There is no better place to talk about the global impact of cancer, and ways to prevent and treat it, than at the World Economic Forum in Davos, Switzerland.
Cancer, once overshadowed by infectious diseases, especially in lower-income countries, is now a top killer, behind cardiovascular diseases. In 2018, 18 million people were diagnosed with cancer and more than 9 million died of it. That’s the equivalent of the population of Hungary or the United Arab Emirates, or cities like New York or London.
Those are big numbers, with a frightful burden on personal and national health. But there are ways to shrink them.
An important first step is a more intense focus on prevention. It offers a truly cost-effective solution, as somewhere between one-third and one-half of all cancers are preventable. Tobacco smoking, physical inactivity, excess weight, unhealthy eating habits, and heavy alcohol use — all of which are modifiable — contribute to the development of a wide range of cancers.
Infections account for about 15 percent of all cancers. Wider use of vaccines against hepatitis B and human papillomavirus could significantly reduce the global burden of cancer.
Poverty is an often overlooked co-factor for the disease that doctor and author Siddhartha Mukherjee has called “the emperor of all maladies.” Efforts to reduce economic disparities around the world — solutions for which have been proposed at Davos — will have important effects on preventing cancer.
Treatment, of course, is as important as prevention. An amazing explosion of exciting science is setting the stage for us to talk about cures for some particularly prevalent cancers. Immunotherapies and other targeted anti-tumor therapies are in many cases changing the game.
Such advances don’t come out of thin air. My company, Merck (known as MSD outside of the United States and Canada), invested more than $60 billion over the last decade into research on medicines and vaccines related to cancer and other diseases. Other companies are also investing heavily in this kind of work, sometimes building on the work of academic investigators, and other times supported by philanthropic organizations and governments.
The development of these innovative products is just the start. We must now work to improve the precision of their use by finding the types of patients who are most likely to benefit from them. That means innovations in genomics and better understanding of which cancers respond to which kinds of therapies.
It also means being mindful that the vast majority of people around the world aren’t getting their cancer care at renowned cancer centers. In fact, access to cancer care is quite limited in many countries.
That’s why my company and many others have joined with the Union for International Cancer Control for its City Cancer Challenge. Its goal is to create more comprehensive cancer centers in cities, especially in low- and middle-income countries, that lack such facilities as a way to increase the number of people with access to quality cancer treatment. Such centers are already underway in a group of four key learning cities: including Asunción, Paraguay; Cali, Colombia; Kumasi, Ghana; and Yangon, Myanmar. The plan is to extend this work to “challenge cities” with populations of 1 million or more.
In that work, as in drug discovery and development, we must all be mindful that an approach that works in one community may not work in another. That’s why it is so important to keep patients at the center of all work on cancer. They shouldn’t be viewed merely as people who have a disease that needs treatment, but as valuable partners. They can provide important insights into everything from what new drugs are needed to how clinical trials should be conducted and what cancer centers should look like.
At the end of the day, this work is about more than bringing a new lifesaving drug to market or extending the reach of high-quality cancer care. It is about giving people hope and the expectation of a healthier life —two truly wonderful gifts.
Julie L. Gerberding, M.D., is chief patient officer and executive vice president for strategic communications, global public policy, and population health at Merck. She was a panelist for the “Combating Cancer” presentation on Jan. 25 at the 2019 World Economic Forum.
Hmmm. You don’t talk about the need to change patent protections or use of TRIPS agreement. You don’t talk about costliness of super-effective drugs like imatinib and opposition of pharma to wider use by governments like Colombia. Not impressed. Lot of sounds and fury in what you say, little substance. This is a hell of a lot more important than “advances in genomics and precision medicine.”
And on prevention, you mention not smoking but you don’t mention need to curb practices of tobacco sellers including third-world country advertising. We need real solutions not nice words.
Making imatinib and a selection of really great drugs (they aren’t all like that, who cares about the marginal advance drugs) available worldwide and weakening “intellectual property protections” would do a heck of lot more than starting cancer centers in four cities. C’mon!
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