This review is an abbreviated version of a report prepared for the American Cancer Society Global Health department and EMD Serono, Inc., a subsidiary of Merck KGaA, Darmstadt, Germany, which was released at the Union for International Cancer Control World Cancer Congress in Paris in November 2016. The original report can be found at https://www.cancer.org/health-care-professionals/our-global-health-work/global-cancer-burden/global-burden-of-cancer-in-women.html. Staff in the Intramural Research Department of the American Cancer Society designed and conducted the study, including analysis, interpretation, and presentation of the review. The funding sources had no involvement in the study design, data analysis and interpretation, or preparation of the review.

The global burden of cancer in women has recently received much attention, but there are few comprehensive reviews of the burden and policy approaches to reduce it. This article, second in series of two, summarizes the most important cancer control priorities with specific examples of proven interventions, with a particular focus on primary prevention in low- and middle-income countries (LMIC). There are a number of effective cancer control measures available to countries of all resource levels. Many of these measures are extremely cost-effective, especially in the case of tobacco control and vaccination. Countries must prioritize efforts to reduce known cancer risk factors and make prevention accessible to all. Effective treatments and palliative care are also needed for those who develop cancer. Given scarce resources, this may seem infeasible in many LMICs, but past experience with other diseases like HIV, tuberculosis, and malaria have shown that it is possible to make affordable care accessible to all. Expansion of population-based cancer registries and research in LMICs are needed for setting cancer control priorities and for determining the most effective interventions. For LMICs, all of these activities require support and commitment from the global community. Cancer Epidemiol Biomarkers Prev; 26(4); 458–70. ©2017 AACR.

See related article by Torre et al. in this CEBP Focus section, “Global Cancer in Women.”

This article is the second in a series of two articles on global cancer in women. The first describes the burden and trends of all cancers combined and for seven major cancer sites (breast, cervix, colorectum, liver, lung, ovary, and uterine corpus), which make up about 60% of cancer cases and deaths in women worldwide, as well as substantial disparities in the burden. This article outlines approaches for combating the growing global burden of these cancers and some other cancers.

Interventions to reduce the burden of cancer among women cover a wide spectrum of activities, including those to eliminate or reduce risk factors for cancer or increase access to care for early detection and treatment. In this article, we briefly discuss some of the most important and cost-effective interventions to curb the growing burden of cancer with emphasis in low- and middle-income countries (LMIC). When available, we present the World Health Organization's (WHO) recommendations, as they are likely to be more applicable to LMICs. It should be noted that these recommendations may be different from national recommendations in some countries.

Cancer awareness is a major contributing factor to cancer prevention and improvement in cancer outcomes (1, 2). Although there are variations across countries, cancer awareness in LMICs is generally low (1, 3). For example, only one-third of Chinese smokers know that smoking causes lung cancer (4), and less than 10% of female university students in many countries in sub-Saharan Africa know that excess body weight is a risk factor for postmenopausal breast cancer (3). Cancer awareness in Africa and West and South Asia is likely to be even lower in women, as adult literacy rates in women in these regions are approximately 15%–20% lower than in men (5). Individuals who are informed about cancers and their main risk factors, symptoms, and outcomes may be more likely to avoid unhealthy behaviors, notably smoking (6, 7), and participate in screening programs (when available), pay attention to early signs and symptoms of cancer, or seek care in a timely manner, when necessary, which can lead to improved cancer outcomes (2, 8–11). For example, although >97% of women in Thailand in 2009 were covered by health insurance schemes that provided free access to cervical cancer screening, women with primary/secondary education and women with a bachelor or higher degree, respectively, were approximately 2 and 4 times more likely to participate in cervical cancer screening than those with no formal education (12). As another example, breast cancer awareness may increase proportion of early-stage breast cancers diagnosed (13, 14). Cancer education and awareness can also reduce the stigma that might be associated with cancer in many populations (15–21). This may be particularly important with regard to women's cancers, for which stigma may be associated with removal of female body parts (e.g., mastectomy and hysterectomy) or with sexually transmitted infections (e.g., human papillomavirus infection; refs. 15–20).

Tobacco use is the leading cause of preventable cancer deaths among women worldwide. In many high-income countries (HIC), smoking prevalence substantially increased first among men and 2–4 decades later in women (Supplementary Fig. S1). The smoking-related cancer mortality in each sex substantially rose 3–5 decades after the increase in smoking prevalence in the corresponding sex (22). This pattern is known as the smoking epidemic model. Smoking prevalence among men peaked much more recently in many LMICs than in HICs (e.g., the 1980s in Asia and the 1950s in the USA; ref. 23). Women have not yet begun smoking in large numbers in many LMICs, especially in Asia and Africa (23), with current smoking prevalence less than 5% in most of these countries. However, tobacco companies are increasingly targeting women in these regions and there is some evidence in some LMICs that smoking prevalence is increasing in young women (24, 25). Therefore, implementing effective tobacco control programs can have a substantial impact on keeping women in LMICs healthier, as there is a huge opportunity to avoid the replication of tobacco epidemic (as observed in HICs) and the future surge in the burden of lung cancer and other smoking-related diseases in this group.

The WHO Framework Convention on Tobacco Control (FCTC) is an international treaty outlining measures to control the global tobacco epidemic. It entered into force in 2005 after being approved by 40 states (26). To assist countries in the implementation of the FCTC, the WHO introduced the MPOWER policy package, a set of evidence-based measures aimed at reducing demand for tobacco through taxation, smoke-free areas, monitoring, cessation assistance, education about the harms of tobacco, and bans on tobacco advertising. These measures have already proven to be effective in reducing smoking in several regions of the world (27, 28).

Increasing awareness about the health hazard of smoking is an essential part of any tobacco control program. One way to increase the awareness is to use health warning labels on cigarette packaging. The FCTC recommends health warning labels on both the back and front, covering at least 50% of the pack. (23). Graphic warning labels are more effective than text-only warnings, and using them can even be more important in LMICs, because they can communicate health information directly to people with low literacy and in multilingual countries (29, 30). Many LMICs in the Americas and several in the Middle East and other regions have introduced warning labeling at the levels recommended by the FCTC (Supplementary Fig. S2, ref. 31). However, in a number of other LMICs, there are still no warning labels on cigarette packages or, where they exist, their size does not meet FCTC criteria. Recommended graphic labels can also help prevent the tobacco industry from using the packages as a marketing tool to attract users, especially youth. For example, in 2007, R.J. Reynolds Tobacco started a marketing campaign for Camel No. 9, targeting girls and young women by advertising in the media and using pink fuchsia or minty-green teal colors on a fashionable, trendy black package. This campaign was quite successful in reaching adolescent girls and increasing the desire to smoke among many of them (32). Among other FCTC provisions that can increase awareness about harms of smoking are mass media campaigns [which can reach many people at low costs, see Article 12 of FCTC (33)], especially when they are government-sponsored, and cessation programs (e.g., messaging through quitlines; ref. 34). Studies in HICs and LMICs have shown that increasing awareness about health effects of secondhand smoke could lead to voluntary smoking bans in households of all income levels (7, 35–37).

Taxation in particular has proven to be very effective in reducing smoking, in addition to being cost-effective (38, 39). The WHO recommends taxes amounting to at least 70% of the retail price, but few countries have reached this level (Fig. 1). HICs generally have higher levels of taxation, while many LMICs, particularly in Africa and the Middle East, have lower levels. Nevertheless, there are a few great success stories in LMICs. The “Sin Tax” Reform Law in the Philippines, for example, has greatly increased the total tobacco tax share (by 45% between 2012 and 2014), indexed the tax to inflation, simplified and improved the taxation system (from a four-tier to a one-tier system), and more importantly, was associated with a decrease in smoking prevalence from 30% in 2011 to 25% in 2015 (31, 40). Moreover, this reform has generated significant incremental revenues, a substantial part of which is used to helping finance the Philippines' universal health care program to provide coverage for low-income people (40).

Figure 1.

Tobacco taxation, 2014.

Figure 1.

Tobacco taxation, 2014.

Close modal

Brazil is an example of the successful implementation of comprehensive tobacco control program which has had an effect on female smoking. Female smoking prevalence decreased from 25% in 1989 to 13% in 2008 following a series of tobacco control measures enacted starting in 1986 (41). By 2008, about 43% of once-daily female smokers in Brazil had quit smoking, and current smoking rate among young women aged 15–24 was only 6% (24). Should this progress be sustained, Brazil will have potentially avoided a huge future burden of tobacco-related cancers and other diseases among women. It should be noted, however, that Brazil has struggled in recent years to maintain the gains in tobacco control as a result of tobacco industry's aggressive actions, such as using the domestic legal system to challenge tobacco control measures (42, 43).

