LMICs – with the exception of some basic prevention – is unnecessary, unaffordable, unattainable, and – perhaps the most pernicious – inappropriate because such an effort would take away resources from other high burden, communicable diseases. These four myths plague and undermine the work of the global community in cancer care and control (CCC), as well as on other non-communicable disease (NCD) and chronic illness.