By Ambassador Sally G. Cowal
We celebrate International Women's Day March 8. Originally, it was an event to promote equal political rights, including the right to vote, for women. As a Chicagoan I'm proud to say that one of the earliest Women's Day observances was held in that city in 1908!
Today, although women have the right to vote almost everywhere, health inequalities and disparities between women in the developed and developing worlds -- and between men and women in many countries and regions of the world -- continue to exist.
Women's health is important, not only for women, but for men and for families. Women are the caregivers in most places in the world, and when a woman is ill or dies prematurely, her family -particularly her children - carry the burden. That is one of the reasons why it is so important to prevent premature illness and death in women from cancer. Although we think of cancer as a disease that affects people in high income countries, the reality is that 57% of cancer cases and 65% of cancer deaths are in low and middle income countries - that is 5.3 million deaths a year. And the trends point to a continuing shift of the burden to lower income countries.
In addition, the cancer experience in lower income countries is very different from the experience of cancer patients in the US. For example, in the US, 60% of breast cancer cases are diagnosed in the earliest stages of disease, whereas in Brazil only 20%, and in Mexico, only 10% are diagnosed at an early stage. When cancer is caught later, treatment is less likely to be successful. As a result, advances in cancer survival that we have experienced over the last few decades in the US are not reflected in the experiences of people with cancer in lower income countries.
Breast and cervical cancers take many women's lives in developing nations
According to the Globocan database from IARC (the International Agency for Research on Cancer, which is part of the World Health Organization), in 2012, 1.7 million women were diagnosed with breast cancer. This was an increase from 2008 estimates of more than 20% in the number. Breast cancer is the most most common cause of cancer death among women, with 522,000 estimated deaths in 2012. IARC points out that in Western Europe there are more than 90 new cases of breast cancer per 100,000 women annually, compared with 30 per 100,000 in eastern Africa. But breast cancer death rates in these two regions are almost identical, at about 15 per 100,000. Why?
The likely explanations for the differences in incidence are related to differences in risk factors between African women and Western European women. Certain lifestyle factors that can lower risk are more common among African women:
The difference in mortality rates are explained by the fact that the treatment options are scarce in Africa and cancers are diagnosed at a later stage (due to the lack of screening and medical examination).
Cervical cancer is another cancer that has a heavy burden on women worldwide. It's the 4th most common cancer affecting women worldwide, with an estimate 528,000 new cases every year, and 266,000 deaths in 2012. Nearly 70% of the global cervical cancer burden falls to the developing world, and India alone reports 20% of all new cases. In sub-Saharan Africa, 65% of women newly diagnosed with cervical cancer die from the disease. In North America, where more women get cervical cancer screening tests and access to treatment, the rate is 38%.
Improving prevention, early detection, and access to treatment
We can tackle these growing threats on multiple fronts:
Improve access to prevention methods: We must make sure people can get the HPV vaccine, which protects against two of the viruses that causes most cervical cancers. But most developing countries do not have access to the Pap smear, which can find cervical cancer and pre-cancers. The recently-issued World Health Organization Guidelines on cervical cancer instead recommend visual inspection with vinegar (VIA) and follow up treatment immediately with cryotherapy (freezing off any lesions they find). This is known as the "screen and treat approach" and is now widely accepted by public health providers as appropriate and cost effective in developing countries.
Improve access to tests that find cancer early: Cancer treatment is most successful when the disease is caught early. Both cervical cancer and breast cancer have effective screening tests (mammograms and clinical breast exams for breast cancer, Pap tests for cervical cancer), but many women in developing countries cannot get them. Mammography is almost non-existent in the developing world, but we can promote clinical breast exams and breast awareness. We must educate communities about these tests and help countries make them more widely available. The American Cancer Society is helping address this problem by launching the Task Force on Non-Communicable Diseases and Women's Health, composed of leading organizations focused on women's health.
Encourage the lifestyle changes that can help reduce cancer risk: Staying at a healthy weight, getting enough physical activity, eating a healthy diet, and not smoking are important for overall health and can help reduce the risk of some cancers. Weight and physical activity are strongly linked to breast cancer, for instance, while smoking is known to raise the risk of cervical cancer. But prevention and awareness are powerful tools. Individuals can take action toward these goals. Governments and advocates also play a role. Sub-Saharan Africa is home to the fastest-growing rates of tobacco use in the developing world. To fight this rise, the Society is working with partners to create the African Tobacco Control Consortium (ATCC). This group will promote evidence-based tobacco control programs and policies to prevent what could become an epidemic of tobacco-caused death and disease in the region.
Improve access to treatment. Cancer services are extremely limited in many lower income countries due to a lack of funding. We must help deliver cost-effective interventions, like early detection programs and affordable, quality medicines, vaccines and technologies, to all people. The needless suffering of individuals with unrelieved pain is also a major problem due to limited resources. The American Cancer Society Treat the Pain program provides technical support to improve patient access to pain medicines.
Improving attitudes about cancer and its treatment
Talking about cancer is also an important strategy. Fear and stigma prevent people from seeking early detection and treatment. Governments, communities, employers, and media all have a role to play to by creating a culture where people can get good information about cancer prevention, screening tests for early detection, and treatment.
The American Cancer Society works closely with policymakers, non-governmental agencies, cancer control organizations, and other groups and individuals to bring attention to cancer as a global priority that requires an urgent response. Through its global Meet the Targets Project, the Society is working to empower and train advocates and organizations to work within their countries to promote stronger commitments against cancer. Enabling a grassroots advocacy network is key to creating a lifesaving impact on cancer around the globe.
Also, to help reduce the stigma of cancer, the American Cancer Society Relay For Life events are held in more than 20 countries around the world. These events often provide the only opportunity for cancer survivors in many parts of the world to share the message that there is life after diagnosis and provide hope to those who have been diagnosed.
It is appropriate that the American Cancer Society recognize International Women's Day. The American Cancer Society is the largest voluntary health organization in the world, with 3 million grass-roots volunteers, a majority of them women. The grassroots movement began with a women's movement in the years prior to World War II when a virtual army of uniformed women cancer volunteers in communities all over the United States sprung up, mainly to promote awareness about cancer and to offer comfort to those suffering. Lacking much in the way of effective treatment it was about all that they could do. But they are the basis of the volunteers of today who make an incredible difference in the world.
Ambassador Cowal is senior vice president of global health for the American Cancer Society.