In many LMICs, reducing household air pollution can significantly improve public health, particularly women's and children's health, as they generally spend far more time than men at home. For example, a higher female lung cancer death rate in China than France (18.0 and 12.9 per 100,000, respectively) in 2012, despite much lower smoking prevalence among women in China (3%) than France (26%) has been attributed to higher exposure of Chinese women to secondhand smoke and household air pollution from using solid fuels (23, 44). In 2012, 4.3 million deaths worldwide (including 272,000 deaths from lung cancer) were attributable to household air pollution due to cooking and heating using solid fuels (45). Of these deaths, only about 19,000 (<1%) occurred in HICs, while 3.3 million (77%) occurred in LMICs in Western Pacific and Southeast Asia (45). The number of deaths was 1.8 million (41%) in women and 0.5 million (13%) in children (45). Two interventions to reduce household air pollution include providing access to clean fuel, notably liquefied petroleum gas (LPG), or improved solid fuel stoves (46). Although improved stoves could substantially reduce airborne particulate matter (PM) from solid fuels when they replace traditional stoves, few can reduce airborne fine particulate levels below suggested limits for PM with diameter ≤2.5 μm (PM2.5) that can penetrate into the gas exchange regions of the lung (46–48). Consequently, WHO recommends the use of LPG as the primary strategy to improve household air quality (47). However, if providing secure and sustainable access to LPG is not currently feasible in some low-resource populations because of its higher costs (46), providing access to improved solid fuel stoves can be an efficient intermediate step in reducing household air pollution until access to LPG is more widespread (47, 49).

The number of deaths attributable to ambient (outdoor) air pollution is slightly higher in men than in women. Globally, 3.7 million deaths were attributed to this exposure in 2012 (including 402,000 lung cancer deaths), 44% of which (1.6 million) occurred in women, 53% in men, and 3% in children (50). Similar to household air pollution, most ambient air pollution–related deaths occur in LMICs (88%). Some of the major pollutants worldwide are PM, ozone (at ground level), nitrogen dioxide, and sulfur dioxide, but air quality usually is reported as mean concentrations of PM10 (PM with diameter ≤10 μm) and PM2.5 (50). In 2016, the annual PM10 mean concentration (μg/m3) was 25–31 in HICs in Europe and Americas, while it was >100 in LMICs in Asia and Africa and >150 in the Eastern Mediterranean region (51), much higher than the limits suggested by WHO (20 μg/m3), although there is no safe level for PM (52). It should be noted that in rural areas, concentration of most ambient air pollutants may be lower, but the concentration of ozone at ground level may be higher than urban areas (53). Efforts to reduce ambient air pollution and its effects require collaboration between many sectors, including governments. Some activities may include investing in cleaner energy sources; improving traffic and increasing public transportation; improving technology in combustion process and filtration in vehicle engines, industries, residential places, and power production; and monitoring and reporting air pollution (53–55). Awareness should be increased to reduce behaviors contributing to air pollution at the individual level, put pressure on policymakers to act, and limit outdoor activities when air pollution level is high (53, 56).

The prevalence of excess body weight (body mass index, BMI ≥ 25 kg/m2; Fig. 2) and physical inactivity is rapidly increasing in many LMICs (57, 58). From 1975 to 2014, for example, the prevalence of excess body weight among women increased from 12% to 33% in China and from 39% to 64% in Iran (59). Both excess body weight and physical inactivity are more common in women than men (58, 60, 61). In particular, the participation of women in leisure activity and sports is much less than men in many LMICs (62). Overall, 5% of all new cancer cases in women worldwide are attributable to excess body weight (63). Also, 7% of breast cancer deaths worldwide are attributable to physical inactivity; this proportion in both sexes combined is 7% for colon cancer and 6% for all-cancer mortality (63).

Figure 2.

Prevalence of excess body weight (BMI ≥ 25 kg/m2) among women age 18+ years, 2014.

Figure 2.

Prevalence of excess body weight (BMI ≥ 25 kg/m2) among women age 18+ years, 2014.

Close modal

The shift in food supply appears to be the main contributor to excess body weight epidemic worldwide: economic development and increase in average income and availability of low-cost processed foods high in fats, refined starches, and sugar have increased the global consumption of foods high in calories (64, 65). Development and implementation of policies to counteract the influx and marketing of such unhealthy foods is often complicated by opposition from the food industry (66). Reduced physical activity due to urbanization is another contributing factor (64).

A number of studies and interventions in LMICs to promote physical activity, healthy diet, and reduce excess body weight, particularly among children in schools, have shown positive results (67–69), and limited evidence indicates that they are cost-effective ways to prevent chronic diseases, including cancer (70, 71), but most of the interventions have been small-scale. The Academia da Cidade in Brazil, an example of a large-scale community intervention, provides free daily physical activity training and equipment in public parks or plazas since the 1990s and has been used as a model to increase physical activity in some other countries (72). Surveys suggest that not only participation in this program but also even knowing about the program or seeing the trainings are associated with higher physical activity (73), indicating the effect of increasing awareness. Improving the design of urban environments, such as more parks and public transportation density, may also help to increase physical activity at the community level (74).

The same types of policies that have been successful in tobacco control have the potential to substantially reduce unhealthy diet (75). A simulation study in several highly populated LMICs has shown cost-effectiveness of several interventions that are used for tobacco control, including mass media campaigns, [food] labeling, advertising regulations, and taxation, as well as worksite interventions, physician counselling, and school-based interventions, in reducing excess body weight, especially with a multiple-intervention strategy (76). Similar to tobacco products, lower-income populations are more sensitive to changes in the price of foods (77). Therefore, a major strategy to improve diet in LMICs can include increasing the price of high-calorie foods through taxation, and perhaps decreasing the price of healthier food items, at least for low-income groups. Mexico was one of the first countries to implement taxation on nonessential high-calorie foods and sugary beverages at the national level in 2014. Although more research is required on the effects of this intervention, short-term results show an average of 5% reduction in the purchase of taxed foods beyond the expected change in one year, while this reduction was 10% in low-income households (78). A greater decrease was observed in purchases of taxed beverages (up to 17%; ref. 79). Food labels provide information about the content of the food and can increase consumer awareness. There are a number of LMICs, mostly in Latin America and Asia, which have mandatory or voluntary labeling legislation (80). Some countries may modify popular labeling systems to make it more appropriate for the needs of the country. For example, Mexico implemented its own mandatory front-of-pack nutrition label, which was announced in 2014 and came into effect in July 2015, and its effects are yet to be evaluated (81, 82).

The human papillomavirus (HPV) and hepatitis B virus (HBV) vaccines are the only two vaccines that prevent cancer. The HPV vaccine can prevent cervical cancer (83) and probably several other HPV-related cancers, including anal cancer (84). HBV vaccination can prevent HBV-related chronic liver disease and liver cancer (85). Several factors have made vaccination one of the most feasible and cost-effective methods to prevent HPV- and HBV-associated cancers, in particular in LMICs. In just a few visits, the vaccines can be delivered to newborns/infants (HBV) or adolescents (HPV). Also, vaccination is much less costly than diagnostic procedures and treatment of chronic diseases and cancers related to these infections.

HPV vaccination

It is believed that HPV infection is involved in all cervical cancers (86); for the burden of disease, see part I of this series. HPV vaccination is generally recommended for adolescent girls, before they become sexually active. This vaccination can prevent many cervical cancer cases globally (Table 1; Supplementary Fig. S3). A WHO analysis suggests that, out of 179 countries included, HPV vaccination will be very cost-effective in 156 countries (87%), cost-effective in 17 other countries, and not cost-effective in only 6 countries (87); the latter countries are mostly located in the Middle East and have low incidence of cervical cancer (Supplementary Fig. S4). According to this analysis, spending approximately US$ 200 million and 390 million per one birth cohort of 12-year-old girls in Africa and Southeast Asia could prevent 130,000 and 150,000 deaths, respectively, which represents 31% and 36% of 420,000 cervical cancer deaths preventable by HPV vaccination in the same age cohort worldwide (87).

Table 1.

The estimated net cost of HPV vaccination and number of cervical cancer deaths prevented by vaccination of one birth cohort of 12-year-old girls (87)

AreaNet cost (million US$)No. of girls to be vaccinated (millions)Cervical cancer deaths prevented (×1000)% Spending (of all countries' spending)% Prevented deaths (of all countries)
Country income level 
 Low 130 9.7 110 3.2 26.2 
 Lower-middle 670 24.8 200 16.3 47.6 
 Upper-middle 830 17.6 90 20.2 21.4 
 High 2,500 6.1 16 61.0 3.8 
WHO region 
 Africa 200 10.8 130 4.9 31.0 
 Americas 1,200 7.5 56 29.3 13.3 
 Europe 1,100 4.9 17 26.8 4.0 
 Eastern Mediterranean 360 6.2 18 8.8 4.3 
 South-East Asia 390 17.0 150 9.5 35.7 
 Western Pacific 930 11.6 42 22.7 10.0 
All countries 4,100 58.1 420 100 100 
AreaNet cost (million US$)No. of girls to be vaccinated (millions)Cervical cancer deaths prevented (×1000)% Spending (of all countries' spending)% Prevented deaths (of all countries)
Country income level 
 Low 130 9.7 110 3.2 26.2 
 Lower-middle 670 24.8 200 16.3 47.6 
 Upper-middle 830 17.6 90 20.2 21.4 
 High 2,500 6.1 16 61.0 3.8 
WHO region 
 Africa 200 10.8 130 4.9 31.0 
 Americas 1,200 7.5 56 29.3 13.3 
 Europe 1,100 4.9 17 26.8 4.0 
 Eastern Mediterranean 360 6.2 18 8.8 4.3 
 South-East Asia 390 17.0 150 9.5 35.7 
 Western Pacific 930 11.6 42 22.7 10.0 
All countries 4,100 58.1 420 100 100 

