The global burden of women’s cancers: a grand challenge in global health

Every year, more than 2 million women worldwide are diagnosed with breast or cervical cancer, yet where a woman lives, her socioeconomic status, and agency largely determines whether she will develop one of these cancers and will ultimately survive. In regions with scarce resources, fragile or fragmented health systems, cancer contributes to the cycle of poverty. Proven and cost-effective interventions are available for both these common cancers, yet for so many women access to these is beyond reach. These inequities highlight the urgent need in low-income and middle-income countries for sustainable investments in the entire continuum of cancer control, from prevention to palliative care, and in the development of high-quality population-based cancer registries. In this first paper of the Series on health, equity, and women's cancers, we describe the burden of breast and cervical cancer, with an emphasis on global and regional trends in incidence, mortality, and survival, and the consequences, especially in socioeconomically disadvantaged women in different settings.

[1]  A. Hailu,et al.  Patient side cost and its predictors for cervical cancer in Ethiopia: a cross sectional hospital based study , 2013, BMC Cancer.

[2]  D. Roy Breast cancer in developing countries. , 1982 .

[3]  Umberto Veronesi,et al.  Global cancer surgery: delivering safe, affordable, and timely cancer surgery. , 2015, The Lancet. Oncology.

[4]  D. Parkin,et al.  Trends in the incidence of cancer in the black population of Harare, Zimbabwe 1991–2010 , 2013, International journal of cancer.

[5]  M. Chávez-MacGregor,et al.  Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995-2007 (the International Cancer Benchmarking Partnership): An analysis of population-based cancer registry data , 2011 .

[6]  G. Colditz,et al.  Meta-analysis of survival in African American and white American patients with breast cancer: ethnicity compared with socioeconomic status. , 2006, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[7]  M. Coleman,et al.  Is England closing the international gap in cancer survival? , 2015, British Journal of Cancer.

[8]  Zhao Chen,et al.  Ethnicity and breast cancer: factors influencing differences in incidence and outcome. , 2005, Journal of the National Cancer Institute.

[9]  M. Plummer,et al.  Time since first sexual intercourse and the risk of cervical cancer , 2012, International journal of cancer.

[10]  E. Chang,et al.  Disparities in breast cancer survival among Asian women by ethnicity and immigrant status: a population-based study. , 2010, American journal of public health.

[11]  Stéphane Verguet,et al.  Disease Control Priorities in Developing Countries , 2015 .

[12]  C. Mathers,et al.  Global burden of cancer in 2008: a systematic analysis of disability-adjusted life-years in 12 world regions , 2012, The Lancet.

[13]  P. Rochon,et al.  A population-based study of ethnicity and breast cancer stage at diagnosis in Ontario. , 2015, Current oncology.

[14]  D. Endrei,et al.  Annual Health Insurance Cost of Breast Cancer Treatment in Hungary. , 2014, Value in Health.

[15]  D. Fisman,et al.  Relative risk of cervical cancer in indigenous women in Australia, Canada, New Zealand, and the United States: A systematic review and meta-analysis , 2012, Journal of public health policy.

[16]  H. Adami,et al.  International incidence rates of invasive cervical cancer before cytological screening , 1997 .

[17]  G. Abdulrahman,et al.  Epidemiology of Breast Cancer in Europe and Africa , 2012, Journal of cancer epidemiology.

[18]  O. Franco,et al.  Cervical cancer in Indigenous women: The case of Australia. , 2011, Maturitas.

[19]  F. Bray,et al.  Survival disparities in Australia: an analysis of patterns of care and comorbidities among indigenous and non-indigenous cancer patients , 2014, BMC Cancer.

[20]  R. Atun,et al.  Improving responsiveness of health systems to non-communicable diseases , 2013, The Lancet.

[21]  F. Knaul,et al.  Women's Health Beyond Reproduction: Meeting the Challenges , 2012, Bulletin of the World Health Organization.

[22]  J. Githaiga,et al.  Comparative study of breast cancer risk factors at Kenyatta National Hospital and the Nairobi Hospital , 2015 .

