Cancer joins AIDS, malaria as global health issue

The fight against diseases like AIDS, malaria and tuberculosis has made Seattle a center for global health.

Now, increasingly, the battle is including cancer — which might seem ridiculously impossible. Isn’t it hard enough to fight infectious diseases in poor countries? Can we afford to start talking about the diseases like cancer, which we still struggle with in the United States?

"That’s the wrong way of thinking," said Dr. Julio Frenk, dean of the School of Public Health at Harvard University, and former advisor to the Gates Foundation. “We are dealing with people, not with diseases."

Frenk spoke at a conference called, "Global Health and Cancer - a Seattle Perspective," hosted on March 17th by the Fred Hutchinson Cancer Research Center.

He cited two main reasons cancer is on the same page as infectious diseases:

"We are victims of our own success," as drugs, vaccines and other approaches save lives. Those survivors are likely to live long enough to develop cancer. For example, more than 5 million people are now getting life-saving AIDS drugs in Africa — an incredible accomplishment. But that doesn’t mean their health needs are finished. "People’s health problems are broader than single diseases," so efforts in poor countries should focus on building up health-care systems. That includes clinics, diagnostic labs, and other services. Dean Jamison, of the University of Washington, showed how rates of cancer – along with diabetes and lung disease – are rising around the world. One reason is the spread of smoking.

Complicating matters, people who survive with AIDS are more likely than everyone else to develop various cancers. In particular, cancers that are induced by viruses, such as a group called "sarcomas," are more common in HIV-positive populations, said Robert Yarchoan of the National Cancer Institute. Some cancers also are more common among people who’ve survived malaria.

The broader problem is illustrated by this anecdote, says Frenk: Imagine a young woman in Africa who seeks treatment for AIDS. She travels several miles to a clinic, with her mother. She gets anti-HIV drugs and will soon improve. Her mother has breast cancer and is told nothing can be done for her, because this is an AIDS-clinic.

"That’s not the way health systems should operate in dealing with families and communities," said Frenk, a former Minister of Health in Mexico. A single clinic should be able to handle most of their problems, he said.

Frenk says this can be done, even in poor countries, if they get organized and set priorities. He cites Rwanda as successful example. But he also says many countries are not spending enough, as a percentage of their Gross Domestic Product (GDP).

"It might sound strange in the U.S., but in most of the world we are not investing enough" in health and health systems, he said.