Breast and cervical cancer screening and care called unequal

Every year, more than two million women worldwide are diagnosed with breast or cervical cancer, but survival rates are largely determined by where a woman lives in the world, a Canadian oncologist says, adding that many of the deaths in developing countries are preventable.

Tuesday's online issue of the medical journal The Lancet includes a series of articles that conclude efforts to tackle breast, cervical and other women's cancers in developing countries have been woefully inadequate.

Maternal mortality has been reduced, but that's only part of the picture, said Dr. Ophira Ginsburg, an assistant professor in the medicine department at the University of Toronto.

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"It doesn't make sense for a woman in a poor country who is able to survive her childbirth, and then she dies when her child is five because she had cancer that was untreated," Ginsburg said in an interview from Paris, where the journal series launched at the 2016 World Cancer Congress.  

The medical oncologist and her international team of co-authors call for international efforts to end preventable cases and deaths from breast and cervical cancers by 2030. Their goals include:

• Immunizing 70 per cent of girls aged nine to 13 against human papillomavirus (HPV).
• Cervical cancer screening for 70 per cent of women aged 30 to 49, with timely, affordable and effective treatment of pre-cancerous cervical lesions.

While no oncologists are needed to meet either goal, the authors call for adequate numbers of trained health-care professionals and culturally appropriate messages to encourage screening.

'There are many women from ethno-cultural minority communities, immigrant women, Indigenous women, in high-income countries who also don't have equal access to cervical and breast screening and care.'- Dr. Ophira Ginsburg

But first, widespread misconceptions that breast and cervical cancers are too difficult and expensive to prevent and treat need to be overcome, Ginsburg said.

The journal pointed to examples of health promotion strategies to get the word out in communities. In Bangladesh,  Grand Challenges Canada offered Ginsburg a grant to co-found a breast clinic that equips community health workers with smartphone apps to encourage women with undiagnosed breast symptoms to seek care.

The inequities also exist in Canada and other developed countries, the authors said.  

"There are many women from ethno-cultural minority communities, immigrant women, Indigenous women, in high-income countries who also don't have equal access to cervical and breast screening and care," Ginsburg said.

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The lessons could be applied at home to improve uptake of cervical cancer screening, she suggested.

To meet the goals, powerful political commitment and substantial financial investment will be needed, the journal said.  

The global community cannot continue to ignore the problem, said co-author Richard Sullivan, professor of cancer and global health at King's College London in England.

"Not only are the costs of essential cancer services for women lower than expected, but scale-up of diagnostic, surgical, and treatment services are a highly effective investment compared to the devastating economic cost to countries, communities, and families incurred by the serious shortfall in cancer care," Sullivan said in a release.

"This situation could be turned around by 2030 if the international community, policymakers, politicians, health-care professionals, and patients address this issue now."