The burden of urological cancers in low‐ and middle‐income countries

The burden of cancer in low and middle income countries (LMICs) continues to rise (1). Evaluation of geographical differences in cancer mortality statistics is specifically of interest in LMICs as (inter)national guidelines are potentially less embedded in standard care and objective measurements to assess underlying mechanisms/explanations for the burden of cancer are often lacking. Monitoring mortality statistics in these countries can thus help assess the effectiveness of national and regional health systems in treating and caring for patients with cancer Torres-Roman et al. deserve to be congratulated for their efforts to monitor mortality rates for prostate cancer at both a regional and national level in Peru (2). The CONCORD initiative from the World Health Organisation (WHO) reported prostate cancer statistics for Peru, but data were limited to the capital area of Lima (1). Torres-Raman et al. report prostate cancer mortality rates between2005-2014 based on data from the Peruvian Ministry of Health, which covers about 70% of all health care providers in Peru. Apart from an overall increase of 15% in mortality rates, substantial variation was observed by geographical region. Mortality rates increased by 16% in the coastal region and highlands, whereas in the rainforest region the rates decreased by 19% (2). One potential explanation for these observed differences could be the difference in ethnic and racial characteristics. The coastal region in Peru has a strong African influence and also has a larger proportion of men above the age of 65 years. In addition to potential differences in access to healthcare, some of the variation in prostate cancer mortality statistics most likely reflects deficiency in reporting systems. Even though this study has its limitations due to missingness and lack of information on other important variables such as ethnicity and socioeconomic status, it provides a first bases for a critical assessment of prostate cancer care in Peru.