Kamaraju Sailaja, Drope Jeffrey, Sankaranarayanan Rengaswamy, Shastri Surendra
Medical College of Wisconsin, Milwaukee, WI.
American Cancer Society, Atlanta, GA.
Am Soc Clin Oncol Educ Book. 2020 Mar;40:1-12. doi: 10.1200/EDBK_280625.
Rising trends in the incidence of cancer in low- and middle-income countries (LMICs) add to the existing challenges with communicable and noncommunicable diseases. While breast and colorectal cancer incidence rates are increasing in LMICs, the incidence of cervical cancer shows a mixed trend, with rising incidence rates in China and sub-Saharan Africa and declining trends in the Indian subcontinent and South America. The increasing frequencies of unhealthy lifestyles, notably less physical activity, obesity, tobacco use, and alcohol consumption are causing a threat to health care in LMICs. Also, poorly developed health systems tend to have inadequate resources to implement early detection and adequate basic treatment. Inequalities in social determinants of health, lack of awareness of cancer and preventive care, lack of efficient referral pathways and patient navigation, and nonexistent or inadequate health care funding can lead to advanced disease presentation at diagnosis. This article provides an overview of opportunities to address cancer control in LMICs, with a focus on tobacco control, vaccination for cervical cancer, novel tools to assist with early detection, and screening for breast and other cancers.
低收入和中等收入国家(LMICs)癌症发病率呈上升趋势,这给现有的传染病和非传染病防控挑战雪上加霜。虽然低收入和中等收入国家的乳腺癌和结直肠癌发病率在上升,但宫颈癌发病率呈现出复杂态势,在中国和撒哈拉以南非洲发病率上升,而在印度次大陆和南美洲则呈下降趋势。不健康生活方式的日益普遍,尤其是缺乏体育锻炼、肥胖、吸烟和饮酒,正给低收入和中等收入国家的医疗保健带来威胁。此外,发展不完善的卫生系统往往资源不足,难以开展早期检测和提供足够的基本治疗。健康社会决定因素方面的不平等、对癌症和预防保健缺乏认识、缺乏有效的转诊途径和患者引导,以及不存在或医疗保健资金不足,都可能导致在诊断时疾病已发展到晚期。本文概述了低收入和中等收入国家应对癌症控制的机会,重点关注烟草控制、宫颈癌疫苗接种、辅助早期检测的新工具以及乳腺癌和其他癌症的筛查。