Published on WBUR's Cognoscenti Blog, 7 February 2018 - full commentary here.
“Well, thank God you live in Boston,” my sister said when I called to tell her about my cancer diagnosis over a decade ago.
That was the refrain I heard over and over. People were talking, of course, about Boston as one of our country's medical meccas and centers of innovation. But the somewhat innocuous comment puts a fine point on a pernicious issue: When it comes to fighting and surviving cancer, where you live makes all the difference.
I’ve been thinking about this — my cancer and the luck of my geography — as we mark World Cancer Day this week.
People often don’t realize that cancer is not only "a first world problem." Rather the whole world faces a looming epidemic: Cancer accounts for more deaths globally than HIV/AIDS, malaria and tuberculosis put together, making it a leading global cause of death and disability.
It’s past time we invest in boundary-breaking approaches in research, education and policy to bridge the global gap in care between the world's richest and poorest countries.
But what does that gap look like on a personal level? I work in international development, fostering partnerships between civic organizations and governments. That means I see global inequities of many kinds; but inequities of cancer care were never something I expected to understand so directly.
I recently joined the demographic of cancer survivors who are more likely to be afflicted by another major illness than have a recurrence. Still, I remember well the steps that got me here. Those early dizzying weeks of testing and surgeries, shuttling among specialists around Boston to pinpoint and understand my rare diagnosis, weighing treatment options, navigating insurance and negotiating accommodations with my employer.
Incredibly, some of the world experts in my type of cancer practiced and studied in my hometown. The anxiety of the unknown was tempered by my early diagnosis, a well-researched treatment approach, options for support groups. Most nights I could sleep in my own bed. My husband and I settled into an intense, challenging, but largely good year, with trust in a medical system that cared for us both and continues to do so even a decade later.
By contrast, I have colleagues in rural Tanzania who are seeing those dizzying early weeks turn to months as they struggle to support their teenage daughter, Anne, who was recently diagnosed with cancer. In significantly different circumstances it’s far less clear what her treatment plan will be and her chances of survival are.
My colleagues’ first step was driving hours to get Anne to the one hospital in Tanzania with diagnostic equipment. Then, they had to rely on long-distance consultations with specialists to understand results. While they waited weeks for medications to become available, they scrambled to secure emergency travel papers and passports, since treatment required flying to neighboring Kenya.
Anne’s case is rapidly stretching the resources of local medical support. And her parents are on their own to coordinate her care while finding ways to keep her education going. Even for a family like theirs, with the ability to act quickly and the resources to make choices, the burden cancer is placing on their family is already exponential compared to my experience.
Our two cases illustrate the stark reality of today's global “cancer divide”: While children treated in the U.S. have an 80 percent chance of survival, that number drops to just 10 percent in Tanzania. Outcomes are similar for the 12 million people in low- and middle-income countries who will be diagnosed with cancer this year. Poverty, as both a contributing factor and result of this disproportionate cancer burden, only adds to the complexity of the challenge.
But there’s good news: The cancer divide is neither inevitable nor insurmountable. Just as the international community has achieved great success in addressing the global HIV/AIDS epidemic, so too can we bridge the cancer care chasm. And there is important momentum.
Scientific discoveries and advances in treatment are being accelerated by collaborations that connect researchers in lower- and middle-income countries with colleagues in the U.S. and other wealthy nations. These partnerships bring together the resources (thus far) concentrated in wealthier nations, with the knowledge, content expertise and innovative ideas emerging across the globe. One example: Researchers and clinicians at Mass General, Brigham and Women’s and Harvard Medical School are building on their HIV program experience with counterparts in Botswana to start improving access to cancer care there. Global Oncology, a Boston-based group, built a digital tool to facilitate thousands of globe-spanning partnerships.
These partnerships are also starting to influence policy making on national and global levels. The United Nations' Sustainable Development Goals (SDGs) include incidents of cancer in global measures of progress. And newly compiled data from all U.N. members equips advocates pushing for increased public investment in their countries and holding governments accountable for making cancer care more accessible to all citizens.
Such advances are a promising start to the moral imperative of bridging the global cancer divide so — as with so many things — the place of your birth doesn’t determine the quality or longevity of your life. They promise a day when the cancer care I received is accessible to people like Anne around the globe.