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ASCO 2019 Annual Meeting

ASCO 2019: Disparities in Prostate Cancer Across the Cancer Continuum

Chicago, IL (UroToday.com) Silke Gillessen, MD, presented on the topic of disparities in prostate cancer globally and across the cancer continuum. She began stating that there is more literature on the disparity for breast cancer than for prostate cancer. The incidence and mortality of prostate cancer varies widely between countries, as seen in Figure 1.

Figure 1 – Differences between countries in incidence and mortality in prostate cancer:


The possible reasons for these differences include:1 
  • Genetic factors causing differences between men of African, Asian, and European ancestry
  • Environmental factors likely to be involved (differences of men of the same ethnicity in different countries)
  • Socioeconomic factors
Radiotherapy is an essential part of cancer treatment, and unfortunately, several African and Asian countries have limited or no access at all to this treatment modality (Figure 2). Additionally, access to cancer drugs varies from country to country, as can be seen in Figure 3. A total of 61% of worldwide cancer sales occur in the US, while only 5% occur in the rest of the world, even though 61% of cancers occur in the rest of the world.

Figure 2 - Access to radiotherapy worldwide:


Figure 3 – Access to cancer drugs:


Notably, the amount spent on cancer care is also substantially different from country to country, and this plays a huge role in the quality of treatment received by patients. 

Unfortunately, the situation in the developing countries will likely exacerbate in the coming years. In many countries, no policies for prevention or early detection exist. The annual rate of new cases of cancer is estimated to increase three times faster in low- and middle-income countries than in high-income countries. In addition to cancer-related to poverty and infection, there is also an increase in cancers associated with increased westernization. Lastly, the reduction of poverty has caused an increase in survival, leading to a higher incidence of cancer cases. Support from governments and policymakers is needed for relevant changes.2

Dr. Gillessen concluded her talk stating that the disparities exist not only between but also within countries. Lower socioeconomic status (SES) in developed countries can lead to problems with access to care across the whole spectrum of the disease. Low SES confers lack of early detection, but also a delay in diagnosis after initial symptoms. Moreover, the quality of care may vary with SES. All these complicate the situation, affecting patient lives worldwide.

Presented by: Silke Gillessen, MD, University of Manchester and The Christie NHS Foundation Trust, Manchester, England 

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, @GoldbergHanan at the 2019 ASCO Annual Meeting #ASCO19, May 31- June 4, 2019, Chicago, IL USA

References:
  1. Chaitoff A, Killeen TC, Nielsen C, et al. Men's health 2018: BPH, prostate cancer, erectile dysfunction, supplements. Cleve Clin J Med. 2018 Nov;85(11):871-880. doi: 10.3949/ccjm.85a.18011Cleve Clin J Med. 2018 Nov;85(11):871-880. doi: 10.3949/ccjm.85a.18011.
  2. Cavalli F. An appeal to world leaders: stop cancer now. Lancet. 2013 Feb 9;381(9865):425-6. doi: 10.1016/S0140-6736(13)60059-8. Epub 2013 Feb 4