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Vol. LXIII, No. 20
September 30, 2011

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Knaul Urges World To Close the Cancer Divide

On the front page...

Dr. Felicia Knaul
Quick: What are some of the diseases that most affect the world’s poor? Did HIV/AIDS, malaria or cholera come to mind?

What about cervical cancer? It’s likely that this disease was not near the top of—or even on—your list, even though more than 90 percent of deaths from this cancer occur in low- and middle-income nations. In fact, two-thirds of all cancer deaths in the world are in low-income countries and 80 percent of all avoidable cancer deaths occur in low- and middle-income countries.

Dr. Felicia Knaul, keynote speaker at the Cancer Detection and Diagnostics Technologies for Global Health conference on Aug. 22-23, spoke about some of these misconceptions concerning cancer and the poor and argued that prevention and treatment of cancers in developing nations should be a global health priority. Knaul is director of the Harvard Global Equity Initiative and the secretariat to the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries. Since 2007, she has also endured 16 rounds of chemotherapy and 10 surgeries to treat her stage 2 breast cancer.


Inspired by her experiences, Knaul founded “Cáncer de Mama: Tómatelo a Pecho,” or “Breast Cancer: Take it to Heart” (literally, “take it to breast”). The non-profit organization promotes research, advocacy, awareness and early detection initiatives for breast cancer throughout Latin America, whose poor women bear a great burden of this disease.

The conference was organized by the Fogarty International Center and NCI and attracted 500 attendees from diverse fields including public health, engineering and private industry. It focused on low-cost diagnostic technologies that have the potential for narrowing global disparities in treatable cancers.

“Harnessing technologies today, combined with communication and information,” said Knaul, “will give local physicians and professional health providers the ability to deal with cancer.”

Conference presenters discussed and demonstrated a number of innovative, low-cost and portable technologies. These included a specially fitted syringe that can biopsy and diagnose Kaposi’s sarcoma and small, paper-based tests that can be read accurately by iPhone. Such easy-to-use devices would be particularly useful in nations where cancer specialists, not to mention doctors, are rare or non-existent.

“We can’t afford not to act,” Knaul exhorted her audience, emphasizing the total global economic costs of cancer death, which reach as high as $943 billion each year

“We can’t afford not to act,” Knaul exhorted her audience, emphasizing the total global economic costs of cancer death, which reach as high as $943 billion each year

Photos: Ernie Branson

Knaul emphasized that not only is cancer a major global health concern, but also many cancers can be prevented or cured in a way that is cost-effective and compatible with other public health initiatives. For example, the mortality rate from cervical cancer in Mexico has plummeted in the last 15 years due to campaigns to promote Pap smears and to educate women about the disease.

“No one would have believed this was possible,” said Knaul. She predicted that as the cervical cancer vaccine becomes more common, this preventable malignancy will become “ghettoized” to poor women with little health care access.

“We can’t afford not to act,” Knaul exhorted her audience, emphasizing the total global economic costs of cancer death, which reach as high as $943 billion each year.

Knaul told the story of a woman named Juanita, a victim of missed opportunities for cancer control. Despite having an obvious breast tumor—and cancer treatment coverage through the Mexican health care system—Juanita did not seek treatment until the cancer had grown so much that she could not use her arm properly.

Juanita inspired Tómatelo a Pecho to lobby for the addition of breast cancer education into the national women’s anti-poverty program. This is an example of a “diagonal strategy,” said Knaul, that grafts cancer awareness and education onto existing anti-poverty, social welfare programs without additional cost. This strategy can improve cancer outcomes through simple interventions that do not require major investment.

Tómatelo a Pecho is now also working with state health ministries in a project funded and led by Mexico’s national health care coverage program to train health promoters and primary care providers in the basics of cancer prevention, detection and care. The hope is that tumors like Juanita’s can be caught earlier and treated more successfully.

“In countries where so many women with breast cancer are being detected at such late stages, we have learned that community health workers can play a key role in ‘downstaging,’” or finding tumors sooner, “even before a woman seeks care from a doctor or a nurse,” said Knaul. “This is not rocket science. It is about sharing basic knowledge, battling cancer and machismo to encourage women to seek care earlier.”

Good surprises can come out of bad events, said Knaul, recalling how butterflies flocked to the brightly colored hats she wore during chemotherapy.

“What this is all about,” she concluded, “is being an optimist and an optimalist—making full use of all the different technologies, information and educational possibilities we have at hand” to improve cancer prevention, detection and treatment around the world. NIHRecord Icon

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