World Cancer Day 2014 “Debunk the myths”

World Cancer Day 2014 (4 February 2014) will build on the success of last year's campaign, by again focusing on Target 5 of the World Cancer Declaration: Reduce stigma and dispel myths about cancer, under the tagline “Debunk the myths”.
World Cancer Day is a chance to raise our collective voices in the name of improving general knowledge around cancer and dismissing misconceptions about the disease. From a global level, we are focusing our messaging on the four myths above. In addition to being in-line with our global advocacy goals, these overarching myths leave a lot of flexibility for members, partners and supporters to adapt and expand on for their own needs.

Myth 1: We don't need to talk about cancer

Truth: Whilst cancer can be a difficult topic to address, particularly in some cultures and settings, dealing with the disease openly can improve outcomes at an individual, community and policy level.

WHEN YOU OR SOMEONE YOU KNOW HAS CANCER

Talking about Cancer

• For most people, a diagnosis of cancer is a life-changing event commonly evoking feelings of shock, fear, anger, sadness, loneliness and anxiety. Talking about cancer to partners, family members, friends and colleagues can help to alleviate these feelings, and yet many people find it difficult. 
• In most settings, cancer remains taboo and people with cancer are even subject to stigma and discrimination that may stop them from admitting they have cancer. 
• Negative public perception of cancer can stifle informed public discussion and perpetuate a cycle of fear and misinformation that hinders raising awareness about cancer prevention and the importance of early detection. Countering cultural barriers against speaking about cancer and contesting misinformation is therefore essential.
• Even within highly engaged communities, the level of knowledge of cancer and the willingness to talk about it with friends and family can be low.  
• There are campaigns that specifically challenge the taboos and embarrassment surrounding some male cancers (prostate, testicular and colorectal cancers) and create awareness of early signs and symptoms.

Cancer Caregiving and Support

• Cancer caregiving can also have an enormous influence on both physical and mental health. Cancer carers – most commonly partners, family members or friends – often receive little information or support, and as a consequence many of them experience emotional distress leading in some cases to depression.
• Providing the right support for both the carer and the person living with cancer can help with coping and improve quality of life. Partners, friends, and family members can help in their own ways, for example, by choosing to join support groups. 
• Support groups can provide a caring and supportive environment for people living with cancer to express their feelings and reduce anxiety and fear as well as a place to share information about cancer treatment options and their side effects.

Cancer and the Workplace

• There is a substantial financial burden associated with cancer patients and their carers both in out-of-pocket expenses and in lost income and benefits.
• For both patients and their carers, receiving support in the workplace can be a significant factor. A supportive approach from employers can reduce anxiety and provide the skills and confidence to deal with cancer at work. Making adjustments such as supporting a phased-return to work can be an important factor in getting people back to work successfully. A job can restore normality, routine, stability, social contact and income.
• In low resource settings, the costs of cancer can be catastrophic for families, with the high costs of cancer treatment and absence from work, impoverishing families.

Cancer, Body Image and Sexual Wellbeing

• The impact on sexual wellbeing is, for many, one of the most devastating consequences of a cancer diagnosis. 
• Issues of body image and sexuality can have a significant impact on partner relationships and in some cases can be the cause of partner rejection. These issues are not restricted to women. Men facing cancer, particularly prostate and testicular cancer, face issues around self-esteem and sexual intimacy as well. 
• The global health community must address the concerns and issues that impact the physical and mental health and wellbeing of cancer survivors and their carers deserves.

“Due to a lack of knowledge, when they hear the word ‘cancer’ they get scared, some hide it and some use traditional medicine until it becomes too late for treatment.”
- A workshop participant from Ethiopia in an interview on beliefs and practices in breast cancer

GLOBAL ADVOCACY MESSAGE: Talking about cancer challenges negative beliefs, attitudes and behaviours that perpetuate myths about cancer, cause fear and stigma and prevent people from seeking early detection and treatment. Governments, communities, employers and media all have a role to play to challenge perceptions about cancer to create a culture where people are empowered to access quality cancer prevention and care.

THE GLOBAL CANCER CONVERSATION

• Cancer constitutes a major challenge to development undermining social and economic advances throughout the world. By 2030, developing countries will bear the brunt of the estimated 21.4 million new cancer cases per year. Yet, there remains limited political will to include cancer control within a global development framework.  
• The staggering risk that cancer poses to economic growth and development is still not recognised despite the fact that we know that this risk can be managed effectively and that a return on investment in health is possible. 
• The cost of cancer is estimated to reach USD 458 billion per year in 2030.
• The World Health Organization estimates that a basic package of cost effective strategies to address the common cancer risk factors (tobacco use, alcohol abuse, unhealthy diet and physical inactivity) would cost only USD 2 billion per year.