[23]  A. Gumber,et al.  Breast and bowel cancer screening uptake patterns over 15 years for UK south Asian ethnic minority populations, corrected for differences in socio-demographic characteristics , 2008, BMC public health.

[24]  A. Feigl,et al.  The Global Economic Burden of Noncommunicable Diseases , 2012 .

[25]  R. Moineddin,et al.  Predictors of low cervical cancer screening among immigrant women in Ontario, Canada , 2011, BMC women's health.

[26]  Laura D'Andrea Tyson,et al.  The global gender gap report. 2010. , 2011 .

[27]  D. Parkin,et al.  Trends in the incidence of cancer in Kampala, Uganda 1991–2010 , 2014, International journal of cancer.

[28]  A. Derossis,et al.  Is Breast Cancer the Same Disease in Asian and Western Countries? , 2010, World Journal of Surgery.

[29]  J. Ferlay,et al.  Cancer Incidence in Five Continents: Inclusion criteria, highlights from Volume X and the global status of cancer registration , 2015, International journal of cancer.

[30]  P. Sheehan,et al.  Advancing social and economic development by investing in women's and children's health: a new Global Investment Framework , 2013, The Lancet.

[31]  J. Yang Of markets and rights: Discourse in the 2008 and 2013 Global Action Plan for the Prevention and Control of Noncommunicable Diseases , 2016 .

[32]  J. Church Human Development Report , 2001 .

[33]  C. Bewtra Clinicopathologic Features of Female Breast Cancer in Kumasi, Ghana , 2010 .

[34]  F. Knaul WOMEN ’ S REPRODUCTIVE HEALTH IN TRANSITION : THE OVERLAPPING CHALLENGE OF BREAST AND CERVICAL CANCER , 2014 .

[35]  M. Coory,et al.  Cancer diagnosis, treatment, and survival in Indigenous and non-Indigenous Australians: a matched cohort study , 2006, The Lancet.

[36]  M. Woodward The economic cost of cancer to patients and their families in South-East Asia. , 2014 .

[37]  S. Connor,et al.  Global atlas of palliative care at the end of life , 2018 .

[38]  M. Siahpush,et al.  Global Inequalities in Cervical Cancer Incidence and Mortality are Linked to Deprivation, Low Socioeconomic Status, and Human Development , 2012, International journal of MCH and AIDS.

[39]  Sharon Friel,et al.  Closing the gap in a generation: health equity through action on the social determinants of health , 2008, The Lancet.

[40]  G. Sen,et al.  Women and Health: the key for sustainable development , 2015, The Lancet.

[41]  C. Perou,et al.  Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. , 2006, JAMA.

[42]  The Agecode Study Group Catastrophic health expenditure and 12-month mortality associated with cancer in Southeast Asia: results from a longitudinal study in eight countries , 2015 .

[43]  T. Ansari,et al.  The financial burden of cancer: Estimates from patients undergoing cancer care in a tertiary care hospital , 2012, International Journal for Equity in Health.

[44]  K. Znati,et al.  [Epidemiological and biologic profile of breast cancer in Fez-Boulemane, Morocco]. , 2011, Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit.

[45]  HPV, HIV and cervical cancer: leveraging synergies to save women’s lives , 2017 .

[46]  C J L M Meijer,et al.  The causal relation between human papillomavirus and cervical cancer. , 2002, Journal of clinical pathology.

[47]  Gretchen A. Stevens,et al.  Global burden of cancer attributable to high body-mass index in 2012: a population-based study. , 2015, The Lancet. Oncology.

[48]  E. Trimble,et al.  Changing global policy to deliver safe, equitable, and affordable care for women’s cancers , 2017, The Lancet.

[49]  Abdul-Rasheed K. Adesunkanmi,et al.  The severity, outcome and challenges of breast cancer in Nigeria. , 2006, Breast.

[50]  Ping Sun,et al.  Differences in breast cancer stage at diagnosis and cancer-specific survival by race and ethnicity in the United States. , 2015, JAMA.