From 2013 to 2015, the number of countries that had introduced HPV vaccination in their national immunization program increased from 45 (Supplementary Fig. S2) to 81 (Supplementary Fig. S5; ref. 88, 89), in large part due to an increase in international monetary and technical assistance to LMICs by the Global Alliance for Vaccines and Immunization (GAVI; ref. 90). However, inclusion of HPV vaccination in a national program does not necessarily indicate a high vaccination coverage in that country. For example, in 2014, only 50% of girls aged 13–17 in the United States had received 2 doses of HPV vaccine (91). Nevertheless, available data strongly indicate that high coverage for HPV vaccination is potentially achievable worldwide, including in LMICs, through political commitment, securing financial resources, increasing awareness about cervical cancer and its prevention, and when the program is appropriately designed according to the needs of the community (92, 93). For instance, Bhutan (94), Rwanda (95), and Uganda (96) achieved vaccination coverages of approximately 90% or more in girls. Inclusion of HPV vaccine delivery through schools in HPV vaccination programs, as shown in the above three and some other countries, have been associated with a better vaccination adherence in LMICs (93). Initial guidelines recommended 3 doses of HPV vaccines, but current WHO guidelines have reduced it 2 doses of bivalent or quadrivalent vaccines for girls <15 years (except those who are immunocompromised and/or HIV infected), which reduces the cost and can increase the adherence (97). However, there may be variations in vaccination guidelines across countries. For example, the US Centers for Disease Control and Prevention (CDC) recommends a 2-dose schedule only for the nonavalent HPV vaccine (98).

HBV vaccination

Chronic HBV infection (i.e., persistence of HBsAg for at least 6 months) affects 240 million people, and between 20% and 30% of people with chronic infection will eventually develop cirrhosis and/or liver cancer (99). This infection is associated with about 686,000 deaths (300,000 of which liver cancer; ref. 100), and most of these deaths occur in LMICs (99). HBV vaccination is the most cost-effective measure to prevent HBV infection and its complications (99, 101). In 1992, WHO recommended the inclusion of HBV vaccination in all national infant immunization programs. Since then, almost all countries have followed this recommendation. However, although prevalence of HBV infection is high (>8%) in 28 countries in the WHO African region and 10 countries in the Western Pacific (102), the coverage in many countries in these two regions is not optimal and needs to be improved as a priority (Supplementary Fig. S6). In addition to the importance of securing adequate long-term local or international funding (e.g., through Gavi; ref. 103), improvements in effectiveness of vaccine delivery may increase the coverage. Some of the improvements include increasing the coverage of the vaccine supply chain, increasing awareness about benefits of the vaccination among providers and the general population, and finding ways to increase the number of infants born in facilities that can provide HBV vaccine, as well as the number of infants who are born elsewhere and receive the vaccine soon after birth (104).

There are also some LMICs in Asia and South America that have relatively low HBV infection rates and suboptimal vaccination coverage. These countries will also benefit from an increase in the coverage. For example, despite a moderate HBV infection rate of 2%–4%, it has been estimated that every year 17,000 people in India die because of HBV-related liver cancer (105). This number does not include deaths from more common acute and chronic complications of HBV infection, including acute and chronic hepatitis or liver failure and cirrhosis of the liver. HBV vaccination coverage is less than optimal in several HICs. In 6 European countries (Denmark, Finland, Iceland, Norway, Sweden, and the United Kingdom), where the prevalence of chronic HBV infection is <1% (102), universal HBV vaccination is considered unnecessary, and only high-risk groups and infants born to pregnant women who test positive for HBV infection receive vaccination (106). In those countries, however, many eligible infants (born to mothers with HBV) and infants born to mothers with unknown HBV status (especially among immigrants) may not receive some or any doses of HBV vaccine (106, 107).

The majority of cancers, including breast and cervical cancers, are diagnosed at a later stage in sub-Saharan Africa and other parts of the developing world (108–111). Major contributing factors include lack of knowledge about cancer signs and symptoms, low literacy rates, seeking traditional medicine, delays in referral and diagnosis, absence of local health care facilities (distance), lack of transportation, and unaffordability of care (10, 110, 112–116), which highlight the importance of both increasing cancer awareness in the general public and health care providers and improving access to early detection.

There is strong evidence for the effectiveness of screening for cervical, breast, and colorectal cancers. Generally, cervical and breast cancers are more likely to be diagnosed in younger women, and their incidence rates among women in LMICs are higher than colorectal cancer. For example, the estimated incidence rate per 100,000 among women in Eastern Africa in 2012 was 42.7 for cervical cancer, 30.4 for breast cancer, and 6.1 for colorectal cancer (117). On the basis of the burden and needed infrastructure, cervical cancer screening definitely has a much higher priority in LMICs than breast and colorectal cancer screening; between the latter two, breast cancer screening may have a higher priority (118). However, setting priorities for screening in a given country will depend on the availability of resources and infrastructure and cost-effectiveness of the intervention.

Cervical cancer screening

Cervical cancer screening can reduce cervical cancer incidence and mortality (119, 120). As mentioned in part I of this series, the standard screening method in HICs (based on cytology, or Pap test) has not been as successful in most LMICs due to the lack of appropriate infrastructure and logistics (Fig. 3A). In these countries, screening based on HPV DNA testing or visual inspection with acetic acid, (VIA; screen and treat) could be alternative approaches (121). Currently, WHO recommends screening of women ≥30 years, with priority given to women aged 30–49 years (121). The age range and screening intervals will depend on resources. Although the recommended interval is 5 years after a negative HPV DNA test and 3–5 years after a negative VIA or cytology (121), even screening once in a lifetime could be beneficial (121, 122). Several studies have shown cost-effectiveness of either HPV DNA testing or VIA for preventing cervical cancer cases in LMICs (Table 2; refs. 122–124).

Figure 3.

A, Countries with large-scale cervical (based on Pap smear) and breast cancer screening programs, 2014. B, HPV screening programs using HPV DNA testing and visual inspection with acetic acid, 2015.

Figure 3.

A, Countries with large-scale cervical (based on Pap smear) and breast cancer screening programs, 2014. B, HPV screening programs using HPV DNA testing and visual inspection with acetic acid, 2015.

Close modal
Table 2.

Estimated mean reduction in lifetime risk of cervical cancer (%) following screening, HPV vaccination, or both, versus no interventions, in select LMICs

CountryScreening only (Pap test)aScreening only (HPV DNA test)bVaccination onlycVaccination + screening (HPV DNA test)
Argentina (176) 18.2  52.2 68.6 
Chile (176) 14.2  45.6 60.0 
Colombia (176) 20.8  49.4 67.1 
Peru (176) 19.1  43.0 55.0 
Mexico (176) 16.7  40.3 56.4 
South Africa (123) 14.7 24.8 46.4 59.7 
Uganda (123) 15.1 25.0 51.5 63.7 
CountryScreening only (Pap test)aScreening only (HPV DNA test)bVaccination onlycVaccination + screening (HPV DNA test)
Argentina (176) 18.2  52.2 68.6 
Chile (176) 14.2  45.6 60.0 
Colombia (176) 20.8  49.4 67.1 
Peru (176) 19.1  43.0 55.0 
Mexico (176) 16.7  40.3 56.4 
South Africa (123) 14.7 24.8 46.4 59.7 
Uganda (123) 15.1 25.0 51.5 63.7 

aCytology-based screening for 3 times at ages 35, 40, and 45 years, assuming 70% population coverage for 3-visit testing (first visit: Pap test; if necessary, second: colposcopy and biopsy, third: treatment).

bScreening based on HPV DNA testing 3 times per lifetime at ages 35, 40, and 45, assuming 70% population coverage with 2-visit HPV DNA testing each time (one day for testing, the other for results, and if necessary, treatment).

cVaccination at ages 9–12 years, assuming 70% coverage of the female population with three doses given by age 12.

A number of LMICs had started a national or pilot cervical cancer screening program (Fig. 3B). However, many LMICs have not done so, including several countries in sub-Saharan Africa, especially in Central Africa, where the burden of cervical cancer is the highest. This is probably because of a mixture of having limited resources and infrastructure and lack of sufficient political support. Malawi, a country in Southern Africa in which cervical cancer accounts for 45% of all female cancers (125), has become one of the few African countries with a national cancer screening program due to strong support from the government. Despite an increase in participation of women in cancer screening in Malawi (9% in 2011 to 27% in 2015), however, the participation in this country or other LMICs with a national program is still far below the optimal levels, and many screened women may not receive the required treatment (which is generally cryotherapy) or may be lost to follow-up for a repeat cryotherapy, or when necessary, other treatments (125, 126). In a feasibility study coordinated by WHO in 6 African countries, 39% of the screened women eligible for treatment did not receive cryotherapy for several reasons, including equipment being nonfunctional on the day of screening (126). In addition to governments' commitment to establishing and scaling up cervical cancer screening programs, the following actions could increase the efficiency of the programs: increasing awareness about the screening, providing standardized counselling, active follow-up, ensuring reliable equipment, reducing the lag between screening and treatment, and integrating the screening into routine primary health care to women (20, 126). Implementation research is also needed to increase participation rates and decrease loss to follow-up.

