The prediction is dire: Cancer cases around the world are expected to surge 77% by 2050, a new report from the World Health Organization estimates. That attention-grabbing statistic, based on an analysis of 185 countries, cites a growing, aging population and factors including tobacco, alcohol, obesity, and pollution.
Perhaps the most damning part of the report reveals the disparities determined by income. Women living in low-income countries are less likely to develop breast cancer (1 in 27) than if they lived in a wealthier country (1 in 12). But women in poorer nations are far more likely to die of the disease (1 in 48) than if they lived in a high-income nation (1 in 71), since they often lack sufficient access to screening and treatment options.
Aparna Parikh, an oncologist who directs the Global Cancer Care Center at the Mass General Cancer Center, spoke to STAT about what those numbers mean and what can and should be done to change them. “Where you live shouldn’t determine how you get cancer or get diagnosed with cancer or get treated with cancer,” said Parikh, who was not involved in the report.
This interview has been edited and condensed for clarity.
What do you make of the prediction that we will see so many more cases?
Is that striking? Yes. And unsettling? Yes. A 77% increase is alarming, but it’s not necessarily surprising given what we’ve seen around the growing global cancer death burden over and over the last decade. That is going to have an impact on everyone.
What about the disparities noted by the report?
What was the most striking here is the kind of disproportionate impact on less developed countries, not only in terms of proportionality, but absolute burden as well. The mortality that we see in these countries is just stark. It’s our problem for all of us to think through together because these kinds of disparities, as we’re seeing with these numbers, are only getting worse.
What do the cancers with the highest incidence — lung cancer, breast cancer, colorectal cancer — have in common?
For lung cancer, if you have a certain smoking or exposure history, there are low-dose CT scans available. For breast cancer, there is mammography. For colorectal cancer, there is colonoscopy. I think this is where screening does save lives. I think the other take-home from this report is the importance of investment not only on the therapeutic side, but on the screening side.
Is there consensus on screening?
Some of the nihilists in global health will say, well, if you don’t have the systems in place to actually treat the cancer, why should we screen? If you can set up capacity for mammography, or clinical breast exams from a provider, or colonoscopy, which is more resource intensive, but then you don’t have the downstream health systems to treat them, is that ethical?
Do you have an answer?
I think we need to focus on health system strengthening for screening and early detection. And it’s not an option to not think about how we bolster those services when we see numbers like this.
Tell me about your work to change that picture.
From the education side, I co-started a program several years ago where we bring oncologists [from low- and middle-income countries] to Boston for some enhanced training opportunities, based on their career preferences, in terms of what areas they feel they would value-add for how care is delivered.
And outside the U.S.?
In India, I’m working with an organization called Karkinos Healthcare that has a digital platform for screening patients and then navigating patients through care. It is actually a for-profit company, but was generously funded and started by a lot of Indian philanthropists.Through their network, we’re running very practical clinical trials, trials that would not necessarily have a home here, but actually could have a lot of implications for patients there.
Such as?
One example is this concept of immunotherapy. Immunotherapy is very effective for certain tumor types. If you have the right tumor type and right biomarker, where you may respond to immunotherapy, these are patients where stage 4 cancers are cured. But the cost is really prohibitive to give patients immunotherapy in low- and middle-income countries.
There’s some data that you only need a 10th of the dose of immunotherapy to actually get the activity. But the biopharma company here has never invested in studying a 10th of the dose — it doesn’t do them any service to have their drugs sold at a 10th of the amount. And given the compelling data and actually some experience in giving a small dose, we’re looking at clinical trials to study that question. Do you get the same efficacy? We think that if we can show that, then that may have implications, not only in India, but across the world where some of these therapies are unavailable.
You spent time with, and worked with, Paul Farmer, who before his death in 2022 co-founded Partners In Health to deliver high-quality care in resource-poor places. Are there lessons to apply in India, with this organization?
The Partners in Health term is accompagnateur, someone carrying the patient throughout the journey. Given the scale of India and the scale of the population, this Indian organization uses technology to help facilitate the accompaniment of the patient. They’re screening tens of thousands of patients a day and doing risk assessments, and they have invested a lot in community health workers that speak the same languages, but are using digital platforms and technology to help that care delivery process.
How is that working?
Really well. They have astounding retention of care, and navigating patients from a farming village to a tertiary or quaternary care, keeping as much of the care as close to home as possible, minimizing the impact of loss of work for the patients and only putting them where they need to be for certain care if absolutely necessary. That’s all enabled by that sort of tech system.
Other thoughts on the WHO report?
I think it’s really important that these governments prioritize cancer care, but it’s upon us in the global cancer care community to really think about access to affordable care and good quality care, too.