The Cancer Burden in Latin America
In Latin America, the majority of the countries are experiencing an epidemiological transition, whereby the disease burden is shifting from infectious diseases to chronic conditions, with a corresponding escalation in rates of cancer. More than 70 percent of cancers are diagnosed when the disease is incurable. Cervical cancer continues to be a major threat in the lesser developed countries of the region, and in pockets of greater poverty within more advanced countries, while rates of prostate and breast cancer are increasing in the more industrialized countries, due to dietary changes that often accompany rising standards of living. The specter of tobacco looms across the entire region, and it is anticipated that if smoking rates do not decrease, lung cancer will emerge as the main killer in the region. Cancer control is further hampered by weak public health systems across the region, with the possible exceptions of Chile and Uruguay. In the region, the public health system confronts a variety of challenges, including:
- Most governments in the region tend to focus on addressing health challenges related to infectious disease and infant mortality, largely ignoring the evolution of chronic diseases, including cancer, as the looming health threat that can and will bankrupt their public health systems.
- Early detection programs are either ineffective, or not even in place, and cancers are therefore diagnosed at later stages, when chances for recovery are less likely.
- Treatment for later-stage cancers typically occurs in public hospitals that have overwhelmed their limited resources by trying to meet the great demand for services through their severely compromised infrastructures. As a result, the focus is on providing the minimum services to keep up with an overwhelming caseload, rather than on offering high quality of care.
- Most countries lack basic cancer planning tools such as population-based cancer registries, up to date clinical guidelines and consistent provision of care.
- Vast underserved populations remain vulnerable due to geographical gaps in the availability of cancer treatment, early detection and palliative care services.
Despite these challenges, most governments in the region have some form of cancer control strategies in place, with some national cancer control plans for site-specific cancers such as breast and cervical cancers. Health personnel make do with limited resources and operate with a high level of professionalism. Most countries in the region have ratified and signed the World Health Organization Framework Convention on Tobacco Control (FCTC), the first treaty negotiated under the auspices of the World Health Organization.
In most countries of the region, cancer is stigmatized and viewed as a “death sentence,” with a culture of silence surrounding the disease. Under this belief system, cancer is viewed through a lens of fatalism, with the disease being the patient’s “destiny,” implying that there is no action or treatment that can change the outcome of certain death. In this environment, upon diagnosis, the patient feels powerless and perceives that there are no options for survival. Unfortunately, given income inequalities and the weak health infrastructure, often options are indeed limited. Perceptions of cancer vary with educational levels, social indicators and access to early detection and treatment services. In selected countries of the region, including Mexico and Brazil, among others, the NGO community has begun to develop networks of breast cancer survivors to provide emotional and practical support for women undergoing treatment for the disease. These survivors have broken the silence around the disease, and seek to assist others with the social, emotional and physical implications of living with breast cancer. Several groups have moved into the advocacy realm with initiatives to promote changes within the public health system to provide better quality of care and enhanced access to a range of treatment options, including state-of-the-art treatment drugs.
American Cancer Society Involvement
Over the past several years, ACS has collaborated with NGOs and institutions in countries throughout the Latin American region. In the region, ACS has worked on increasing civil society engagement in cancer control through trainings, technical assistance, funding, and building institutional capacity in cancer control advocacy and policy planning, patient empowerment, tobacco control, and NGO management.
History of ACS Collaboration:
- Since 2002, ACS has sponsored the participation of more than 100 scholars from 12 countries in the region at American Cancer Society University (ACSU) events, the signature training program in volunteer management, fundraising, media outreach, tobacco control and cancer control planning, among other key topics. Selected NGOs have received seed grants for small project implementation after participating in ACSU, and ACS has actively built relationships with these NGOs through ongoing project monitoring and evaluation.
- NGOs in several countries of the region have launched Relay For Life, ACS’s highly successful fundraising and patient advocacy program.
- The Latin America Regional Health Grants Program, a 3-year regional initiative, provides training and technical assistance to strengthen the institutional capacity of a network of NGOs from Argentina, Brazil, Colombia, Costa Rica, Mexico and Venezuela, ultimately enhancing the impact of their cancer control programs.
- Since 2007, ACS has recognized the outstanding work of our partners in the region through the annual ACS regional award, the Premio Excelencia Latina, which acknowledges NGO leaders in volunteerism, patient services, education and networking, and provides small grants to support their innovative programs.
- ACS has facilitated government-level comprehensive cancer control planning in several countries of the region, including Mexico, Brazil, Peru, Nicaragua and Uruguay.
- ACS has held a Comprehensive Cancer Leadership Forum (CCCLF) on two occasions in the region, in which policy makers and NGOs held discussions and drafted plans for cancer control change.
- ACS has supported tobacco control initiatives throughout the region through fellowships, grants, regional forums and technical assistance in advocacy efforts to create and enforce smoke-free and taxation policies.
- ACS has launched innovative pilot projects in selected countries of the region, with the potential for region-wide replication, including a pilot patient navigation program with the Mexican National Cancer Institute, designed to help with non-medical issues such as transportation, economic relief, family counseling and housing, and Brazil Breast Cancer Action, a 3-year, $6 million USD program aimed at increasing the impact of breast cancer civil society in the country.