Breast cancer screening

Several HICs have organized opportunistic breast cancer screening programs using mammography. Although a few upper middle-income countries in Eastern Europe and Americas have a breast cancer screening program based on mammography (Fig. 3A), many other LMICs are unlikely to afford such a program with a high coverage/participation rate in the near future (127, 128). There is also limited evidence on cost-effectiveness of mammographic screening in LMICs (129), although there is variation across countries. In its latest position paper, WHO recommends mammography screening for women ages 50–69 years in LMICs only when there is a relatively strong health system and shared decision-making strategies for patients and health care providers meet certain conditions (130). However, in a more recent evaluation, the International Agency for Research on Cancer (IARC) states that mammography is also beneficial for women ages 70–74 years (129). Clinical breast examination may have the potential to be beneficial in LMICs, pending the results of further studies. According to IARC, there is sufficient evidence that clinical breast examination can shift the stage distribution of breast tumors to a lower stage based on three clinical trials and a few observational studies, but the results on its effects on breast cancer mortality in clinical trials are not available yet (129).

Colorectal cancer screening

The various screening modalities (e.g., fecal/blood tests, endoscopies) for colorectal cancer have been discussed in part I of this series. Unlike screening for breast and cervical cancers, there are few countries (all HICs) with organized or opportunistic colorectal cancer screening programs. However, considering the increase in incidence rates of colorectal cancer in countries without screening (131), more countries may consider establishing a colorectal cancer screening program. The implementation of screening programs based on laboratory tests may be more feasible in some middle-income countries, as it reduces the number of people that will need endoscopy (132, 133). For example, a pilot program based on fecal immunochemical test (FIT) every five years and colonoscopy for people with a positive test has been successfully implemented in Lampang province, Thailand; 63% of 127,000 target population were screened and 72% of those with a positive test underwent colonoscopy (133).

About 80% of people with advanced cancer experience moderate to severe pain. Although opioid analgesics such as morphine are a safe, effective, easy to use, and inexpensive means of treating moderate to severe pain in cancer patients (134), LMICs consume <5% of the medicinal opioids despite containing 85% of the world's population (Supplementary Fig. S7), resulting in a large number of cancer patients in LMICs dying with untreated pain (135). This underutilization has a number of causes, including difficulty in obtaining the drugs due to inadequate training of health care providers, legal and regulatory restrictions and supply chain issues, and concerns about diversion, addiction, and abuse. However, with implementing mechanisms for appropriate prescription and delivery of opioids by governments and health care providers and proper training, these barriers can be overcome (134, 136, 137). In Uganda, for instance, the government now makes oral morphine available to patients with cancer at no cost, and nurses with special training in palliative medicine can prescribe morphine; this has improved pain control, especially in rural areas (138, 139).

About 80% of cancer patients may need surgery at least once during their treatment (140) and about 50% may benefit from radiotherapy (141). In LMICs, moreover, surgery is often the only available curative or palliative treatment in the absence of radiotherapy or chemotherapy due to resource constraints (142). However, less than 25% of patients globally will receive safe, affordable, and timely surgery (140), and access to radiotherapy is limited in many LMICs, particularly in Africa and Southeast Asia, where about 30 countries have no radiotherapy services available (Supplementary Fig. S8; refs. 138, 143). Even when radiotherapy equipment is available, it may not be functioning properly (144). Many LMICs may need international assistance to establish sustainable access to radiotherapy equipment. Currently, the main source of assistance is the International Atomic Energy Agency (IAEA), which in collaboration with WHO and some international cancer organizations, works with ministries of health in capacity building, such as training of radiotherapy workforce and the procurement of equipment (145).

The cost of cancer drugs has skyrocketed with the development of new and more effective targeted treatments and immunotherapy (146). The WHO List of Essential Medicines, whose selections are based on public health impact as well as relative cost-effectiveness compared with similar drugs, contains 46 cancer medicines as of May 2015 (146, 147). There are a number of cancer drugs on the list which can be obtained at a relatively low cost; for example, the total cost of generic drugs per patient for treating Burkitt lymphoma in Cameroon, Ghana, and Malawi, with a 50% cure rate, is <US$50 (148). However, there are also others that may be cost-prohibitive in lower-income settings and even for equitable access in HICs. Some approaches to make cancer drugs more affordable in LMICs include providing generic drugs, negotiation with pharmaceuticals for lower prices, expansion of health coverage, and increase in involvement in clinical trials (149).

Many LMICs lack a sufficient number of trained specialists to diagnose and treat cancer due to scarcity of local educational opportunities and/or “brain drain”, when highly-skilled professionals emigrate (150). For instance, many countries in sub-Saharan Africa have fewer than one pathologist per million inhabitants (Supplementary Fig. S9; ref. 151). When a country lacks sufficient number of oncologists, surgeons and some other health professionals may be responsible for providing cancer care beyond their specialty (142). This indicates that while there is a need for oncologic specialists in places where there are none, some cancer treatments can still be successfully delivered in these settings. Collaborations between local leadership and cancer specialists in other countries have started in several LMICs to deliver cancer care through local physicians and nurses (152, 153). For example, Rwanda is one of the first countries in sub-Saharan Africa that has established a cancer center in a rural area to provide basic imaging, pathology services, surgery, chemotherapy, and palliative care (153). In its first two years of action (2012–2014), the center provided care to 2,326 patients, 71% of whom were women (154). Individuals living outside larger cities in LMICs may need to travel long distances to have access to cancer care, with additional costs of travel, accommodation, and absence from work for patients and people accompanying them (1).

Affordability of cancer care, even when available, is a major issue in LMICs. For example, 81% of cervical cancer cases referred for radiotherapy to a treatment center in Nigeria and 70% of patients who required chemotherapy in a center in Tanzania did not receive the treatment mostly because of financial issues (143, 155). Health insurance plans in many LMICs may cover a relatively small proportion of the population and have high copayments, and they may not cover some cancer care services because of their high cost (134). Establishing publicly funded universal health coverage (UHC) in LMICs is likely to increase access to care even for low-income people (156, 157). WHO recommends taking into account the three dimensions of coverage: proportion of the service cost covered, the number of covered services, and the proportion of covered people (157). There should also be a balance among cancer treatment and preventive and early detection measures. Nevertheless, due to limited resources, providing UHC will be a challenging task in LMICs, especially in lower income countries (154, 158, 159). Discussing these challenges and possible means to overcome them are beyond the scope of this article, but making strong political commitments is the first step to provide UHC. Despite these challenges, a number of LMICs, notably in the Americas and Southeast Asia, are transitioning to provide UHC, and several countries, such as Bangladesh, Brazil, Colombia, Mexico, Peru, the Philippines, and Thailand, have made substantial progress in expanding UHC, although still more improvements are required (40, 156, 157, 160–162).

Cancer registries and vital registrations are an integral part of any evidence-based cancer control programs as they set priorities and assess the effectiveness of such programs. There are variations in the quality of data and coverage (nationwide versus regional) of population-based cancer registries across countries. The IARC and the International Association of Cancer Registries compile high quality population-based incidence data from around the globe and publish these data periodically as the Cancer Incidence in Five Continents (CI5) series. However, only 14% of the world population was covered by the registries included in the latest edition (Volume X, registration period 2003–2007), with a great disparity in coverage between LMICs and HICs: Africa (2%), Asia (6%), Central and South America (8%), Europe (42%), Oceania (78%), and North America (95%; ref. 163). No population-based cancer registries exist in several countries in sub-Saharan Africa and Central Asia (Supplementary Fig. S10; ref. 138). IARC's GLOBOCAN is another valuable source of information, which provides estimates for cancer incidence and mortality by cancer site and sex for all countries (164). However, national estimates for most LMICs are based on information from nonrepresentative regional registries or neighboring countries (164). To improve the coverage and quality of cancer registries in these countries, IARC has recently established the Global Initiative for Cancer Registry Development (165, 166).

Similar to cancer registries, there is wide variation globally in the availability, quality and completeness of death certification. Almost all countries in Africa and many countries in the Middle East and South-Central and Southeast Asia lack vital registration (Supplementary Fig. S11, ref. 138). Of those countries with vital registration most are of low or medium quality and regional (often urban areas) rather than national. Vital registration systems could also collect some other pieces of valuable information. Since 1998, for example, ascertaining smoking history of decedents has been part of routine death notification process in South Africa, which allowed the estimation of tobacco-attributable deaths in the country (167). Another example is the Navrongo health and demographic surveillance system in Ghana, which collects information on smoking and alcohol drinking at the sub-national level (168, 169).

Cancer research has been primarily focused on cancer problems of HICs, and only about 3% of global cancer research funding goes toward projects relevant to LMICs (170). Although many findings from studies conducted in HICs are applicable to LMICs, there are several other unanswered research questions that are specific to LMICs (171, 172). For example, approximately 90% of cases of esophageal cancers in high-risk populations in Asia and Africa are squamous cell carcinomas (SCC), whereas most esophageal cancers in the United States and other western countries are adenocarcinomas (117). While smoking and excess alcohol consumption are responsible for the majority of esophageal SCC in the United States and other western countries, reasons for the high rates of esophageal SCC in parts of Asia and sub-Saharan Africa are unknown (173). The incidence rate of esophageal SCC is 2–3 times lower in women than men in western countries, but in high-risk populations, this cancer almost equally affects men and women (173). There are also opportunities to identify novel risk factors for cancers in LMICs, which may have significant public health implications for cancer control not only in LMICs but also in HICs. For example, Epstein–Barr virus (EBV) was the first virus that was shown to cause human cancer based on evidence from studies of EBV and Burkitt lymphoma in endemic areas of Africa (174, 175). This discovery was made when the causal association between viruses and human cancers was controversial (175), and it has served as a catalyst for identification of other carcinogenic human viruses. LMICs will need more international collaborations and assistance to conduct cancer research and build the required infrastructure.

