Prostate cancer as a global disease

Data presented earlier this week at a press conference in Atlanta, organized in part by the American Cancer Society, to announce publication of the WHO’s 2008 World Cancer Report, suggested that by 2010 cancer would be the single largest cause of death worldwide.

Peter Boyle, MD, PhD, the director of the International Agency for Research on Cancer, is quoted as stating that cancer will take over from “AIDS, tuberculosis, and malaria combined as the main health challenge in low-resource countries.” What are the implications of these projections for prostate cancer world wide?

Much of the publicity surrounding the 2008 World Cancer Report was focused on issues related to the most preventable forms of cancer: smoking is causing millions of cases of lung cancer and other cancers such as bladder cancer every year; sexually transmitted diseases lead to cervical cancer (now largely preventable with appropriate vaccination strategies); and so on.

By contrast, the global problems caused by prostate cancer may have less immediate impact on mortality but will still place vast pressures on health systems around the world. There is little doubt that the Western diets that are being more and more widely adopted are associated with increased risk for prostate cancer, but these same diets also tend to support better childhood nutrition, greater physical strength and endurance, and a host of other quality of life benefits, including the longer life expectancies that increase risk for prostate cancer.

Even the developed countries, with their relatively sophisticated medical systems and highly trained professionals, are unable, as yet, to treat prostate cancer without introducing significant societal and cost burdens associated with the management of the adverse events of surgery, radiation, hormone therapy, and chemotherapy. We can diagnose prostate cancer with relative accuracy, but the process of treatment is still fraught with perils for the individual.

In the developing world, diagnosis is also relatively easy for those members of the population that have high quality health care coverage, but the relative skill levels of the smaller numbers of specialists treating prostate cancer are lower, with an inevitable increase in risk for adverse events of treatment. And even in developing companies, very large segments of the population have minimal or no access to the type of health care that can manage prostate cancer effectively by diagnosing it early and treating it well. So men who do get prostate cancer tend to be diagnosed late, with advanced or metastatic disease, and with a high risk for brief periods of survival and low quality options for palliative care as their disease progresses.

One therefore has to ask oneself whether early detection is appropriate in nations that cannot provide the high quality care needed to manage the hundreds of throusands of men at risk. As just two examples, in the predominantly Black African nations of Nigeria and Kenya, where there is a high ethnic risk for prostate cancer, but limited resources to diagnose and treat it early, is it ethically appropriate today to seek out and diagnose prostate cancer in perhaps millions of men over the next decade, when few of these men will be able to receive the quality of treatment that is liable to cure their disease with low risk for complications?

Prostate Cancer International, Inc. (the owner of The “New” Prostate Cancer InfoLink) has taken the stance that “knowledge is power” and that men and their families around the globe need to know and understand the risks for prostate cancer so that they can make appropriate decisions in their own best interests. This is why we have already made sites like Prostate Cancer Africa, Prostate Cancer Caribbean, and El Cáncer de Próstata en Latinoamérica available for the populations of these regions. But knowledge needs to be augmented with access to appropriate, high quality care, and this will be a harder challenge to address, particularly in those nations that have limited financial resources to fund the development of a sophisticated medical infrastructure.

As Prostate Cancer International continues to develop, one of our priorities will be to assist in the development and support of health care systems around the world that can offer the most appropriate quality of care for prostate cancer patients world wide. This is no small challenge, and will require funding efforts that are ill-defined at this time. However, by taking on this specific challenge, we may be able to facilitate development of health care models and mechanisms that will be of value to patients with many other forms of cancer too.

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