Cancer, the fight is not the same for everyone

The February 4th and the world cancer day. The occasion, as for other events of this kind, is to make a balance about what has been done and what still remains to be done. It doesn’t sound redundant to say that much remains to be done: with 10 million deaths a year only cancers kill less than cardiovascular disease. And the personal experience of practically everyone does not disprove the feeling that cancer is everywhere. In the balance, however, what has already been done must also be considered, demonstrating how important it is to continue to commit ourselves at all levels – prevention, research, clinical, political, social – because the results will then come. Although not everywhere yet with the same scope.

Healing and survival

Today more and more we also talk about survival gains and, even, healing. First, however, we must understand the meaning of these words: not as a mere absence of the disease after a certain number of years (in type 5), more properly, as they remember by the Italian Association of Medical Oncology (Aiom) the concept of healing refers to the life expectancy of a cancer patient compared to that of a patient without cancer. Thus, it is said “healed” a person when their life expectancy becomes equal to that of a person of the same age in the general population. Define the survival it is, apparently, simpler, and less misleading. It is a more objective measure but depends on innumerable factors: the type of tumor, the timeliness of diagnosis and access to treatment, the age of the person and their clinical, socio-economic (including any insurance) and lifestyle conditions availability and adherence to screening programs and adequate health facilities. But not only, they add from the American Cancer Society: the attitudes of doctors and patients also count, just as their beliefs and prejudices can make a difference. And many of all of these factors are undeniably determined and in turn influenced by where you live. Of those 10 million dead, 70% did esteem hit low- and middle-income countriesto get the idea.

This premise serves to understand how to interpret survival and mortality data and their evolution over time. If it is indeed possible to observe trends, on the other hand these trends hide inevitable differences, by type of tumor, personal history, availability and possibility of access to treatment. The theme of inequalities it is one of the most sensitive nodes of the health response to health needs. Cancer is certainly no exception and has been chosen for the three-year period 2022-2024 as that of the international campaign of World Cancer Day. “Close the care gap”, is the motto of the Union for International Cancer Control (UICC). As evidence that, despite i progress facts in the fight against cancer the pace is still too different from country to country.

Inequalities in the fight against cancer

Just take a look at data put together by associations, experts and advocacy organisations to become aware of these inequalities (which certainly do not concern only cancer), and not only between the rich and poor areas of the world and usually opposed. For example survival for breast cancer at five years is close to 90% in high-income countries, but does not reach 70% in India and stops at 40% in some areas of Africa. But similar data exist for other tumours: for colorectal cancer the percentages range from 12% in some African areas to around 70% in Europe, North America and Oceania. For cancers with different prognoses in high-income countries – such as colorectal, pancreatic or lung cancer – the available data show that since the 1990s the trend has been clear: reduction in mortality and increase in net survival (ICBP-SURVMARK2, Global Cancer Observatory). Earnings that, more or less universally, can be traced back to the binomial of early diagnosis and research advances, and which have a fairly global trend, albeit with different speeds. But there are also differences within the Western world, they are everywhere, reiterates one reports on the theme of the UICC.

One of the last to bring it to light study published Lancet Regional Health Europe which showed how the socio-economic inequalities affect the cancer mortality rate.

“Everywhere in Europe, people with more low levels of education have higher rates for almost all types of cancers than people with higher levels of education, especially for cancers associated with tobacco or infections”. The Baltic and Eastern European regions are those where the greatest inequalities are found. On average, the authors summarize, about 32% of deaths in the men and 16% in women are associated with inequalities related to education. Which in turn carry more weight depending on where you live: “While society’s most advantaged people are relatively protected against cancer mortality regardless of where they live on the continent – reads again in the paper – for the less advantaged the country of residence has a great importance with respect to cancer mortality”. That is, in other words: being poor and poorly educated weighs more in some countries, while for the more highly educated groups the differences between the various European countries are narrower.

“The neoplasms which are most affected by the social gradient are those of the lung, stomach and uterine cervix – commented the president of Aiom (Italian Association of Medical Oncology, Saverio Cinieri, on the occasion of the World Day against Cancer, emphasizing how prevention, including social prevention, is one of the points in which to invest in the fight against tumours – The more we understand the biological processes, risk factors and health determinants that favor the onset of cancer, the more effective prevention, diagnosis and treatment become. The main risk factors must be tackled, taking into account all the health determinants, including education and socioeconomic status. We need a 360-degree vision, which also includes the uncomfortable conditions of citizens, so as not to leave anyone behind”.