Cancer is a major public health problem among women in both HICs and LMICs, and there are a number of effective cancer control measures available to countries of all resource levels to combat the growing burden of the disease. Most primary prevention measures are extremely cost-effective, especially tobacco control and vaccination, and they can also substantially reduce the burden of some other common noncommunicable diseases such as diabetes and cardiovascular diseases. Effective treatments and palliative care are also needed for those who develop cancer. However, the use of the newest cancer drugs and technologies may not be feasible in most LMICS due to cost and infrastructure requirements, but there are drugs and technologies that could be adapted in a cost-effective manner to provide effective treatment options. In addition to these needs, the availability of high-quality population-based cancer registries and etiologic, health services, and implementation research are essential for cancer control priority setting and for determining the most effective interventions in a given context. For LMICs, all of these activities may require support and commitment from the global community.

No potential conflicts of interest were disclosed.

1.
Cazap
E
,
Magrath
I
,
Kingham
TP
,
Elzawawy
A
. 
Structural barriers to diagnosis and treatment of cancer in low- and middle-income countries: the urgent need for scaling up
.
J Clin Oncol
2016
;
34
:
14
9
.
2.
Lim
JN
,
Ojo
AA
. 
Barriers to utilisation of cervical cancer screening in Sub Sahara Africa: a systematic review
.
Eur J Cancer Care
2017
.
3.
Peltzer
K
,
Pengpid
S
. 
Awareness of breast cancer risk among female university students from 24 low, middle income and emerging economy countries
.
Asian Pac J Cancer Prev
2014
;
15
:
7875
8
.
4.
Yang
J
,
Hammond
D
,
Driezen
P
,
Fong
GT
,
Jiang
Y
. 
Health knowledge and perception of risks among Chinese smokers and non-smokers: findings from the Wave 1 ITC China Survey
.
Tob Control
2010
;
19
Suppl 2
:
i18
23
.
5.
UNESCO Institute for Statistics
. 
US fact sheet, no. 32: Adult and youth literacy
; 
2015
.
6.
Centers for Disease Control and Prevention
. 
Tobacco use–United States, 1900–1999
.
MMWR Morb Mortal Wkly Rep
1999
;
48
:
986
93
.
7.
Rosen
LJ
,
Myers
V
,
Hovell
M
,
Zucker
D
,
Ben Noach
M
. 
Meta-analysis of parental protection of children from tobacco smoke exposure
.
Pediatrics
2014
;
133
:
698
714
.
8.
Parsa
P
,
Kandiah
M
,
Abdul Rahman
H
,
Zulkefli
NM
. 
Barriers for breast cancer screening among Asian women: a mini literature review
.
Asian Pac J Cancer Prev
2006
;
7
:
509
14
.
9.
Austoker
J
,
Bankhead
C
,
Forbes
LJ
,
Atkins
L
,
Martin
F
,
Robb
K
, et al
Interventions to promote cancer awareness and early presentation: systematic review
.
Br J Cancer
2009
;
101
Suppl 2
:
S31
9
.
10.
Murugan
N
,
Dickens
C
,
McCormack
V
,
Joffe
M
,
Jacobson
J
,
Cubasch
H
. 
Down-staging of breast cancer in the pre-screening era: experiences from Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
.
S Afr Med J
2014
;
104
:
380
.
11.
Honein-AbouHaidar
GN
,
Kastner
M
,
Vuong
V
,
Perrier
L
,
Daly
C
,
Rabeneck
L
, et al
Systematic review and meta-study synthesis of qualitative studies evaluating facilitators and barriers to participation in colorectal cancer screening
.
Cancer Epidemiol Biomarkers Prev
2016
;
25
:
907
17
.
12.
Mukem
S
,
Meng
Q
,
Sriplung
H
,
Tangcharoensathien
V
. 
Low coverage and disparities of breast and cervical cancer screening in Thai women: analysis of national representative household surveys
.
Asian Pac J Cancer Prev
2015
;
16
:
8541
51
.
13.
Sankaranarayanan
R
,
Ramadas
K
,
Thara
S
,
Muwonge
R
,
Prabhakar
J
,
Augustine
P
, et al
Clinical breast examination: preliminary results from a cluster randomized controlled trial in India
.
J Natl Cancer Inst
2011
;
103
:
1476
80
.
14.
Gadgil
A
,
Sauvaget
C
,
Roy
N
,
Muwonge
R
,
Kantharia
S
,
Chakrabarty
A
, et al
Cancer early detection program based on awareness and clinical breast examination: interim results from an urban community in Mumbai, India
.
Breast
2017
;
31
:
85
9
.
15.
Denieffe
S
,
Gooney
M
. 
A meta-synthesis of women's symptoms experience and breast cancer
.
Eur J Cancer Care
2011
;
20
:
424
35
.
16.
Williams-Brennan
L
,
Gastaldo
D
,
Cole
DC
,
Paszat
L
. 
Social determinants of health associated with cervical cancer screening among women living in developing countries: a scoping review
.
Arch Gynecol Obstet
2012
;
286
:
1487
505
.
17.
Bello
M
. 
Awareness is the first step in battle against breast cancer
.
Bull World Health Organ
2012
;
90
:
164
5
.
18.
Bou Khalil
R
. 
Attitudes, beliefs and perceptions regarding truth disclosure of cancer-related information in the Middle East: a review
.
Palliat Support Care
2013
;
11
:
69
78
.
19.
Dey
S
. 
Preventing breast cancer in LMICS via screening and/or early detection: the real and the surreal
.
World J Clin Oncol
2014
;
5
:
509
19
.
20.
Chidyaonga-Maseko
F
,
Chirwa
ML
,
Muula
AS
. 
Underutilization of cervical cancer prevention services in low and middle income countries: a review of contributing factors
.
Pan Afr Med J
2015
;
21
:
231
.
21.
Chambers
SK
,
Dunn
J
,
Occhipinti
S
,
Hughes
S
,
Baade
P
,
Sinclair
S
, et al
A systematic review of the impact of stigma and nihilism on lung cancer outcomes
.
BMC Cancer
2012
;
12
:
184
.
22.
Thun
M
,
Peto
R
,
Boreham
J
,
Lopez
AD
. 
Stages of the cigarette epidemic on entering its second century
.
Tob Control
2012
;
21
:
96
101
.
23.
Islami
F
,
Stoklosa
M
,
Drope
J
,
Jemal
A
. 
Global and regional patterns of tobacco smoking and tobacco control policies
.
Eur Urol
2015
;
1
:
3
16
.
24.
Giovino
GA
,
Mirza
SA
,
Samet
JM
,
Gupta
PC
,
Jarvis
MJ
,
Bhala
N
, et al
Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative cross-sectional household surveys
.
Lancet
2012
;
380
:
668
79
.
25.
Ho
MG
,
Ma
S
,
Chai
W
,
Xia
W
,
Yang
G
,
Novotny
TE
. 
Smoking among rural and urban young women in China
.
Tob Control
2010
;
19
:
13
8
.
26.
World Health Organization
.
WHO framework convention on tobacco control
.
Geneva, Switzerland
:
World Health Organization
; 
2003
.
27.
Levy
DT
,
Chaloupka
F
,
Gitchell
J
. 
The effects of tobacco control policies on smoking rates: a tobacco control scorecard
.
J Public Health Manag Pract
2004
;
10
:
338
53
.
28.
Myers
ML
. 
The FCTC's evidence-based policies remain a key to ending the tobacco epidemic
.
Tob Control
2013
;
22
Suppl 1
:
i45
6
.
29.
Fong
GT
,
Hammond
D
,
Hitchman
SC
. 
The impact of pictures on the effectiveness of tobacco warnings
.
Bull World Health Organ
2009
;
87
:
640
3
.
30.
Adebiyi
AO
,
Uchendu
OC
,
Bamgboye
E
,
Ibitoye
O
,
Omotola
B
. 
Perceived effectiveness of graphic health warnings as a deterrent for smoking initiation among adolescents in selected schools in southwest Nigeria
.
Tob Induc Dis
2016
;
14
:
7
.
31.
World Health Organization
.
Report on the Global Tobacco Epidemic 2015
.
Geneva, Switzerland
:
World Health Organization
; 
2015
.
32.
Pierce
JP
,
Messer
K
,
James
LE
,
White
MM
,
Kealey
S
,
Vallone
DM
, et al
Camel no. 9 cigarette-marketing campaign targeted young teenage girls
.
Pediatrics
2010
;
125
:
619
26
.
33.
