29. Health Service Interventions for Cancer Control in Developing Countries

Abstract

Cancers caused by bacterial or viral infections, such as cervical, liver, and stomach cancer, make up a much larger part of total cancer cases in developing countries. This suggests that these cancers are closely associated with the inadequate health care systems and environmental causes found within developing nations. Cancers such as lung, colorectal, breast, and prostate appear at higher rates in developed cultures, a pattern usually attributed to Western living with regard to diet, tobacco use, and other carcinogens. The increasing prevalence of these types of cancer in developing countries may be the result of the introduction of these lifestyle elements into their cultures.

Analyses of the cost–effectiveness of the different stages of cancer prevention and treatment for seven different cancers (cervical, liver, stomach, esophageal, lung, colorectal, and breast) provide important information for policy makers. Primary prevention, such as immunizations and health education programming, proved cost–effective, as did cancer treatment and palliative care intervention. Screening for cancers presented varying results, most proving either cost–effective or uncertain as a result of variable or insufficient data, except liver cancer screening, which was judged to be not cost–effective. While most cost–effectiveness research regarding cancer had been performed in developed countries, it is possible to venture an appraisal of values within developing nations when mitigating factors, such as local availability and costs, are included in its calculation. Only further study of health care technology and programming, health service research, and national economic evaluation can truly indicate the accuracy of cost–effectiveness assessment. Small pilot programs in developing countries would be an ideal entrance into this avenue of inquiry.