PWR Greetings for Cancer Care Symposium

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Health Professionals: Partners in establishing and promoting awareness, prevention and treatment of cancers”
May 31, 2012
Gerardo de Cosio, MD, MPH
PAHO/WHO Representative to Belize

Good morning colleagues in health, ladies and gentlemen. It gives me pleasure to participate in this important Cancer Care Symposium as this is an important global public health problem and a priority for the Pan American Health Organization (PAHO).

World Health Organization (WHO) has published that “Cancer is to a large extent avoidable. Many cancers can be prevented. Others can be detected early in their development, treated and cured. Even with late stage cancer, the pain can be reduced, the progression of the cancer slowed, and patients and their families helped to cope.” But how to reach this level when we all know that cancer treatment and care is very expensive, when there is scarcity of human resources, or the cancer facilities, treatment and diagnosis technology are just simply not there or they are limited.

The WHO has estimated that worldwide each year almost 8 million people die of cancer. Cancer is the second global leading cause of death after cardiovascular disease. I would like to add that each year more people die from cancer than from AIDS, malaria and tuberculosis combined, that is less than 4 million people or half the all cancer deaths.

For examples, PAHO/WHO has estimated that the fatality rate of cancer in Belize, that is of all those who are diagnosed with cancer in the country, 67% will die (74% for males and 61% for females). Despite that there are proven intervention in the world for prevention, diagnosis, treatment and care, these services are not widely available everywhere. Unfortunately, the majority of all cancer deaths occur in less developed region.

Going back to the fatality rate concept, I would like to mention that in countries where services are available such as the Unites States, the fatality rate is only 39%, which is much lower than in low income countries like Belize.

Many cancers can be prevented. That is move from unhealthy lifestyles to health lifestyles. WHO has estimated that 40% of all cancer deaths are preventable and tobacco and harmful alcohol use are the main risks to address. Then why we just say no to tobacco use and second hand smoking?

If simple measures are taken, they can reduce the risk of developing some form of cancer. For example, overweight and obesity are causally associated with several types of cancer such as esophagus, colorectum, breast, endometrium and kidney. For Belize this is important because believe it or not, about 60% of the Belizean population presents some form of overweight or obesity. So why we don’t eat more fruits and vegetables to maintain a healthy weight? Physical inactivity is a major contributor to the rise in rates of overweight and obesity. Therefore, there is a need to develop more areas for physical activity that are in addition safe, secure and lighted to allow all people of all ages to practice any form of exercise. WHO estimates that raised body mass index and physical inactivity account for an attributable fraction of 19% of breast cancer mortality, and 26% of colorectal cancer mortality. That is if these people would have a normal weight at least 19 out of 100 breast cancer and 26 out of 100 colorectal cancer deaths can be prevented. In addition, the Ministry of Health jointly with PAHO is beginning to coordinate a Faces, Voices, and Place project in which with the support of the Government, municipality and the participation of the community, healthy lifestyles will be promoted.
Avoiding excessive exposure to ultraviolet rays (and believe me Belize has plenty of sun, in addition to sand and sea). There are some vaccines available to help reduce cervical cancer such as the use of the human papillomavirus vaccine and hepatitis B for hepatic cancer. I could go on and on listing more risk factors. However, I would like to use the WHO stepwise framework that includes three steps:

1. Where are we now? (know the present state of the problem)
2. Where do we want to be? (policies, define targets and goals, etc.)
3. How do we get there? (identify the steps needed to implement the policy and the program)

The components of cancer as recommended by WHO are prevention, early detection, diagnosis and treatment, palliative care, and policy and advocacy.
Finally, I would like to say that a cancer program has to integrate its efforts within a broaden programs such as the prevention and control of chronic diseases as many of the risk factors to be addressed in cancer will also has a positive effect in the prevention and delay of complications of cardiovascular diseases and diabetes.

Thank you to all of you for this opportunity and I wish you the best of success in the Symposium.