WHO Framework Convention on Tobacco Control (packaging and labelling of tobacco products)
.
Geneva, Switzerland
:
World Health Organization
; 
2008
.
34.
Eriksen
MP
,
Mackay
J
,
Schluger
N
,
Islami
F
,
Drope
J
. 
The tobacco atlas
. 5th ed.
Atlanta, GA
:
American Cancer Society
; 
2015
.
35.
Eakin
MN
,
Rand
CS
,
Borrelli
B
,
Bilderback
A
,
Hovell
M
,
Riekert
KA
. 
Effectiveness of motivational interviewing to reduce head start children's secondhand smoke exposure. A randomized clinical trial
.
Am J Respir Crit Care Med
2014
;
189
:
1530
7
.
36.
Wei
X
,
Zhang
Z
,
Song
X
,
Xu
Y
,
Wu
W
,
Lao
X
, et al
Household smoking restrictions related to secondhand smoke exposure in Guangdong, China: a population representative survey
.
Nicotine Tob Res
2014
;
16
:
390
6
.
37.
Huang
K
,
Chen
H
,
Liao
J
,
Nong
G
,
Yang
L
,
Winickoff
JP
, et al
Factors associated with complete home smoking ban among Chinese parents of young children
.
Int J Environ Res Public Health
2016
;
13
:
161
.
38.
Ranson
MK
,
Jha
P
,
Chaloupka
FJ
,
Nguyen
SN
. 
Global and regional estimates of the effectiveness and cost-effectiveness of price increases and other tobacco control policies
.
Nicotine Tob Res
2002
;
4
:
311
9
.
39.
Jha
P
,
Peto
R
. 
Global effects of smoking, of quitting, and of taxing tobacco
.
N Engl J Med
2014
;
370
:
60
8
.
40.
Kaiser
K
,
Bredenkamp
C
,
Iglesias
R
.
Sin tax reform in the Philippines: transforming public finance, health, and governance for more inclusive development
.
Washington, DC
:
International Bank for Reconstruction and Development/The World Bank
; 
2016
.
41.
Szklo
AS
,
de Almeida
LM
,
Figueiredo
VC
,
Autran
M
,
Malta
D
,
Caixeta
R
, et al
A snapshot of the striking decrease in cigarette smoking prevalence in Brazil between 1989 and 2008
.
Prev Med
2012
;
54
:
162
7
.
42.
Jurberg
C
. 
Brazil and tobacco use: a hard nut to crack
.
Bull World Health Organ
2009
;
87
:
812
3
.
43.
Bialous
S
,
de Costa e Silva
VL
,
Drope
J
,
Lencucha
R
,
McGrady
B
,
Richter
AP
.
The political economy of tobacco control in Brazil: protecting public health in a complex policy environment
.
Rio de Janeiro, Brazil and Atlanta, GA
:
Centro de Estudos sobre Tabaco e Saúde, Escola Nacional de Saúde Pública/FIOCRUZ and American Cancer Society
; 
2014
.
44.
Islami
F
,
Torre
LA
,
Jemal
A
. 
Global trends of lung cancer mortality and smoking prevalence
.
Transl Lung Cancer Res
2015
;
4
:
327
38
.
45.
World Health Organization
.
Burden of disease from household air pollution for 2012
.
Geneva, Switzerland
:
World Health Organization
; 
2014
.
46.
Mehta
S
,
Shahpar
C
. 
The health benefits of intervention to reduce indoor air pollution from solid fuel use: a cost-effectiveness analysis
.
Energy Sustainable Dev
2004
;
8
:
53
9
.
47.
World Health Organization
.
WHO indoor air quality guidelines: household fuel combustion
.
Geneva, Switzerland
:
WHO Press
; 
2014
.
48.
Hutton
G
,
Rehfuess
E
,
Tediosi
F
. 
Evaluation of the costs and benefits of interventions to reduce indoor air pollution
.
Energy Sustainable Dev
2007
;
11
:
34
43
.
49.
Amegah
AK
,
Jaakkola
JJ
. 
Household air pollution and the sustainable development goals
.
Bull World Health Organ
2016
;
94
:
215
21
.
50.
World Health Organization
.
Ambient air pollution: a global assessment of exposure and burden of disease
.
Geneva, Switzerland
:
World Health Organization
; 
2016
.
51.
World Health Organization
. 
WHO global urban ambient air pollution database (updated 2016)
.
Available from
: http://www.who.int/phe/health_topics/outdoorair/databases/cities/en/.
52.
World Health Organization
.
WHO air quality guidelines for particulate matter, ozone, nitorgen dioxide and sulfur dioxide - global update 2005
.
Geneva, Switzerland
:
World Health Organization
; 
2006
.
53.
Kelly
FJ
,
Fussell
JC
. 
Air pollution and public health: emerging hazards and improved understanding of risk
.
Environ Geochem Health
2015
;
37
:
631
49
.
54.
Giannadaki
D
,
Lelieveld
J
,
Pozzer
A
. 
Implementing the US air quality standard for PM2.5 worldwide can prevent millions of premature deaths per year
.
Environ Health
2016
;
15
:
88
.
55.
Giles
LV
,
Barn
P
,
Kunzli
N
,
Romieu
I
,
Mittleman
MA
,
van Eeden
S
, et al
From good intentions to proven interventions: effectiveness of actions to reduce the health impacts of air pollution
.
Environ Health Perspect
2011
;
119
:
29
36
.
56.
Laumbach
R
,
Meng
Q
,
Kipen
H
. 
What can individuals do to reduce personal health risks from air pollution?
J Thorac Dis
2015
;
7
:
96
107
.
57.
Stevens
GA
,
Singh
GM
,
Lu
Y
,
Danaei
G
,
Lin
JK
,
Finucane
MM
, et al
National, regional, and global trends in adult overweight and obesity prevalences
.
Popul Health Metr
2012
;
10
:
22
.
58.
Hallal
PC
,
Andersen
LB
,
Bull
FC
,
Guthold
R
,
Haskell
W
,
Ekelund
U
, et al
Global physical activity levels: surveillance progress, pitfalls, and prospects
.
Lancet
2012
;
380
:
247
57
.
59.
NCD Risk Factor Collaboration
. 
Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants
.
Lancet
2016
;
387
:
1377
96
.
60.
Kanter
R
,
Caballero
B
. 
Global gender disparities in obesity: a review
.
Adv Nutr
2012
;
3
:
491
8
.
61.
Ng
M
,
Fleming
T
,
Robinson
M
,
Thomson
B
,
Graetz
N
,
Margono
C
, et al
Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease study 2013
.
Lancet
2014
;
384
:
766
81
.
62.
United Nations
.
Women 2000 and beyond: Women, gender equality and sport
.
New York, NY
:
United Nations Secretariat
; 
2007
.
63.
Arnold
M
,
Pandeya
N
,
Byrnes
G
,
Renehan
AG
,
Stevens
GA
,
Ezzati
M
, et al
Global burden of cancer attributable to high body-mass index in 2012: a population-based study
.
Lancet Oncol
2015
;
16
:
36
46
.
64.
Mitchell
S
,
Shaw
D
. 
The worldwide epidemic of female obesity
.
Best Pract Res Clin Obstet Gynaecol
2015
;
29
:
289
99
.
65.
Zobel
EH
,
Hansen
TW
,
Rossing
P
,
von Scholten
BJ
. 
Global changes in food supply and the obesity epidemic
.
Curr Obes Rep
2016
;
5
:
449
55
66.
James
WP
. 
WHO recognition of the global obesity epidemic
.
Int J Obes
2008
;
32
Suppl 7
:
S120
6
.
67.
Verstraeten
R
,
Roberfroid
D
,
Lachat
C
,
Leroy
JL
,
Holdsworth
M
,
Maes
L
, et al
Effectiveness of preventive school-based obesity interventions in low- and middle-income countries: a systematic review
.
Am J Clin Nutr
2012
;
96
:
415
38
.
68.
Hoehner
CM
,
Ribeiro
IC
,
Parra
DC
,
Reis
RS
,
Azevedo
MR
,
Hino
AA
, et al
Physical activity interventions in Latin America: expanding and classifying the evidence
.
Am J Prev Med
2013
;
44
:
e31
40
.
69.
Barbosa Filho
VC
,
Minatto
G
,
Mota
J
,
Silva
KS
,
de Campos
W
,
Lopes Ada
S
. 
Promoting physical activity for children and adolescents in low- and middle-income countries: an umbrella systematic review. A review on promoting physical activity in LMIC
.
Prev Med
2016
;
88
:
115
26
.
70.
Sutton
L
,
Karan
A
,
Mahal
A
. 
Evidence for cost-effectiveness of lifestyle primary preventions for cardiovascular disease in the Asia-Pacific region: a systematic review
.
Global Health
2014
;
10
:
79
.
71.
Bray
F
,
Jemal
A
,
Torre
LA
,
Forman
D
,
Vineis
P
. 
Long-term realism and cost-effectiveness: primary prevention in combatting cancer and associated inequalities worldwide
.
J Natl Cancer Inst