“Prevention of NCDs including cancer is a precondition for, an outcome of and an indicator of all three dimensions of sustainable development: economic development, environmental sustainability and social inclusion”
- Global Action Plan on NCDs

GLOBAL ADVOCACY MESSAGE: Investing in prevention and early detection of cancer is cheaper than dealing with the consequences

Myth 2: There are no signs or symptoms of cancer

Truth: For many cancers, there are warning signs and symptoms and the benefits of early detection are indisputable

RECOGNISE SIGNS AND SYMPTOMS

It is important for individuals, communities, health professionals and policy makers to be aware of, and educated in recognising the signs and symptoms for cancer (where possible).

• It is true that early signs and symptoms are not known for all cancers, but for many cancers, including breast, cervical, skin, oral and colorectal cancers, and some childhood cancers, the benefits of early detection are indisputable.
• Awareness is the first step to early detection and improving cancer outcomes. Whilst some of the cancers with the poorest survival rates, such as ovarian and pancreatic cancers, rarely show early warning signs, cancer researchers globally are seeking innovative ways to improve early detection and develop new tests for early diagnosis for these cancers. 
• With few exceptions, early stage cancers are more treatable than late stage cancers.  
• Equipping primary healthcare workers with the appropriate knowledge and tools to recognise the warning signs and symptoms of cancer is essential to reduce the likelihood of misdiagnosis and ensure prompt referral to specialist medical care at an early stage of the disease.
• Strategies for help-seeking behaviour should be encouraged.
• Recognition of early warning signs of some cancers is particularly relevant in low resource settings – it is cost-effective and in some cases does not require any specialist diagnostic technologies. E.g. clinical breast examination (CBE) performed by primary healthcare workers has the potential to detect cancers earlier, particularly in areas where the majority of breast cancers are diagnosed at an advanced stage. 

EARLY DETECTION

Early detection is multifaceted. Strategies that raise awareness about cancer and the importance of seeking care when symptoms are present, along with interventions for early diagnosis have the greatest chance of improving cancer outcomes. 

ACHIEVING EQUITY IN EARLY DETECTION

Achieving equity in cancer early detection and care should be a priority.

• In low resource settings, many cancers are being diagnosed at a late stage due to:
  • A lack of investment in cancer services, particularly at the primary healthcare level.
  • Limited awareness about the value of early diagnosis and the importance of seeking care when signs and symptoms are present, even among health professionals.
  • Proliferation of myths and misconceptions about cancer diagnosis and treatment, as well as stigma, gender and social inequities, can lead individuals to seek alternative care in place of standard treatment or to avoid care altogether. 
• For cervical cancer, studies have shown that even a single screening between the ages of 30 and 40 can reduce a woman’s lifetime risk of cervical cancer by one third.
• For colorectal cancer, there is a wide and growing range of testing options that can be tailored to a country’s resources and burden of disease. 
• The critical issues for all screening programmes are to select the test that is most appropriate for the context in order to achieve high screening coverage, high quality testing and reliable follow up. 

Myth 3: There is nothing I can do about cancer

Truth: There is a lot that can be done at an individual, community and policy level, and with the right strategies, a third of the most common cancers can be prevented.

PROMOTING HEALTHY LIFESTYLES

The conditions in which people live and work, and their lifestyles, influence their health and quality of life.

• Global, regional and national policies and programmes that promote healthy lifestyles are essential to reducing cancers that are caused by factors such as harmful use of alcohol, unhealthy diet and lack of physical activity.
• Tobacco use, the most common risk factor, is linked to 71% of lung cancer deaths and accounts for at least 22% of all cancer deaths. Based on current trends, tobacco use is estimated to kill one billion people in the 21st century.
• Alcohol is a known risk factor for cancer. It is strongly linked with an increased risk of cancers of the mouth, pharynx, larynx, oesophagus, bowel and breast, and may also increase the risk of liver cancer and bowel cancer in women. 
• Overweight and obesity is increasing globally at an alarming rate, including among children and adolescents. Also of concern is the high proportion of overweight people living in low resource settings (two-thirds of the global total). Overweight and obesity is also strongly linked to increased risks of bowel, breast, uterine, pancreatic, oesophagus, kidney and gallbladder cancers.
• Rising rates of obesity will lead to increased cancer rates unless policies and actions are taken to improve people’s diets and levels of physical activity.