[51]  Gavin Yamey,et al.  Global health 2035: a world converging within a generation , 2013, The Lancet.

[52]  Charles Kooperberg,et al.  Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. , 2002, JAMA.

[53]  R. Peto,et al.  Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100,000 women in 123 randomised trials. , 2012, Lancet.

[54]  M. Manyama,et al.  Pathological features of Breast Cancer seen in Northwestern Tanzania: a nine years retrospective study , 2011, BMC Research Notes.

[55]  Laura D'Andrea Tyson,et al.  The global gender gap report , 2006 .

[56]  R. Love,et al.  Breast Cancer: A Neglected Disease for the Majority of Affected Women Worldwide , 2011, The breast journal.

[57]  M. Shrime,et al.  The Lancet Oncology Commission Global cancer surgery: delivering safe, aff ordable, and timely cancer surgery , 2015 .

[58]  A. Sreedevi,et al.  Epidemiology of cervical cancer with special focus on India , 2015, International journal of women's health.

[59]  M. Davari,et al.  The direct medical costs of breast cancer in Isfahan-Iran , 2012 .

[60]  Hutcha Sriplung,et al.  Cancer survival in Africa, Asia, and Central America: a population-based study. , 2010, The Lancet. Oncology.

[61]  D. Flum,et al.  Guideline‐concordant cancer care and survival among American Indian/Alaskan Native patients , 2014, Cancer.

[62]  S. Sanjosé,et al.  Interventions to close the divide for women with breast and cervical cancer between low-income and middle-income countries and high-income countries , 2017, The Lancet.

[63]  S. Gomez,et al.  Breast Cancer Mortality in African-American and Non-Hispanic White Women by Molecular Subtype and Stage at Diagnosis: A Population-Based Study , 2015, Cancer Epidemiology, Biomarkers & Prevention.

[64]  Jennifer S. Smith,et al.  Incidence and progression of cervical lesions in women with HIV: a systematic global review , 2014, International journal of STD & AIDS.

[65]  A. Jemal,et al.  Breast Cancer Incidence Rates in U.S. Women Are No Longer Declining , 2011, Cancer Epidemiology, Biomarkers & Prevention.

[66]  Breakaway : The global burden of cancer — challenges and opportunities , 2009 .

[67]  M. Davari,et al.  The Direct Medical Costs of Breast Cancer in Iran: Analyzing the Patient's Level Data from a Cancer Specific Hospital in Isfahan , 2013, International journal of preventive medicine.

[68]  A. Jemal,et al.  Breast cancer survival in Ethiopia: A cohort study of 1,070 women , 2014, International journal of cancer.

[69]  F. Bray,et al.  Cancer incidence in indigenous people in Australia, New Zealand, Canada, and the USA: a comparative population-based study. , 2015, The Lancet. Oncology.

[70]  F. Bray,et al.  Global estimates of human papillomavirus vaccination coverage by region and income level: a pooled analysis. , 2016, The Lancet. Global health.

[71]  S. Newmann,et al.  Social inequities along the cervical cancer continuum: a structured review , 2005, Cancer Causes & Control.

[72]  J. Griggs,et al.  American Society of Clinical Oncology clinical practice guideline: update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. , 2010, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[73]  C. Mathers,et al.  Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012 , 2015, International journal of cancer.

[74]  A. Boutayeb,et al.  Estimation of the cost of treatment by chemotherapy for early breast cancer in Morocco , 2010, Cost effectiveness and resource allocation : C/E.

[75]  Junior Bazile,et al.  Intergenerational impacts of maternal mortality: Qualitative findings from rural Malawi , 2015, Reproductive Health.

[76]  M. Coleman,et al.  Cancer survival differences between South Asians and non-South Asians of England in 1986–2004, accounting for age at diagnosis and deprivation , 2015, British Journal of Cancer.

[77]  Jeffrey H Silber,et al.  Characteristics associated with differences in survival among black and white women with breast cancer. , 2013, JAMA.

[78]  P. Porter,et al.  "Westernizing" women's risks? Breast cancer in lower-income countries. , 2008, The New England journal of medicine.

