Open Letter to Lady Scotland

Posted by On March 30, 2017

The Lancet Oncology, Volume 18, Issue 4: David Weller, Mark Lodge, Tim Eden, David Fleming, Eric Bouffet, Celina Schocken,  Ian Magrath, Jon Rosser, Elize Joubert, Carlos Rodriguez-Galindo, Lynette Denny, Carmen Vallejo-Auste on behalf of the signatories

Full letter can be found here. . .

On Dec 5, 2016, we wrote to Baroness Scotland asking that the issues surrounding cervical cancer in women and endemic childhood cancers could be included on the agenda for the meeting of the Commonwealth Health Ministers in May, 2017. However, we were informed that the agenda for the meeting had been closed. Nonetheless, we believe that the health of women and children is of paramount importance for the welfare and health of the populations of Commonwealth member states, and should be discussed in this prestigious forum. Cervical cancer is either the leading or the second most frequent cancer in women in many of the low-income and middle-income Commonwealth countries (appendix). Cervical cancer is also the easiest and least expensive of all cancers to potentially prevent and detect, and the most likely cancer to be cured if detected early, with consequent reductions in mortality in women. Prevention is key and every Commonwealth country should ideally have appropriate local provision for cervical cancer screening, training of health-care professionals to treat pre-malignant lesions, and a well organised human papilloma virus (HPV) vaccination programme to prevent cervical cancer.

Although less frequent in terms of overall incidence, endemic childhood cancers, such as African Burkitt lymphoma (the most common childhood tumour in sub-Saharan Africa), Kaposi sarcoma, and sporadic retinoblastoma impose a heavy burden on poor communities, yet they are easily curable at affordable costs, if diagnosed early. Despite this, these cancers typically present at an advanced stage, with very high mortality incidence. At present, 60–80% of children with cancer in low-income and middle-income countries die because their cancer is undetected, misdiagnosed, or diagnosed too late for curative treatment. Health-care professionals in Commonwealth countries where infection and cancers of later childhood are endemic should be trained to identify these cases early, with a parallel investment in diagnostic and treatment facilities. Indeed, treatment for these infection-associated tumours with inexpensive generic, off-licence WHO-recommended essential medicines could cure at least 50% of patients in low-income and middle-income countries if cancers are diagnosed early and drugs are available.

The Commonwealth is a unique global community in which individual members have differing levels of expertise in awareness, diagnostics, treatment, and staffing. We urge the representatives of the Commonwealth member states to share their wealth of experience in a discussion at the Commonwealth Health Ministers Meeting (Geneva, Switzerland) in May, 2017, and to consider how to support, either collectively or through international partnerships, the following: the scaling up of existing HPV vaccination and cervical cancer screening services for all affected populations; the establishment of systems to track Commonwealth progress in expanding cervical cancer coverage, and to monitor resource investments; the development of more user-friendly technologies and screening infrastructure, which facilitate the diagnosis and treatment of pre-malignant lesions for cervical cancer in emerging country settings; a research programme to identify a one-dose vaccine that can also address additional HPV pathogens beyond the current HPV 16 and 18 that are relevant for high-incidence regions, and identify and refine models of low-cost approaches to cervical cancer screening that strengthen health systems by using existing knowledge and technologies; improvements in the early detection, diagnosis, and treatment of childhood cancers via raised public awareness of, and professional training in, the early signs of malignant disease; investigation of the links between controlling infectious diseases and cancer incidence in children.

The identification and implementation of innovative cost-effective strategies to prevent and reduce cervical cancer and endemic childhood cancers will benefit all Commonwealth member states. Including cervical and childhood cancer on the meeting agenda will highlight the health issues of women and children, reduce family poverty, and help member states with their aim to control non-communicable diseases in their countries. We are happy to provide further information to support and inform this discussion at the 2018 Commonwealth Health Ministers’ meeting.

We declare no competing interests.