11
The need to build on recent progressof Red Nacional Acuerdo Contra el Cáncer in
Ecuador. Stomach cancer, a type that is linked
to unhealthy diets,^16 also has a high incidence
in the region.Time for results
Overall, incidence rates for all cancers in the
12 Latin American countries surveyed are
relatively low: only one of the 12 countries,
Uruguay, is in the top 50 countries for the
age-standardised cancer rate in 2018, at 263.
cases per 100,000 per year.^17 However, relative
to incidence, mortality rates in Latin America
are disproportionately high.^18 The M:I ratio
is a simple metric used to assess the overall
efficiency of cancer management. It relies on
the assumption that, given a similar cancer
load, a country with a more successful cancer-
control programme will see fewer deaths.^19
This broad metric, which considers all cancers
together, may mask the inherent differences
in cancer management efficiency possible for
different types of cancer. Better healthcare
systems overall have been associated with
better M:I ratios.^20 Based on the M:I ratio, the
LAC region is the third worst after Africa and
Asia, and above Europe, North America and
Oceania.But there are stark disparities within the
group of 12 countries examined in this report.
Bolivia’s M:I ratio is similar to that of Africa.
Conversely, the ratios of Colombia, Brazil,
Costa Rica and Mexico are between those of
Europe and North America. But as incidence(^16) F Bray et al., “Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries”, CA: a
Cancer Journal for Clinicians, 2018.
(^17) World Cancer Research Fund International. Global cancer data by country: exploring which countries have the highest cancer rates, 2018.
(^18) MP Curado and DL Bezerra de Souza, “Cancer Burden in Latin America and the Caribbean.” Annals of Global Health, 2014.
(^19) The Economist Intelligence Unit. “Cancer control, access and inequality in Latin America: a tale of light and shadow”, 2017.
(^20) Eunji Choi et al., “Cancer mortality-to-incidence ratio as an indicator of cancer management outcomes in Organization for Economic Cooperation
and Development countries”, Epidemiology and Health, 2017.
is higher in the latter, mortality appears to be
comparatively higher in LAC. As an example,
Andre Cezar Medici, senior health economist
at the World Bank, explains, “mortality by
cancer in Brazil is higher than it could be due
to structural problems such as late detection
and small coverage of preventive measures
and early treatment, especially for the poor
and the SUS-dependent population [the
population depending on the Sistema Único
de Saúde, the country’s publicly funded
healthcare system].”
An examination of survival data, a key metric
of effectiveness of cancer management, shows
that for most of the countries analysed there
is still a way to go. For Raul Murillo, director
of the Javeriana University Oncology Centre
in Bogotá, Colombia, looking at outcomes
such as survival is fundamental, “In Colombia,
survival has in some cases decreased. We may
be excellently prepared, but we need results.”
Survival data are not available for some
of the countries, namely Bolivia, Mexico,
Panama and Paraguay. Then, in most cases,
Latin American countries are lagging behind
reference countries the US and the UK.
And again, disparities within the region are
noticeable. For example, Costa Rica has a
survival rate higher than the UK for breast
cancer, but Colombia’s rate is much lower
than the UK’s. Chile has a significantly lower
survival rate for lung cancer than the other
countries. The survival rate of colon cancer in
Costa Rica is almost double that of Colombia.