Aging populations, lifestyle factors, urbanization, smoking, alcohol consumption, increased use of pesticides and fungicides and environmental factors are fueling the growth of cancer worldwide.

Cancer cases are expected to surge 57% worldwide in the next 20 years, an imminent human disaster that will require a renewed focus on prevention to combat, according to the World Health Organization (WHO).

Developing World to be Hard Hit
The World Cancer Report, produced by the WHO and released on World Cancer Day, predicts that the number of cancer cases will rise from an estimated 14 million annually in 2012 to 22 million within two decades. Over the same period, cancer deaths are predicted to rise from 8.2 million a year to 13 million. The developing nations will be disproportionality hit, whereas wealthy nations will struggle to deal with spiralling treatment costs.

It is a disaster scenario which requires more commitment to prevention and early detection. In 2010, the economic cost of the disease worldwide was estimated at $1.16 trillion, and affecting the economies of rich countries. It is well beyond the means of poor ones.

More than 60% of the world’s cases and about 70% of the world’s cancer deaths occurred in Africa, Asia and Central and South America. Estimates say that cancer reduces typical GDP by 2%.

In the developing world, we are only beginning to understand how serious the cancer problem is. Cancers related to the HIV epidemics in developing countries and spread of hepatitis C are also on the rise, but so too is the general age of the population in developing nations.

Today, more people in developing nations have the potential to live long enough to see their grandchildren, something that was not true even a decade ago in many developing economies – but their risk of having cancer is increasing.

As an example, consider India, which is on the verge of a major cancer epidemic.

IARC’s GLOBOCAN project, which tabulates cancer statistics globally, estimated that 14 million new cases were recorded in the world in 2012. A total of 8 million people died of cancer in 2012 out of which 700,000 were in India.

So India has 17% of the world’s population and about 8% of its cancer patients.

One wonders how accurate the figures are, and whether patient reporting was correct.  However, India already has a lower life expectancy and an overwhelming proportion of young people.

Newer methods of diagnosis and cure require significant investment. As technology advances, the cost of diagnosis and monitoring will keep going up. The newer drugs are expensive.

In addition, cancer patients are living longer, which means longer duration of treatment. All this is bad news in a country where most patients must pay for medical expenses out of pocket. There is poor government medical (Health Care) infrastructure and its presence in rural India is very low. 

In men, the leading cancers are lung and oral cancer whereas breast and cervical cancers are the leading killers of women, although both can generally be successfully treated if detected earlier. Unfortunately, awareness is missing in majority of the population.

Lack of awareness of the disease, the high cost of setting up cancer care centers, the psychological stigma of high medicine costs, and a scarcity of specialized oncologists are all obstacles that developing nations, such as India, need to overcome.

GE & Philips are developing low cost imaging equipment for the Indian market but cohesive efforts from both government and private sector is required.

More Oncology Data Needed
In addition, 60 to 70% of cancer patients typically do not respond well to the first line of chemotherapy. This is because the genetic make-up of the tumor makes it resistant to several drugs, but an oncologist can only find out what works through trial and error.
Governments, health care bodies, pharmaceutical associations and pharmaceutical companies will have to play a major role in addressing cancer in the developing world. Rural programs will be especially important in nations such as India, because 65% of the population lives there.

On a positive note, the rise of cancer in India has at least captured the attention of drug makers, both innovators and generic companies. Indian generics companies including Natco Pharma, Sun Pharma, Shipla Medicare and BDR Pharma are working on approaches that will support both trade and government.

The fate of Indian anti-cancer drugs will depend on Indian government policy, on whether it grants compulsory licenses or not.  Public awareness and mass education by the media will be important, as will Investment strategies of private health care companies with specialized Cancer Hospitals in rural areas.

Generic medicines will need to be distributed via health care centers and free detection camps. We have a long way to go in addressing cancer in India and other developing nations, but a cohesive focus should yield positive results.