GLOBAL ADVOCACY MESSAGE:  The implementation of policies and programmes that support a life-course approach to prevention, and strengthen the capacity of individuals to adopt healthy lifestyles choices can bring about behavioural change, which can help prevent cancer.

Healthy Workplaces

• Organisations of all sizes can create environments that protect and promote the health of their employees, by providing: 
  • 100% tobacco and smoke-free environments
  • Provision of and access to healthy food options
  • Workplace health education programmes and policies that create awareness of cancer risk factors and the importance of early detection.
• Specific efforts are also needed to reduce the global burden of occupational cancer risks.
• The World Health Organization (WHO) estimates that 177,000 cancer deaths each year are related to occupational exposure to selected carcinogens, with one in every three deaths estimated to be caused by asbestos.
• Another known recreational and workplace exposure is ultraviolet (UV) light, usually from the sun.  Exposure to UV light is the main cause of skin cancer.

Myth 4: I don't have the right to cancer care

Truth: All people have the right to access proven and effective cancer treatments and services on equal terms, and without suffering hardship as a consequence.

ACCESS TO CANCER CARE IS A MATTER OF SOCIAL JUSTICE

Disparities in cancer outcomes exist between the developed and developing world for most cancers.

• Patients in low resource settings whose cancer may be curable in the developed world, often suffer and die unnecessarily due to a lack of awareness, resources and access to affordable and quality cancer services.
• Gender inequities in power, resources, culture and inadequate investment at a primary healthcare level restrict women in low resource settings from accessing essential cancer services, e.g. cancer prevention and early detection programmes.
• Over 85% of the 275,000 women who die every year from cervical cancer are from developing countries.
• More than 70% of the 160,000 newly diagnosed cases of childhood cancer worldwide each year lack access to effective treatment. The result is an unacceptably low survival rate of ~10% in some low- and middle-income countries compared to ~90% in some high-income countries.
• Poor and vulnerable populations are unable to afford expensive cancer medicines and treatments, which must often be paid by patients out-of-pocket, pushing families further into poverty.

GLOBAL ADVOCACY MESSAGE Cancer is not just a health matter. It has wide-reaching social, economic and human rights implications, and is a significant barrier to achieving inclusive and equitable development. Inequality is deepening – social and environmental factors and the double disease burden of exposures in many low- and middle-income countries are keeping the 'bottom billion' locked in chronic poverty and threatening national economies.

ACCESS TO EFFECTIVE, QUALITY AND AFFORDABLE CANCER SERVICES IS THE RIGHT OF ALL INDIVIDUALS 

All people should have access, without discrimination, to needed health services, and safe, affordable, and effective medicines and technologies.

“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being”
- Universal Declaration of Human Rights

• In many cases the largest and most unacceptable gap in cancer care is the lack of adequate palliative care and access to pain relief. 
• A short list of medications can control pain for almost 90% of all people with cancer pain including children, yet little to no access to adequate pain treatment is the norm in many countries.
• Inequities in access to cancer services are closely associated with socioeconomic status with poor and vulnerable populations unable to afford expensive cancer medicines, as well as experiencing other obstacles to access such as distance to quality treatment facilities.
• Differences in occupation, gender, ethnicity and in particular education, are also linked with common cancer risk factors e.g. poor nutrition, tobacco use and second-hand smoke, and harmful use of alcohol, regardless of the resource setting.
• In many countries, irrelevant of their resource setting, lack of health insurance and other barriers prevent people from getting access to even basic healthcare. 
• Universal health coverage to ensure that all people have access to health services without financial hardship is a critical component of sustainable development and poverty reduction, and a key element of any effort to reduce social inequities in cancer outcomes.
• There are successful cancer control and care programmes in many low resource settings now in place, using locally appropriate solutions that provide sustainable and equitable cancer services, from prevention to early detection, treatment and palliative care.

According to the World Health Organization (WHO), universal coverage is the hallmark of a government’s commitment to improve the wellbeing of all its citizens.

GLOBAL ADVOCACY MESSAGE Cost-effective interventions must be made available in an equitable manner through access to information and education about cancer at the primary health care level, as well as early detection programmes and affordable, quality medicines, vaccines and technologies, delivered as part of national cancer control plans. Social protection measures, including universal health coverage, are essential to ensure that all individuals and families have full access to healthcare and opportunities to prevent and control cancer. “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being” - The Universal Declaration of Human Rights

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