Sunday 7 April is World Health Day. This year the message from the World Health Organisation (WHO) is about ensuring everyone can obtain the care they need, when they need it.
One alarming statistic, according to a new modelling study led by Harvard T.H. Chan School of Public Health, is that nearly half of all childhood cancers are not being diagnosed globally.
The study, published in Lancet Oncology, discovered that in 2015 alone there were 397,000 cases of childhood cancer worldwide, but only 224,000 were diagnosed.
Lead author Zachary Ward, a doctoral student in health policy at Harvard Chan School, said there is a misconception that childhood cancer does not exist in developing countries, and this is due because often cancer registries are non-existent in these countries. If they are, there are significant barriers to successfully diagnosing and recording cases of childhood cancer.
If health systems around the world don’t improve, the report estimates that 2.9 million out of 6.7 million projected childhood cancer cases (43 per cent) will be missed between 2015 and 2030.
Watch a video with the authors.
“Our model suggests that nearly one in two children with cancer are never diagnosed and may die untreated,” said Ward. “This new model provides specific estimates of childhood cancer that have been lacking.”
In the new study, researchers developed a model to simulate childhood cancer incidence for 200 countries and territories worldwide. The model included data from cancer registries in countries where they exist. It also took into account trends in population growth and urbanization, geographical variation in cancer incidence, and health system barriers to access and referral that contribute to underdiagnosis.
The prevalence of undiagnosed cancer cases varied widely across regions, from just three per cent in western Europe and North America to 57 per cent in western Africa, the study estimated. In south Asia, 49 per cent of cases were undiagnosed. The researchers said that 92 per cent of new cases of cancer are occurring in low and middle-income countries, a higher proportion than previously thought.
The authors hope that their findings will help guide health systems in setting new policies to improve diagnosis and management of childhood cancers.
Ward envisages the next steps would be to determine the best way to address the barriers - firstly to primary care and then to specialist referral - so that treatment for all children with cancer can be expanded globally.
“Health systems in low-income and middle-income countries are clearly failing to meet the needs of children with cancer,” said Rifat Atun, professor of global health systems and senior author of the study.
“Universal health coverage, a target of United Nations Sustainable Development Goals, must include cancer in children as a priority to prevent needless deaths,” he said.
“Estimating the total incidence of global childhood cancer: a simulation-based analysis,” Zachary J. Ward, Jennifer M. Yeh, Nickhill Bhakta, A. Lindsay Frazier, Rifat Atun, Lancet Oncology, February 26, 2019, doi: 10.1016/S1470-2045(18)30909-4