The Stakes are High, the Goal the Same – Overcome Cancer

As a pediatric oncologist, I have sat across from a family and told them the heart wrenching news that their child has cancer. Many families tell me later that this was the worst day of their lives. Although I was the bearer of bad news, I had a strong oncology training, a collaborative team of healthcare professionals with multidisciplinary backgrounds, and the resources to help many families beat cancer.

The U.S. has had many cancer treatment success stories where people can live long healthy lives after a diagnosis. One success story is the treatment of the most common childhood cancer – acute lymphoblastic leukemia, a cancer of white blood cells. Through clinical trials, research, and collaboration, the 5-year survival rate for acute lymphoblastic leukemia in the U.S. increased from 60% in 1975 to about 90% in 2010 for children 0-14 years¹. Unfortunately, where you live affects your cancer diagnosis, treatment, and eventually survival². The 5-year survival for the same type of cancer ranges from 34% in Mongolia to 54% in Columbia. In some places we do not know the survival rate because there are no cancer registries. This is because many developing countries don’t have the trained healthcare professionals, infrastructure, and resources necessary to diagnose and treat cancer.

I joined the Office of International Cancer Control in the Division of Cancer Prevention and Control at CDC as an Epidemic Intelligence Service (EIS) Officer in July 2016. I transitioned from being an oncologist who treats individual patients to an EIS officer at CDC because I want to have a population-level impact in improving cancer outcomes in resource limited settings. Based on current knowledge, we can prevent about 40% of all cancers³. Most preventable cancers are linked to tobacco use, harmful alcohol use, unhealthy diet, and infectious agents (many that are vaccine preventable). I believe that people, regardless of where they live, shouldn’t die of cancers we know how to prevent or treat.

Data is important in population-level cancer control and prevention. Countries need surveillance systems, such as cancer registries, to know who has what type of cancer in order to design and implement effective cancer prevention and treatment plans for their population. Yet high-quality cancer registries cover only 14% of the world’s total population⁴.

For my first project at CDC, I travelled to Jamaica and the Bahamas to provide technical assistance as they established comprehensive population-based cancer registries. Dr. Tamu Sadler-Davidson of the Jamaican Ministry of Health stated, “[Registries are] critically important in taking an evidence-based approach to planning and monitoring some of our programs. We want data to be better able to understand the trends, distribution and causes as it relates to different types of cancers.” Our team made recommendations and shared experiences from cancer registration in the U.S, such as standardizing data collection processes across the country, building support for national cancer surveillance in the public sector as well as the medical community and public health agencies, and using technology to facilitate the timeliness, accuracy, and completeness of cancer data.

For my next project, I participated in The World Health Organization (WHO) Expert Consultation to Scale Up Cancer Care in the Eastern Mediterranean Region in Cairo, Egypt. I learned from colleagues from eight countries the strengths of their public health and healthcare systems, but also areas that could be improved. For example, some places do not have an action plan for preventing, detecting, and treating cancer. Other countries do not have access to medicines or experienced healthcare professionals. In the meeting we discussed what countries can to improve their cancer response and what tools they can use to monitor progress.

Being at CDC and visiting different countries has shown me that surveillance systems such as cancer registries and prevention are key for decreasing the burden of cancer. For example, vaccinating children and adolescents prevents cervical (HPV vaccine) and liver (HBV vaccine) cancers later in life. I look forward to continuing to work with public health professionals, healthcare providers, and families to meet the goal that every child who has cancer lives a long, healthy life. The stakes are high. The goal is the same –overcome cancer.

References

1. Howlader N, Noone AM, Krapcho M: SEER Cancer Statistics Review (CSR) 1975-2013. Bethesda, Md: National Cancer Institute, 2015.
2. Allemani C, Weir HK, Carreira H, Harewood R, Spika D, Wang XS, et al. Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet. 2015 Mar 14;385(9972):977-1010. Epub 2014 Nov 26.
3. Prevention. Cancer control: Knowledge into action: WHO Guide for Effective Programmes, Module 2 (electronic version). World Health Organization 2007.
4. Cancer Incidence in Five Continents, Vol. X (electronic version). Lyon: International Agency for Research on Cancer. Accessed 13 January 2017.