As of today, there are around 43.8 million people around the world who are within five years of a cancer diagnosis, reports the Union for International Cancer Control (UICC). 

Yet data shows that less than 30% of low-income countries have access to the right cancer treatment services – compared to 90% in high-income countries. In fact, an estimated 70% of deaths caused by cancer occur in low-to-middle income countries (LMICs). 

In statistics provided by the UICC as part of its the official #WorldCancerDay campaign marked on 4 February, an estimated 10 million individuals died of cancer in 2020. 

What’s frustrating is that an approximate 30-50% of all cancer cases are preventable, but it is the phenomenal gap in access to cancer care that is proving challenging. For example, 90% of all LMICs do not have access to radiotherapy, an essential method of treating cancer. Furthermore, a mere 5% of global resources for cancer prevention and control are spent in LMICs. 

The Middle East and Africa (MEA) comprises a large percentage of LMICs, and in a new report released by the Swedish Institute for Health Economics (IHE) and the Pharmaceutical Research and Manufacturers of America (PhRMA), new cancer cases in the region are set to double by 2040 – if action is not taken now to change this.

The UICC also states that by 2040, the global demand for cancer chemotherapy will increase from 10 million to 15 million – two-thirds of which is expected to come from patients living in LMICs.

“The number of newly diagnosed cancer cases has been increasing in all MEA countries, partly related to demographic changes and unfavourable trends in major risk factors such as smoking and obesity,” said Thomas Hofmarcher, Health Economist at IHE. “It means that cancer is set to become the number two cause of disease burden in the MEA countries.”

BREAKING DOWN CHALLENGES

Titled 'Cancer Care in the Middle East and Africa', IHE’s report focuses on nine territories – MEA-9 – in the region. They are Algeria, Egypt, Jordan, Kuwait, Lebanon, Morocco, Saudi Arabia, South Africa, and the United Arab Emirates (UAE).

According to the paper, in MEA-9, the annual number of newly diagnosed cancer cases per 100,000 inhabitants has been on the rise since the year 2000. This is attributed to demographic changes, plus an increase in risk factors, such as smoking and obesity. 

Due to demographic development, newly diagnosed cancer cases could double from 410,000 to 720,000 cases per year from 2020 to 2040.

HealthcareITNews explores and breaks down four countries – one from North Africa, one from the Levant and two from the GCC – from the report below. 

EGYPT

Population: 100.4 million

GDP per capita: $12,261

Life expectancy: 71.7 years

Total health expenditure: 4.9% of GDP

Most common cancer types in men: Liver, Bladder, Non-Hodgkin lymphoma

Most common cancer types in women: Breast, Liver, Non-Hodgkin lymphoma

Key prevention strategies: Smoking bans need to be enforced, while rising obesity levels also need to be addressed.

When it comes to early detection of cancer cases in Egypt, one of the main challenges cited is the low level of health literacy amongst the general population, as well as the average level of training amongst primary healthcare professionals who can recognise early symptoms of cancer.

Breast and cervical cancer screening programmes need to be strengthened, while it is recommended that, given rising obesity rates, a colorectal cancer screening programme should be considered and introduced.

Many challenges remain in diagnosis and treatment, including lack of access to the right diagnostic and treatment services and technology.

LEBANON

Population: 6.9 million

GDP per capita: $15,167

Life expectancy: 78.8 years

Total health expenditure: 8.4% of GDP

Most common cancer types in men: Prostate, Bladder, Lung

Most common cancer types in women: Breast, Colorectal, Lung

Key prevention strategies: Smoking bans need to be enforced, while rising obesity levels also need to be addressed.

Predictably, Lebanon’s ongoing economic crisis is the main challenge facing cancer care in the country. An estimated 53% of local citizens do not have access to government or private health insurance schemes.

In terms of early detection, while health literacy is marginally better compared to other territories, it still needs to be improved – the only national awareness campaign is said to be for breast cancer.

As for diagnosis and treatment, the crisis has resulted in the decline of medical professionals, due to moving away from Lebanon due to financial reasons. More medical staff are required. Also, in terms of treatment, those who have health insurance have access to newer drugs than those who do not.

