Imaging: towards a global solution to overcome the cancer pandemic
Journal – The lancet oncology
Article type – Opinion
Publication date – Mar – 2021
Authors – Isabelle Borget, Nathalie Lassau, Corinne Balleyguier, Aurélie Bardet, Fabrice Barlesi
Keywords – IMAGINE, LMICs, oncology
Open access – Yes
Speciality – Health policy, Surgical oncology
World region Global
Language – English
Submitted to the One Surgery Index on March 19, 2021 at 10:11 pm
In The Lancet Oncology, Hedvig Hricak and colleagues present a wide and rich review of cancer imaging in low-income and middle-income countries (LMICs).1 This Lancet Oncology Commission on medical imaging and nuclear medicine includes an inventory of resources, identification of needs, and a tightly argued call to action.
The UN has defined global health and access to care as a target for sustainable development.2 In the meantime, the burden of cancer is increasing worldwide and is higher in LMICs than in high-income countries (HICs), with these countries experiencing a greater share of global cancer deaths (57·3% for Asia and 7·3% for Africa) than the share of global cancer incidence (48·4% and 5·8%, respectively).3, 4 However, the proportional level of care for cancer remains low in LMICs.
To provide insights on access to imaging, the IMAGINE (the International Atomic Energy Agency Medical imAGIng and Nuclear mEdicine) global resources database was developed. It has allowed demonstration of high disparities between countries and a paucity of imaging resources in LMICs with, for example, one CT scanner for 1 694 000 people in LMICs versus one for 25 000 people in HICs.
Because insufficient or no access to imaging causes delays in diagnosis, cancer survival in LMICs is still worse than in wealthier countries: more people are diagnosed in LMICs when their cancer has already spread and more people receive less intensive or effective treatment than in HICs. Hence, imaging is an essential step towards staging and better cancer care. Surgical, chemotherapy, and radiotherapy management cannot be optimised without an appropriate imaging plan. Like previous studies,5, 6 the present analysis reveals the potential benefits of scaling up imaging modalities in cancer management by improving 5-year survival.
Hricak and colleagues show the synergy between imaging, treatment, and quality of care for cancer management, and the individual effects are not additive.3, 7 Their microsimulation model demonstrated that simultaneous expansion of imaging, treatment, and quality of care would avert 9 549 500 deaths worldwide between 2020 and 2030, but four times fewer deaths (2 463 500) would be averted with the scale-up of imaging alone. Earlier diagnosis and optimal staging of cancer are efficient8 because treatment for earlier cancer stages is more effective and less costly than treatment for advanced or metastatic disease.
Hricak and colleagues advocate for an integrated cancer care management approach to avoid fragmented or incomplete delivery of care. The provision of affordable and comprehensive cancer care, including imaging, in LMICs will be most effectively and efficiently accomplished with a coordinated and global coalition (involving governments, civil society, patients, health-care professionals, professional associations, researchers, funders, international agencies, private sector, and innovators) to scale up targeted and strategic investments.
Now is the right time for LMICs to increase their use of medical imaging and nuclear medicine.
OSI Number – 20961