Progress and remaining challenges for cancer control in Latin America and the Caribbean - 30/10/15

Doi : 10.1016/S1470-2045(15)00218-1

Kathrin Strasser-Weippl, MD ^a,^b, Yanin Chavarri-Guerra, MD ^b,^c,^e, Cynthia Villarreal-Garza, ProfMD ^h,^j, Brittany L Bychkovsky, MD ^k,^l, Marcio Debiasi, MD ^m,ⁿ, Pedro E R Liedke, MD ^o,^p, Enrique Soto-Perez-de-Celis ^d, Don Dizon, MD ^g,^l, Eduardo Cazap, MD ^q, Gilberto de Lima Lopes, MD ^r,^s, Diego Touya, MD ^t, Joāo Soares Nunes, MD ^u, Jessica St Louis, BA ^b,^e, Caroline Vail, BS ^b,^e, Alexandra Bukowski, BS ^b,^e, Pier Ramos-Elias, MD ^h, Karla Unger-Saldaña, PhD ⁱ, Denise Froes Brandao, MD ^v, Mayra E Ferreyra, MD ^w, Silvana Luciani, MHSc ^x, Angelica Nogueira-Rodrigues, MD ^y,^z, Aknar Freire de Carvalho Calabrich, MD ^aa, Marcela G Del Carmen, MD ^f,^l, Jose Alejandro Rauh-Hain, MD ^g,^l, Kathleen Schmeler, ProfMD ^ab, Raúl Sala, MD ^ac, Paul E Goss, ProfMD ^b,^e,^l,^⁎

^a Centre for Oncology and Hematology, Wilhelminen Hospital, Vienna, Austria

^b The Global Cancer Institute, Boston, MA, USA

^c Hemato-Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico

^d Department of Geriatrics, Cancer Care in the Elderly Clinic, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico

^e Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA

^f Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA, USA

^g Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA

^h Instituto de Cancerología, Centro de Cáncer de Mama, Tecnologico de Monterrey, Monterrey, Nuevo León, Mexico

ⁱ Cátedra CONACYT, Unidad de Epidemiología, Instituto Nacional de Cancerologia, Mexico City, Mexico

^j Departmento de Investigación y de Tumores Mamarios, Instituto Nacional de Cancerologia, Mexico City, Mexico

^k Dana Farber Cancer Institute, Boston, MA, USA

^l Harvard Medical School, Boston, MA, USA

^m Hospital Mae de Deus, Porto Alegre, Rio Grande do Sul, Brazil

ⁿ Hospital Sao Lucas da PUCRS, Porto Alegre, Rio Grande do Sul, Brazil

^o Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil

^p Instituto do Câncer Mãe de Deus, Porto Alegre, Rio Grande do Sul, Brazil

^q Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina

^r Medical Oncology, Centro Paulista de Oncologia and Oncoclinicas do Brasil Group, São Paulo, Brazil

^s Johns Hopkins University School of Medicine, Baltimore, MD, USA

^t Department of Oncology, University of the Republic, Montevideo, Uruguay

^u Hospital do Câncer de Barretos, Barretos, São Paulo, Brazil

^v Universidade Federal de São Paulo, Brazil, São Paulo, Brazil

^w Oncology Department, Maria Curie Hospital, Buenos Aires, Argentina

^x Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA

^y Federal University, Minas Gerais, Brazil

^z EVA—Group Brasileiro de Tumores Ginecológicos, Brazilian Gynecologic Oncology Group, Bahia, Brazil

^aa Clinica AMO, Salvador, Bahia, Brazil

^ab The University of Texas MD Anderson Cancer Center, Houston, TX, USA

^ac Grupo Argentino de Investigación Clínica en Oncología—GAICO, Rosario, Santa Fe, Argentina

^* Correspondence to: Prof Paul E Goss, Avon Breast Cancer Center of Excellence, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Lawrence House, Boston MA 02114, USA Correspondence to: Prof Paul E Goss Avon Breast Cancer Center of Excellence Massachusetts General Hospital Cancer Center 55 Fruit Street Lawrence House Boston MA 02114 USA

Summary

Cancer is one of the leading causes of mortality worldwide, and an increasing threat in low-income and middle-income countries. Our findings in the 2013 Commission in The Lancet Oncology showed several discrepancies between the cancer landscape in Latin America and more developed countries. We reported that funding for health care was a small percentage of national gross domestic product and the percentage of health-care funds diverted to cancer care was even lower. Funds, insurance coverage, doctors, health-care workers, resources, and equipment were also very inequitably distributed between and within countries. We reported that a scarcity of cancer registries hampered the design of credible cancer plans, including initiatives for primary prevention. When we were commissioned by The Lancet Oncology to write an update to our report, we were sceptical that we would uncover much change. To our surprise and gratification much progress has been made in this short time. We are pleased to highlight structural reforms in health-care systems, new programmes for disenfranchised populations, expansion of cancer registries and cancer plans, and implementation of policies to improve primary cancer prevention.

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