2015
;
107
:
djv273
.
72.
Pratt
M
,
Perez
LG
,
Goenka
S
,
Brownson
RC
,
Bauman
A
,
Sarmiento
OL
, et al
Can population levels of physical activity be increased? Global evidence and experience
.
Prog Cardiovasc Dis
2015
;
57
:
356
67
.
73.
Simoes
EJ
,
Hallal
PC
,
Siqueira
FV
,
Schmaltz
C
,
Menor
D
,
Malta
DC
, et al
Effectiveness of a scaled up physical activity intervention in Brazil: a natural experiment
.
Prev Med
. 
2016
Sep 28. [Epub ahead of print].
74.
Sallis
JF
,
Cerin
E
,
Conway
TL
,
Adams
MA
,
Frank
LD
,
Pratt
M
, et al
Physical activity in relation to urban environments in 14 cities worldwide: a cross-sectional study
.
Lancet
2016
;
387
:
2207
17
.
75.
Drope
J
,
Lencucha
R
. 
Evolving norms at the intersection of health and trade
.
J Health Polit Policy Law
2014
;
39
:
591
631
.
76.
Cecchini
M
,
Sassi
F
,
Lauer
JA
,
Lee
YY
,
Guajardo-Barron
V
,
Chisholm
D
. 
Tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-effectiveness
.
Lancet
2010
;
376
:
1775
84
.
77.
Green
R
,
Cornelsen
L
,
Dangour
AD
,
Turner
R
,
Shankar
B
,
Mazzocchi
M
, et al
The effect of rising food prices on food consumption: systematic review with meta-regression
.
BMJ
2013
;
346
:
f3703
.
78.
Batis
C
,
Rivera
JA
,
Popkin
BM
,
Taillie
LS
. 
First-year evaluation of Mexico's tax on nonessential energy-dense foods: an observational study
.
PLoS Med
2016
;
13
:
e1002057
.
79.
Colchero
MA
,
Popkin
BM
,
Rivera
JA
,
Ng
SW
. 
Beverage purchases from stores in Mexico under the excise tax on sugar sweetened beverages: observational study
.
BMJ
2016
;
352
:
h6704
.
80.
Kasapila
W
,
Shaarani
SM
. 
Legislation–impact and trends in nutrition labeling: a global overview
.
Crit Rev Food Sci Nutr
2016
;
56
:
56
64
.
81.
Global Agricultural Information Network - USDA Foreign Agricultural Service
. 
Mexico's new front-of-pack labeling regulations
; 
2014
.
GAIN report number, MX4305
.
82.
Barquera
S
,
Campos
I
,
Rivera
JA
. 
Mexico attempts to tackle obesity: The process, results, push backs and future challenges
.
Obes Rev
2013
;
14
Suppl 2
:
69
78
.
83.
Committee on Adenloscent Health Care Immunization Expert Work Group
. 
Committee opinion no. 641: Human papillomavirus vaccination
.
Obstet Gynecol
2015
;
126
:
e38
43
.
84.
Deshmukh
AA
,
Chhatwal
J
,
Chiao
EY
,
Nyitray
AG
,
Das
P
,
Cantor
SB
. 
Long-term outcomes of adding HPV vaccine to the anal intraepithelial neoplasia treatment regimen in HIV-positive men who have sex with men
.
Clin Infect Dis
2015
;
61
:
1527
35
.
85.
El-Serag
HB
. 
Epidemiology of viral hepatitis and hepatocellular carcinoma
.
Gastroenterology
2012
;
142
:
1264
73
.
86.
Crosbie
EJ
,
Einstein
MH
,
Franceschi
S
,
Kitchener
HC
. 
Human papillomavirus and cervical cancer
.
Lancet
2013
;
382
:
889
99
.
87.
Jit
M
,
Brisson
M
,
Portnoy
A
,
Hutubessy
R
. 
Cost-effectiveness of female human papillomavirus vaccination in 179 countries: a PRIME modelling study
.
Lancet Glob Health
2014
;
2
:
e406
14
.
88.
World Health Organization
. 
Countries using HPV vaccine in national immunization schedule and planned introductions, May 2013
.
Available from
: http://www.who.int/immunization/diseases/hpv/decision_implementation/en/.
89.
Cervical Cancer Action
. 
Global progress in cervical cancer prevention
.
Available from
: http://www.cervicalcanceraction.org/comments/maps.php.
90.
Haakenstad
A
,
Birger
M
,
Singh
L
,
Liu
P
,
Lim
S
,
Ng
M
, et al
Vaccine assistance to low- and middle-income countries increased to $3.6 billion in 2014
.
Health Aff
2016
;
35
:
242
9
.
91.
Reagan-Steiner
S
,
Yankey
D
,
Jeyarajah
J
,
Elam-Evans
LD
,
Singleton
JA
,
Curtis
CR
, et al
National, regional, state, and selected local area vaccination coverage among adolescents aged 13–17 years–United States, 2014
.
MMWR Morb Mortal Wkly Rep
2015
;
64
:
784
92
.
92.
Ladner
J
,
Besson
MH
,
Rodrigues
M
,
Audureau
E
,
Saba
J
. 
Performance of 21 HPV vaccination programs implemented in low and middle-income countries, 2009–2013
.
BMC Public Health
2014
;
14
:
670
.
93.
Ladner
J
,
Besson
MH
,
Hampshire
R
,
Tapert
L
,
Chirenje
M
,
Saba
J
. 
Assessment of eight HPV vaccination programs implemented in lowest income countries
.
BMC Public Health
2012
;
12
:
370
.
94.
Dorji
T
,
Tshomo
U
,
Phuntsho
S
,
Tamang
TD
,
Tshokey
T
,
Baussano
I
, et al
Introduction of a national HPV vaccination program into Bhutan
.
Vaccine
2015
;
33
:
3726
30
.
95.
Binagwaho
A
,
Ngabo
F
,
Wagner
CM
,
Mugeni
C
,
Gatera
M
,
Nutt
CT
, et al
Integration of comprehensive women's health programmes into health systems: Cervical cancer prevention, care and control in Rwanda
.
Bull World Health Organ
2013
;
91
:
697
703
.
96.
Mugisha
E
,
LaMontagne
DS
,
Katahoire
AR
,
Murokora
D
,
Kumakech
E
,
Seruyange
R
, et al
Feasibility of delivering HPV vaccine to girls aged 10 to 15 years in Uganda
.
Afr Health Sci
2015
;
15
:
33
41
.
97.
Human papillomavirus vaccines: WHO position paper, October 2014
.
Wkly Epidemiol Rec
2014
;
89
:
465
91
.
98.
U.S. Centers for Disease Control and Prevention
. 
CDC recommends only two HPV shots for younger adolescents
; 
2016
.
Available from
: http://www.cdc.gov/media/releases/2016/p1020-hpv-shots.html
99.
World Health Organization
.
Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection
.
Geneva, Switzerland
:
WHO Press
; 
2015
.
100.
GBD 2013 Mortality and Causes of Death Collaborators
. 
Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the global burden of disease study 2013
.
Lancet
2015
;
385
:
117
71
.
101.
La Torre
G
,
Mannocci
A
,
Saulle
R
,
Colamesta
V
,
Meggiolaro
A
,
Mipatrini
D
, et al
Economic evaluation of HBV vaccination: a systematic review of recent publications (2000–2013)
.
Hum Vaccin Immunother
2016
:
12
:
2299
311
102.
Schweitzer
A
,
Horn
J
,
Mikolajczyk
RT
,
Krause
G
,
Ott
JJ
. 
Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013
.
Lancet
2015
;
386
:
1546
55
.
103.
Kim
SY
,
Salomon
JA
,
Goldie
SJ
. 
Economic evaluation of hepatitis B vaccination in low-income countries: Using cost-effectiveness affordability curves
.
Bull World Health Organ
2007
;
85
:
833
42
.
104.
Franco
E
,
Bagnato
B
,
Marino
MG
,
Meleleo
C
,
Serino
L
,
Zaratti
L
. 
Hepatitis B: epidemiology and prevention in developing countries
.
World J Hepatol
2012
;
4
:
74
80
.
105.
Islami
F
,
Dikshit
R
,
Mallath
MK
,
Jemal
A
. 
Primary liver cancer deaths and related years of life lost attributable to hepatitis B and C viruses in India
.
Cancer Epidemiol
2016
;
40
:
79
86
.
106.
Lernout
T
,
Hendrickx
G
,
Vorsters
A
,
Mosina
L
,
Emiroglu
N
,
Van Damme
P
. 
A cohesive European policy for hepatitis B vaccination, are we there yet?
Clin Microbiol Infect
2014
;
20
Suppl 5
:
19
24
.
107.
Kunoee
A
,
Nielsen
J
,
Cowan
S
. 
Hepatitis B vaccination coverage and risk factors associated with incomplete vaccination of children born to hepatitis B surface antigen-positive mothers, Denmark, 2006 to 2010
.
Euro Surveill
2016
;
21
:
pii=30136
.
108.
Jemal
A
,
Bray
F
,
Forman
D
,
O'Brien
M
,
Ferlay
J
,
Center
M
, et al
Cancer burden in Africa and opportunities for prevention
.
Cancer
2012
;
118
:
4372
84
.
109.
Islami
F
,
Lortet-Tieulent
J
,
Okello
C
,
Adoubi
I
,
Mbalawa
CG
,
Ward
EM
, et al