SAUDI ARABIA

Population: 34.3 million

GDP per capita: $48,948

Life expectancy: 74.9 years

Total health expenditure: 6.4% of GDP

Most common cancer types in men: Colorectal, Non-Hodgkin lymphoma, Leukaemia

Most common cancer types in women: Breast, Thyroid, Colorectal

Key prevention strategies: Smoking bans need to be enforced, while rising obesity levels also need to be addressed. Additionally, with cervical cancer being the eighth most common cancer in women, a strategy to roll out a vaccination programme against HPV in children should be considered. An HCV screening programme for adults that offers antiviral therapy should also be considered to eliminate HCV.

In terms of early detection, health literacy can also be improved. The Saudi Vision 2030 promises to improve awareness campaigns. Given rising obesity rates, a colorectal cancer screening programme should also be considered.

The main challenge of cancer and diagnosis and treatment in the Kingdom is access, with cancer care primarily available in Riyadh, Jeddah, and Dammam. Access to care outside of these regions remains limited.

UNITED ARAB EMIRATES

Population: 9.8 million

GDP per capita: $69,958

Life expectancy: 77.8 years

Total health expenditure: 4.2% of GDP

Most common cancer types in men: Colorectal, Prostate, Leukaemia

Most common cancer types in women: Breast, Thyroid, Colorectal

Key prevention strategies: While the UAE was praised by the report for its awareness campaigns – with good collaboration between all stakeholders involved – some challenges remain, including smoking and obesity.

In terms of early detection, health literacy and cultural barriers prevent some communities from seeking medical care when experiencing cancer systems. As a result, non-organised cancer screening programmes could be turned into organised ones.

As for diagnosis and treatment, while the quality of cancer care in the UAE is high, the report states that many cancer patients lack knowledge on where to seek care or how to navigate the healthcare system. In terms of staff, attention should be paid to educational and training programmes in order to keep up with changing technology. 

INEQUALITY IN HEALTHCARE

What’s apparent in the breakdown is the clear correlation between survival and healthcare investment. For example, Kuwait, Saudi Arabia, and the UAE – countries with a high per-capita health spend – have a much higher survival rate than those of Egypt and Morocco.

The UICC also acknowledges this.

“While we live in a time of awe-inspiring advancements in cancer prevention, diagnosis and treatment, many of us who seek cancer care hit barriers at every turn,” the organisation said. “Income, education, geographical location and discrimination based on ethnicity, gender, sexual orientation, age, disability and lifestyle are just a few of the factors that can negatively affect care.

“So, this year’s World Cancer Day’s theme, ‘Close the Care Gap’, is all about raising awareness of this equity gap that affects almost everyone, in high as well as LMICs, and is costing lives.”

HOPE AND OPPORTUNITY

The good news is that the region has the power to improve cancer care in the MEA or MENA region. With investment in treatment and technology, and the region’s younger generations cited as key.

According to the IHC report, a “holistic approach” to cancer care is crucial. This comprises prevention, early detection, diagnosis and treatment, survivorship, and governance. 

“The MEA’s younger population could be the key to advancing efforts to create a stronger cancer care ecosystem,” continued Hofmarcher. “The region’s general demographic structure that sees a mostly constant share of the population in working age in the coming decades is conducive to building a strong economy. 

“This demographic window of opportunity should be used to invest in cancer care, with the investment yielding health returns that reinforce the economy – a situation that results in a positive feedback loop of a healthier society and a healthier economy.”

Samir Khalil, Executive Director for PhRMA Middle East and Africa, added: “In addition to creating a more egalitarian cancer care ecosystem, we need to ensure that governments and health authorities are in receipt of the latest and most accurate clinical information on which to base their policies. 

“Cancer care decisions should be evidence-based, necessitating the generation and use of local data.”

And companies – from multinationals to startups – and local health authorities in the MEA region are working to bring more innovation to cancer care. Just this week, for example, it was announced that Microsoft Arabia and Roche are working together to bring AI solutions for the early diagnosis of cancer to countries including Saudi Arabia, the UAE, Egypt, Oman, Bahrain, Qatar, Lebanon, Jordan, and Syria.

The more stakeholders work together, the better the outcomes for patients throughout the region. 

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Follow the stories around World Cancer Day via the official hashtags #CloseTheCareGap and #WorldCancerDay