The role of cancer research in noncommunicable disease control

Abstract

Noncommunicable diseases were estimated to claim more than 36 million lives worldwide in 2008. Major contributors to this burden were cardiovascular disease, cancer, chronic respiratory diseases, and diabetes. The United Nations General Assembly held a high-level meeting on noncommunicable diseases in September 2011 for heads of states and governments, conscious of the projected increases in disease incidence, particularly in low- and middle-income countries. This meeting followed the Special Session on HIV/AIDS in 2001, the only other high-level meeting to discuss a health topic and orient the global political agenda toward a growing threat to human development. Proposed strategies for control of noncommunicable diseases focused mainly on the shared risk factors of tobacco, harmful use of alcohol, physical inactivity, and unhealthy diet. However, for cancer, a broader response is required. Notably, the heterogeneity of cancer with respect to its geographical distribution, etiology, and pathology all demand a more nuanced, regional, or even local approach. Preparations for the meeting elicited enormous attention from governments and nongovernmental organizations, but the engagement of the research community was less evident. This commentary calls for the involvement of the cancer research community in response to the further action detailed in the United Nations Political Declaration emanating from the meeting, identifies a number of cancer-specific priorities, including vaccination against hepatitis B virus and human papillomavirus, cervical cancer screening, and early detection of breast cancer, and suggests areas where cancer research can provide the evidence base for cancer control, notably in improving the quality and coverage of cancer registration, elucidating cancer etiology, and evaluating interventions, including their implementation in low-resource health-care settings. Finally, the need for global cooperation in developing a research agenda for low- and middle-income countries is highlighted.

Figure 1.

WHO global strategy for the prevention and control of noncommunicable diseases. Shown are the four major noncommunicable diseases (column 1) under consideration, together with both the shared population (column 2) and individual risk factors (column 3) highlighted in the WHO Global Status Report on noncommunicable diseases 2010 (7).

Figure 2.

Cancer burden in relation to the Human Development Index (HDI). Data adapted from (28). The HDI is composed of three dimensions: health, as measured by life expectancy at birth; education, as measured by years of schooling; and living standards, as measured by gross national income per capita.

Figure 3.

Global map of cancer incidence. A) Liver cancer. B) Colorectal cancer. Data are age-standardized incidence rates per 100 000 per year. Source: GLOBOCAN 2008 (8).