Inequity in Cancer Care: A Global Perspective
Human Health Reports No. 3
International Atomic Energy Agency IAEA
Available online PDF [51p.] at: http://bit.ly/lXoG9p
“……….There is enough evidence to assert that people with a lower socioeconomic status experience greater cancer incidence and shorter survival rates after diagnosis. Yet, socioeconomic status, a function of income, education and occupation, does not itself cause cancer or poor outcomes. Rather, it is a marker for the underlying physical and social factors that cause the disease, its recurrence and its eventual outcome.
Lower socioeconomic status can lead to access problems along the entire spectrum of care, starting from early detection issues to the delays in diagnosis after the appearance of initial symptoms. Apart from logistical barriers to access, people of lower socioeconomic status are more likely to remain uninformed about early detection programmes and disease management, including the early signs, symptoms and availability of cancer treatment. Lastly, but certainly not least important, the quality of available care may vary with socioeconomic status .
Health care disparities arise from a complex interplay of economic, social, and cultural factors . It is well known that cancer is a major cause of death throughout the world, second only to cardiovascular diseases. Around ten million new cancer patients are diagnosed every year . The overall incidence of cancer in developing countries is half of that observed in the developed world, and it is increasing rapidly. Site specific cancer survival rates in developing countries are often less than one third of those in the developed world . In contrast, cancer mortality is already comparable between the developing and the developed world.
It would be unrealistic to attempt to find a molecular explanation for the difference in incidence and mortality for most cancers between more and less affluent socioeconomic groups. However, it is likely that many more genetic and epigenetic alterations that have been identified so far are required to complete the process of carcinogenesis. This would eventually explain in molecular terms the demonstrated effect of environmental exposures .
The cost of cancer care is another key issue when addressing cancer disparities. This varies dramatically according to the disease and its stage, and whether curative therapy is to be attempted. There is no doubt that there are enormous limitations in the use of cancer resources in developing countries. Apart from the cost of the treatment itself, cancer management generally requires the participation of a number of trained professionals, who are
The magnitude of socioeconomic differences varies between populations, and over time also within populations . This suggests that identifying factors that influence socioeconomic status and health, and the pathways by which they operate, may be an important public health measure to reduce inequality in health….”
1. INTRODUCTION .
2. DISPARITIES IN CANCER INCIDENCE AND MORTALITY
3. CANCER RISK FACTORS
3.1. Tobacco consumption
3.2. Alcohol drinking
3.3. Nutrition and physical activity
3.4. Sexual behaviour and reproductive health
3.5. Environmental pollution .
4. CANCER SCREENING
4.1. Cervical cancer screening
4.1.1. South and
4.1.4. Breast cancer screening.
4.1.5. Oral cancer screening
5. WOMEN’S CANCER
6. CHILDHOOD CANCER
7. CANCER SURVIVAL
8. ACCESS TO CANCER THERAPY
8.1. Cancer care
8.2. Access to radiation therapy.
8.2.1. Megavoltage radiation units according to population.
8.2.2. Megavoltage radiotherapy units according to cancer incidence
8.2.3. Megavoltage radiotherapy units related to gross domestic product (GDP) .
8.2.4. Provision of brachytherapy .
8.2.5. Inequalities in radiotherapy: Gender issues
8.2.6. IAEA activities in radiotherapy and cancer control
10. POLICY TO ADDRESS INEQUALITY
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