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Cancer: A New Frontier in Global Health

February 03, 2015

Cancer prevention and treatment in low- and middle-income countries lags a decade or two behind prevention and treatment for communicable diseases, due to low awareness, lack of attention, and insufficient local capacity and infrastructure. But Duke Global Health Institute (DGHI) professor and director of Duke’s global cancer initiative Nelson Chao believes there’s enormous potential to alleviate suffering and save lives through cancer prevention and treatment in these areas of the world. 

DGHI Envisions a Global Cancer Career Path

DGHI leadership recognized the need to focus attention on non-communicable diseases like cancer and cardiovascular disease in order to effectively address the global burden of disease. So, together with the Duke Cancer Institute (DCI), DGHI established the Global Cancer Initiative early last year. 

Chao has found that a major challenge in his work is that few oncologists can envision a career path that includes practice in a global setting. And in fact, no clear cut training path exists for global cancer work. Chao hopes to change this.

The Scope of the Problem

According to Chao, 70 percent of the world’s 7 million cancer deaths occur in low- and middle-income countries, which also will—by 2030—bear the brunt of 27 million new cancer cases and 17 million cancer deaths. 

“The costs of inaction are huge and unperceived,” said Chao, “And there are many opportunities for breakthroughs for those of us interested in advancing the field through research, education and clinical practice.” He characterizes the nascent development of cancer care in the developing world as being at a stage that precedes hope—that cancer patients in these countries tend to not even hope for a successful treatment. He contrasts this outlook with that of patients in the west who can readily access cancer centers with state-of-the art care and who not only hope for, but often expect, a cure.

Addressing Global Cancer, One Center at a Time

Since launching the Global Cancer Initiative, Chao and his colleagues have worked to build a three-site system of education, research and clinical care in the Tata Medical Center in Kolkata, India; the Barretos Cancer Center in Barretos, Brazil; and at the Bugando Hospital in Mwanza, Tanzania, respectively. 

In an interesting education triangle, Tanzanian physicians are being trained at the Tata Institute, while the Institute’s nurses are receiving advanced training at Duke. Global Health Pathway trainee Laura Musselwhite will spend a year doing clinical research on cervical cancer at Barretos. 

And, as Chao describes it, Global Health Pathway trainee Kristin Schroeder is “planting the Duke flag” in cancer care at Bugando Hospital as she works to establish the region’s first pediatric oncology unit. Beyond education, research and clinical care, Chao sees huge untapped potential in the area of cancer prevention, particularly with respect to tobacco control. Tobacco use is a leading cause of several preventable cancers.

Duke and DGHI Are Well-Suited to Take On Global Cancer

The theme of World Cancer Day tomorrow is “Not Beyond Us,” which reflects how Duke Cancer Institute and DGHI view prevention, treatment and ultimately a cure for cancer. “We have existing partnerships, clinical expertise and health professionals who have been cross-trained in global health,” said Chao. “DCI and DHGI are uniquely positioned to address cancer in global settings.”

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70% of the world's 7 million cancer deaths occur in low- and middle-income countries
World Health Organization, February 2015

We have existing partnerships, clinical expertise and health professionals who have been cross-trained in global health. DCI and DHGI are uniquely positioned to address cancer in global settings.

Nelson Chao, director of Duke’s global cancer initiative

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