The Cold Costs Of Cancer

Marilynn Marchione, AP

Cancer is the world’s top economic killer as well as its likely leading cause of death, the American Cancer Society contends in a new report it will present at a global cancer conference in China. Cancer costs more in productivity and lost life than AIDS, malaria, the flu and other diseases that spread person-to-person, the report concludes.

Chronic diseases including cancer, heart disease and diabetes account for more than 60 percent of deaths worldwide but less than three percent of public and private funding for global health, said Rachel Nugent of the Center for Global Development, a Washington-based policy research group.

Money shouldn’t be taken away from fighting diseases that spread person-to-person, but the amount devoted to cancer is way out of whack with the impact it has, said Dr. Otis Brawley, the cancer society’s chief medical officer. Cancer’s economic toll was $895 billion in 2008 — equivalent to 1.5 percent of the world’s gross domestic product, the report states. That’s in terms of disability and years of life lost — not the cost of treating the disease, which wasn’t addressed in the report.

The World Health Organization has long predicted that cancer would overtake heart disease this year as the leading cause of death. About 7.6 million people died of cancer in 2008, and about 12.4 million new cases are diagnosed each year. Tobacco use and obesity are fueling a rise in chronic diseases, while vaccines and better treatments have led to drops in some infectious diseases.

Many groups have been pushing for more attention to non-infectious causes of death, and the United Nations General Assembly has set a meeting on this a year from now. Some policy experts are comparing it to the global initiative that led to big increases in spending on AIDS nearly a decade ago.

“This needs to be discussed at the UN — how we are going to deal with this rising burden of chronic disease,” said Dr. Andreas Ullrich, medical officer for cancer control at WHO. “The answer is not a fight against each other, but more cooperation on areas that overlap, such as cancers with infectious causes, such as cervical cancer and HPV, human papillomavirus,” Ullrich said.

Any review of priorities is sure to be contentious, though.

The cancer society’s report is the first major effort to look at the economic cost in terms of global productivity. It was done with Livestrong, cancer survivor and cyclist Lance Armstrong’s foundation. Authors plan to publish it in a scientific journal and to present it at a meeting of the World Cancer Congress in Shenzen, China.

Researchers used the World Health Organization’s death and disability reports, and economic data from the World Bank. They calculated disability-adjusted life years, which reflect the impact a disease has on how long and how productively people live. “That has become a more and more common way of looking at the global burden of disease,” said Wendy Max, a health economist at the University of California, San Francisco.

Lung and related cancers account for $180 billion of the $895 billion total. Smokers die an average of 15 years earlier than non-smokers, the report says. Heart disease follows cancer, with an economic impact of $753 billion. “Heart conditions usually hit people towards the end of their life. The cancers struck people much earlier in their life cycle,” said the lead author, cancer society health economist Hana Ross.

In a separate article published online Monday by the British medical journal Lancet, cancer scientists and advocates urged more money to fight cancer in poor countries. Only five percent of cancer treatment and prevention money goes to the countries that bear 80 percent of the burden of the disease, said one of the authors, Dr. Julio Frenk, dean of Harvard’s School of Public Health. “We are literally being victims of our own success” — more people are surviving infectious diseases and living long enough to develop cancer, but treatment gaps remain, he said.

Dr. Lawrence Shulman, chief medical officer of the Dana-Farber Cancer Institute in Boston, said cure rates for breast cancer are 80 percent or more in the U.S. and half that in many other countries. Many treatments are quite affordable “and could be successfully delivered in even the poorest settings,” he said.