0

25

50

75

100

PREVENTION & EARLY DETECTION TREATMENT / SURVIVORSHIP / END OF LIFE POLICY & RESEARCH

N a t i o n a lP i l o t

Monitor for breast cancer recurrence, second primary cancers

Monitor for long-term complications

Genetic testing and counseling

Screening for high-risk cancers

LIMITEDMonitor for endocrine medication adherence

BASIC

MAXIMAL

Year of death

ASR

(Wor

ld) p

er 10

0,00

0

Figure 3

1977 1983 1989 1995 2001 2007 20130

1

2

3

4

5

6

7

55-59 60-64 65-69 70-74 75-79 80-84 85+0

5

10

15

20

25

30

Attained age

Figure 2

55-59 60-64 65-69 70-74 75-79 80-84 85+0

5

10

15

20

25

30

Attained age

HPV vaccination

HBV vaccination

Cervical cancer screening

Breast cancer screening (opportunistic)

Breast cancer screening (population- based)

WHO Essential Medicines List

Radiotherapy National treatment guidelines

Palliative care

Survivorship care

Pediatric cancer care

Vulnerable populations

Cost of the plan

Cancer research

Financial resources

Cancer registries

No program Pilot National

FIGURE 26.1

Proportion (%) of countries with NCD plans/national cancer control plans that address key components across the cancer continuum, by income level, 2018

canceratlas.cancer.org canceratlas.cancer.org

26 TAKING ACTION

Disproportionately high rates of cervical cancer in lower-HDI countries are almost entirely

due to lack of screening.

Monitoring practices for breast cancer survivorship care can vary

by resource availability.

MAP 26.1

early detection: Cervical cancer screening using visual inspection with acetic acid, as of June 2017

The risk of dying from lung cancer can be

substantially reduced by quitting smoking

at any age.

MALE

FEMALE

If 70% of all eligible girls were vaccinated, an estimated

178,000 cervical cancer deaths could be avoided annually

worldwide.High income countries Upper middle income countries

Lower middle income countriesLow income countries

Mortality from childhood cancer has decreased in many high-income countries due to

treatment advances, but similar progress is lacking in

lower-resource countries.

FIGURE 26.3

treatment: Childhood cancer mortality trends, all cancer sites combined, males 0–19 years, 1975–2013

EgyptColombiaBrazilUnited StatesJapan

THE CANCER CONTINUUM An Overview of Interventions and Potential for Impact

Resource-appropriate, broad application of known interventions in each country can substantially reduce the morbidity and mortality associated with cancer.

The cancer continuum is represented in national

non-communicable disease and cancer control plans.

1

0

6

5

7

38

66 34

Regular screening for cervical, colorectal, breast, and lung cancers allows detection of these diseases at an early stage, when treatments are more successful and the chance for survival and cure is high. MAP 26.1 Screening for colorectal and cervical cancers also prevents cancer by detecting precancerous lessions for removal by surgery or other forms of treatment. A heightened awareness of warning signs for cancer of the oral cavity, skin, and some other cancers may also lead to detection of cancers at early stage (see 30, Early Detection).

Effective treatment modes (surgery, radiation, chemotherapy, hormonal therapy, immunotherapy) have been developed for several cancers, including for cancers of the breast, colon and rectum, and testis and for many childhood cancers. FIGURE 26.3 (see 31, Management and Treatment) For certain cancers such as testis, treatment could lead to cure, even for advanced-stage disease. Awareness and availability of services to meet the needs of cancer survivors are increasing worldwide FIGURE 26.4, and pain associated with cancer can be controlled by administration of analgesic drugs. FIGURE 26.5

(see 32, Pain Control)Resource-appropriate application of known

interventions in each country could prevent a substantial proportion of cancer deaths. However, such broad interventions have not materialized in most parts of the world largely because of lack of political commitment.

Evidence-based, resource appropriate interventions for cancer prevention and control exist across the cancer continuum in each country, from prevention of risk factors to early detection, treatment, survivorship, and end-of-life care. FIGURE 26.1 Tobacco use, the cause of the largest number of preventable cancers worldwide, can be substantially reduced through raising excise tax on tobacco products, smoke-free air laws, health warnings on tobacco packaging, and restrictions on promotion and advertising of tobacco products. FIGURE 26.2 (see 28, Tobacco Control) Unhealthy diet and physical inactivity can be reduced through increased public awareness about their health hazards and through public policies (e.g., excise tax on sweetened beverages) and structural and environmental interventions (e.g., pedestrian and bike lanes) (see 27, Health Promotion). The hepatitis B virus (HBV) and human papillomavirus (HPV), infections that cause liver cancer (HBV) and cervical and other urogenital and oropharyngeal cancers (HPV), can be prevented through vacci-nation (see 29, Vaccination). Indoor and outdoor air pollution can be reduced through use of clean stoves, cleaner fuels, and proper ventilation, and air quality guidelines and policies. Protection from harmful sun exposure could reduce the risk of skin cancer. Cancer-causing occupational exposures could be prevented through improved work place safety. Addressing cancer risk factors can also have a shared impact on other non-communicable diseases.

copyright © 2019 the american cancer society, inc.

FIGURE 26.4

survivorship: Breast Health Global Initiative resource allocations for monitoring breast cancer survivorship care

Cancer forms a large portion of end-of-life palliative care

needs worldwide.

FIGURE 26.5

end-of-life care: Adult palliative care needs at the end of life by disease (%) worldwide, 2011

CancerCardiovascular diseasesChronic obstructive pulmonary disease HIV/AIDSDiabetes mellitus Other Other diseases

FIGURE 26.2

prevention: Cumulative probability (%) of death from lung cancer by attained age and smoking status

Current SmokerQuit 70+Quit 60-69Quit 50-59Quit 40-49Quit <40Never Smoker