[79]  L. Bogaert Age at diagnosis of preinvasive and invasive cervical neoplasia in South Africa: HIV-positive versus HIV-negative women. , 2011 .

[80]  David A Jaffray,et al.  Costs, affordability, and feasibility of an essential package of cancer control interventions in low-income and middle-income countries: key messages from Disease Control Priorities, 3rd edition , 2016, The Lancet.

[81]  Jennifer Leaning,et al.  Consequences of maternal mortality on infant and child survival: a 25-year longitudinal analysis in Butajira Ethiopia (1987-2011) , 2015, BMC Genomics.

[82]  R. Sullivan,et al.  114INESMO EUROPEAN CONSORTIUM STUDY ON THE AVAILABILITY OF ANTI-NEOPLASTIC MEDICINES ACROSS EUROPE. , 2014, Annals of Oncology.

[83]  D. Forman,et al.  Cancer in indigenous people in Latin America and the Caribbean: a review , 2013, Cancer medicine.

[84]  F. Bray,et al.  Costs , aff ordability , and feasibility of an essential package of cancer control interventions in low-income and middle-income countries : key messages from Disease Control Priorities , 3 rd edition , 2015 .

[85]  J. Ranstam,et al.  Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50 302 women with breast cancer and 96 973 women without the disease , 2002, The Lancet.

[86]  R. Salamon,et al.  Direct costs of cervical cancer management in Morocco. , 2012, Asian Pacific journal of cancer prevention : APJCP.

[87]  N. Muñoz,et al.  Chapter 3: Cofactors in human papillomavirus carcinogenesis--role of parity, oral contraceptives, and tobacco smoking. , 2003, Journal of the National Cancer Institute. Monographs.

[88]  D. Bakker,et al.  Factors influencing mammography participation in Canada: an integrative review of the literature , 2009, Current oncology.

[89]  M. Holmes,et al.  Disparities across the breast cancer continuum , 2005, Cancer Causes & Control.

[90]  P. Coyte,et al.  Cost of treatment for breast cancer in central Vietnam , 2013, Global health action.

[91]  S. Garg,et al.  Expenditure audit of women with breast cancer in a tertiary care hospital of Delhi. , 2011, Indian journal of cancer.

[92]  Dan J Stein,et al.  Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013 , 2015, The Lancet.

[93]  S. Ayaya,et al.  Nutritional Status of Orphaned and Separated Children and Adolescents Living in Community and Institutional Environments in Uasin Gishu County, Kenya , 2013, PloS one.

[94]  Michael Baumann,et al.  Expanding global access to radiotherapy. , 2015, The Lancet. Oncology.

[95]  M. Coleman,et al.  Cancer survival in Europe 1999-2007 by country and age: results of EUROCARE--5-a population-based study. , 2014, The Lancet. Oncology.

[96]  E. Matos,et al.  The socio-economic impact of cervical cancer on patients and their families in Argentina, and its influence on radiotherapy compliance. Results from a cross-sectional study. , 2007, Gynecologic oncology.

[97]  M. Poljak,et al.  Patterns and trends in human papillomavirus-related diseases in Central and Eastern Europe and Central Asia. , 2013, Vaccine.

[98]  Heather Eliassen,et al.  Menarche, menopause, and breast cancer risk: individual participant meta-analysis, including 118 964 women with breast cancer from 117 epidemiological studies , 2012, The Lancet. Oncology.

[99]  S. Goldie,et al.  Cost Effectiveness and Resource Allocation Open Access Estimating the Cost of Cervical Cancer Screening in Five Developing Countries , 2006 .

[100]  M. Whitehead,et al.  The concepts and principles of equity and health. , 1992, International journal of health services : planning, administration, evaluation.

[101]  Helena Carreira,et al.  Global surveillance of cancer survival 1995–2009: analysis of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2) , 2015, The Lancet.

[102]  G. Maskarinec,et al.  Ethnic Differences in Breast Cancer Survival: Status and Determinants , 2011, Women's health.