Today is World Cancer Day.
Cancer is #2 among the leading causes of death in both the United States and the world. Approximately 75% of cancer deaths occur in low- and middle-income countries, countries where the number of cases is also rising most rapidly. Never are the medical and ethical dilemmas in mission medicine more difficult than when dealing with questions of cancer. Even if the surgical and laboratory resources exist in a mission country to diagnose a person’s cancer, the medications, radiology services, and specialized surgery to treat a diagnosed cancer may not exist, or may be too expensive for a person to afford.
If there is no health insurance and no “discretionary income”, money to diagnose and treat a cancer must come at the expense of other necessities of life for a patient and their family. As with so many things in mission medicine, when you stop focusing entirely on what can’t be done you begin to see everything that is possible to improve the lives of your patients.
30-50% of cancer is preventable and that just happens to be the very best approach to cancer. Advice such as to avoid tobacco and alcohol, as well as obtaining any available vaccines which can help prevent infection-associated cancers (such as for hepatitis B and human papilloma virus), are vital in reducing a person’s risk for cancer. Secondly, if you are seeing a patient in a mission hospital with cancer, you investigate any possible sources of care for their disease in the country and talk with the patient about realistic expectations so that they can make good decisions. Thirdly, regardless of what is medically possible and what a patient decides, you walk with them where life takes them and continue to do whatever you can to treat disease and to provide comfort.