Moving the dial on cancer research equity: a Lancet Group commitment

Are we making progress in addressing the global cancer challenge?

The question was put to attendees of the first World Oncology Forum in 2012, and the expert consensus was no, we were not making enough progress. More than a decade later, in very different times, it is worth asking the question once again.

New estimates suggest nearly 10 million people died from cancer in 2022. No country is exempt from its impacts and, according to current projections, cancer will become the global leading cause of premature death in this century. Cancer exerts an extraordinary burden on individuals and societies, with many hidden costs that go beyond the clinical impact of the disease. And yet, more is known about cancer than ever before.

Advances in understanding and technology mean over one-third of cancer cases could be prevented. The recent Lancet Commission on women, power, and cancer suggested that, of the 2.3 million women who die prematurely from cancer each year, 1.5 million lives could be saved by eliminating exposures to key risk factors or via early detection and diagnosis. If all women could access optimal cancer care, a further 800,000 deaths could be prevented.

For the third year running, the theme for World Cancer Day is “Close the care gap”. Gross inequities in access to cancer services remain within and between countries. As a case in point, the 2023 Lancet Oncology Commission on global cancer surgery highlighted stagnation and glaring inadequacies in cancer surgery; “Surgery is not only one of the most cost-effective methods of treatment, but also tends to be more durable for many malignancies. Unfortunately…restricted access to safe, timely, high-quality, and affordable cancer surgical care is a harsh reality”.

While these issues are of global significance, the knowledge base to address them is lacking, and some initiatives can be misdirected. “Most of our evidence is based on research done in high-income countries and large white populations; it typically does not take into account the large variation in global cancer, demography, gender, or the realities of access to care”, said David Collingridge, Editor-in-Chief of The Lancet Oncology, at the World Economic Forum 2024 in an Affiliate Session on “Increasing access to cancer care in low- and middle-income countries (LMICs)”. With more than 35 million new cancer cases predicted in 2050—mostly in countries with a low or medium Human Development Index—local research, direction, and engagement are vital to cancer control efforts.

“For the third year running, the theme for World Cancer Day is ‘Close the care gap’. Gross inequities in access to cancer services remain within and between countries.”

The commercial determinants of cancer also demand our attention. In the EU, smoking accounted for at least a quarter of all cancer deaths between 2000 and 2020. Unveiled at last year’s European Cancer Summit, the new “Time to Accelerate: Together Against Cancer” manifesto calls for, among other things, an adult smoking prevalence of 5% by 2040. “[This] would—if achieved primarily via cessation—contribute most to the overall EU goals to reduce cancer deaths”, stated Andreas Charalambous and colleagues in a recent Comment.

The EU manifesto is a welcome signal amid political U-turns on measures designed to tackle commercial determinants of ill health. In November 2023, New Zealand’s government abandoned plans introduced by the previous administration to outlaw smoking for future generations. “The motivation for this volte-face was inevitably linked to lobbying by the tobacco industry,” say Lancet Oncology editors.

Domination of the research agenda by pharmaceutical companies has also had an impact. As noted by Common Sense Oncology, a focus on new drugs and sophisticated therapies has come at the expense of investigating different approaches to surgery and radiotherapy - both of which can cure more patients than cancer medicines. The Lancet’s latest Editorial explores inadequacies in the cancer research ecosystem in more detail.

There is no sugar-coating the scale of the challenge before us; however, “innovative advocacy can help the push for more equitable cancer care”, says Vania Wisdom, Senior Executive Editor and Oncology Ambassador at The Lancet. She continues, “There exists an opportunity to accelerate cancer control through an equity agenda based on collaborative research that transcends commercial interests and national borders. Many cancer deaths could be averted if research were to be focused on the implementation of treatments and interventions already known to work.”

In this spirit, The Lancet Group has announced oncology as an advocacy priority through our 2024 In Focus initiative; “[We are] renewing our commitment to prioritising innovative research, in all its forms, that directly benefits the lives of cancer patients everywhere.”

Find out more, and explore the content featured in this article below ⤵️

The Lancet Oncology

• The 2023 “Lancet Oncology Commission on global cancer surgery”, by Chandrakanth Ali and colleagues
• “Accelerating progress on EU cancer control”, a Comment by Andreas Charalambous and colleagues
• “World Oncology Forum amplifies its appeal in global fight against cancer”, an essay by Franco Cavalli and colleagues
• “Commercial determinants of cancer”, an Editorial
• “Common Sense Oncology: outcomes that matters”, a Comment by Christopher Booth and colleagues

The Lancet

• The “Lancet Commission on women, power, and cancer”, by Ophira Ginsburg and colleagues
• “Cancer research equity: innovations for the many, not the few”, an Editorial
• “The need for pragmatic, affordable, and practice-changing real-life clinical trials in oncology”, a Viewpoint by Alexandra Leary and colleagues