Tumor size and stage of breast cancer in Cote d'Ivoire and Republic of Congo - results from population-based cancer registries
.
Breast
2015
;
24
:
713
7
.
110.
Kantelhardt
EJ
,
Muluken
G
,
Sefonias
G
,
Wondimu
A
,
Gebert
HC
,
Unverzagt
S
, et al
A review on breast cancer care in Africa
.
Breast Care
2015
;
10
:
364
70
.
111.
Brinton
LA
,
Figueroa
JD
,
Awuah
B
,
Yarney
J
,
Wiafe
S
,
Wood
SN
, et al
Breast cancer in Sub-Saharan Africa: opportunities for prevention
.
Breast Cancer Res Treat
2014
;
144
:
467
78
.
112.
Devi
BC
,
Tang
TS
,
Corbex
M
. 
Reducing by half the percentage of late-stage presentation for breast and cervix cancer over 4 years: a pilot study of clinical downstaging in Sarawak, Malaysia
.
Ann Oncol
2007
;
18
:
1172
6
.
113.
Sankaranarayanan
R
. 
Screening for cancer in low- and middle-income countries
.
Ann Glob Health
2014
;
80
:
412
7
.
114.
Shaikh
AJ
,
Khokhar
NA
,
Raza
S
,
Kumar
S
,
Haider
G
,
Haider
AG
, et al
Knowledge, attitude and practices of non-oncologist physicians regarding cancer and palliative care: a multi-center study from Pakistan
.
Asian Pac J Cancer Prev
2008
;
9
:
581
4
.
115.
Thanapirom
K
,
Treeprasertsuk
S
,
Rerknimitr
R
. 
Awareness of colorectal cancer screening in primary care physicians
.
J Med Assoc Thai
2012
;
95
:
859
65
.
116.
Tanriverdi
O
,
Yavuzsen
T
,
Akman
T
,
Senler
FC
,
Taskoylu
BY
,
Turhal
S
, et al
The perspective of non-oncologist physicians on patients with metastatic cancer and palliative care (ALONE study): a study of the palliative care working committee of the Turkish oncology group (TOG)
.
J Cancer Educ
2015
;
30
:
253
9
.
117.
Torre
LA
,
Bray
F
,
Siegel
RL
,
Ferlay
J
,
Lortet-Tieulent
J
,
Jemal
A
. 
Global cancer statistics, 2012
.
CA Cancer J Clin
2015
;
65
:
87
108
.
118.
Sullivan
T
,
Sullivan
R
,
Ginsburg
OM
. 
Screening for cancer: considerations for low- and middle-income countries
.
In
:
Gelband
H
,
Jha
P
,
Sankaranarayanan
R
,
Horton
S
,
editors
.
Cancer: Disease control priorities, third edition (volume 3)
.
Washington (DC)
:
World Bank
; 
2015
.
119.
Smith
RA
,
Andrews
K
,
Brooks
D
,
DeSantis
CE
,
Fedewa
SA
,
Lortet-Tieulent
J
, et al
Cancer screening in the United States, 2016: a review of current American Cancer Society guidelines and current issues in cancer screening
.
CA Cancer J Clin
2016
;
66
:
96
114
.
120.
Vaccarella
S
,
Franceschi
S
,
Zaridze
D
,
Poljak
M
,
Veerus
P
,
Plummer
M
, et al
Preventable fractions of cervical cancer via effective screening in six Baltic, central, and eastern European countries 2017–40: a population-based study
.
Lancet Oncol
2016
;
17
:
1445
1452
.
121.
World Health Organization.
WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention
.
Geneva, Switzerland
:
World Health Organization
; 
2013
.
122.
Campos
NG
,
Castle
PE
,
Wright
TC
 Jr
,
Kim
JJ
. 
Cervical cancer screening in low-resource settings: a cost-effectiveness framework for valuing tradeoffs between test performance and program coverage
.
Int J Cancer
2015
;
137
:
2208
19
.
123.
Kim
JJ
,
Campos
NG
,
O'Shea
M
,
Diaz
M
,
Mutyaba
I
. 
Model-based impact and cost-effectiveness of cervical cancer prevention in sub-Saharan Africa
.
Vaccine
2013
;
31
Suppl 5
:
F60
72
.
124.
Goldie
SJ
,
Gaffikin
L
,
Goldhaber-Fiebert
JD
,
Gordillo-Tobar
A
,
Levin
C
,
Mahe
C
, et al
Cost-effectiveness of cervical-cancer screening in five developing countries
.
N Engl J Med
2005
;
353
:
2158
68
.
125.
Msyamboza
KP
,
Phiri
T
,
Sichali
W
,
Kwenda
W
,
Kachale
F
. 
Cervical cancer screening uptake and challenges in Malawi from 2011 to 2015: retrospective cohort study
.
BMC Public Health
2016
;
16
:
806
.
126.
World Health Organization
. 
Prevention of cervical cancer through screening using visual inspection with acetic acid (via) and treatment with cryotherapy
.
A demonstration project in six African countries: Malawi, Madagascar, Nigeria, Uganda, the United Republic of Tanzania, and Zambia
.
Geneva, Switzerland
:
World Health Organization
; 
2012
.
127.
Li
J
,
Shao
Z
. 
Mammography screening in less developed countries
.
Springerplus
2015
;
4
:
615
.
128.
Di Sibio
A
,
Abriata
G
,
Forman
D
,
Sierra
MS
. 
Female breast cancer in Central and South America
.
Cancer Epidemiol
2016
;
44
Suppl 1
:
S110
S20
.
129.
Lauby-Secretan
B
,
Scoccianti
C
,
Loomis
D
,
Benbrahim-Tallaa
L
,
Bouvard
V
,
Bianchini
F
, et al
Breast-cancer screening–viewpoint of the IARC working group
.
N Engl J Med
2015
;
373
:
2353
8
.
130.
World Health Organization
.
WHO position paper on mammography screening
.
Geneva, Switzerland
; 
2014
.
Report no: 9789241507936
.
131.
Arnold
M
,
Sierra
MS
,
Laversanne
M
,
Soerjomataram
I
,
Jemal
A
,
Bray
F
. 
Global patterns and trends in colorectal cancer incidence and mortality
.
Gut.
2016
Jan 27. [Epub ahead of print].
132.
Schreuders
EH
,
Ruco
A
,
Rabeneck
L
,
Schoen
RE
,
Sung
JJ
,
Young
GP
, et al
Colorectal cancer screening: a global overview of existing programmes
.
Gut
2015
;
64
:
1637
49
.
133.
Khuhaprema
T
,
Sangrajrang
S
,
Lalitwongsa
S
,
Chokvanitphong
V
,
Raunroadroong
T
,
Ratanachu-Ek
T
, et al
Organised colorectal cancer screening in Lampang Province, Thailand: preliminary results from a pilot implementation programme
.
BMJ Open
2014
;
4
:
e003671
.
134.
Gelband
H
,
Sankaranarayanan
R
,
Gauvreau
CL
,
Horton
S
,
Anderson
BO
,
Bray
F
, et al
Costs, affordability, and feasibility of an essential package of cancer control interventions in low-income and middle-income countries: key messages from Disease Control Priorities, 3rd edition
.
Lancet
2016
;
387
:
2133
44
.
135.
Berterame
S
,
Erthal
J
,
Thomas
J
,
Fellner
S
,
Vosse
B
,
Clare
P
, et al
Use of and barriers to access to opioid analgesics: a worldwide, regional, and national study
.
Lancet
2016
;
387
:
1644
56
.
136.
Pergolizzi
JV
,
Zampogna
G
,
Taylor
R
,
Gonima
E
,
Posada
J
,
Raffa
RB
. 
A guide for pain management in low and middle income communities. Managing the risk of opioid abuse in patients with cancer pain
.
Front Pharmacol
2016
;
7
:
42
.
137.
Paudel
BD
,
Ryan
KM
,
Brown
MS
,
Krakauer
EL
,
Rajagopal
MR
,
Maurer
MA
, et al
Opioid availability and palliative care in Nepal: influence of an international pain policy fellowship
.
J Pain Symptom Manage
2015
;
49
:
110
6
.
138.
Jemal
A
,
Vineis
P
,
Bray
F
,
Torre
L
,
Forman
D
,
editors
.
The Cancer Atlas, 2nd edition
.
Atlanta, GA
:
American Cancer Society
; 
2014
.
139.
Jagwe
J
,
Merriman
A
. 
Uganda: delivering analgesia in rural Africa: opioid availability and nurse prescribing
.
J Pain Symptom Manage
2007
;
33
:
547
51
.
140.
Sullivan
R
,
Alatise
OI
,
Anderson
BO
,
Audisio
R
,
Autier
P
,
Aggarwal
A
, et al
Global cancer surgery: delivering safe, affordable, and timely cancer surgery
.
Lancet Oncol
2015
;
16
:
1193
224
.
141.
Delaney
G
,
Jacob
S
,
Featherstone
C
,
Barton
M
. 
The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence-based clinical guidelines
.
Cancer
2005
;
104
:
1129
37
.
142.
Are
C
,
Rajaram
S
,
Are
M
,
Raj
H
,
Anderson
BO
,
Chaluvarya Swamy
R
, et al
A review of global cancer burden: trends, challenges, strategies, and a role for surgeons
.
J Surg Oncol
2013
;
107
:
221
6
.
143.
Abdel-Wahab
M
,
Bourque
JM
,
Pynda
Y
,
Izewska
J
,
Van der Merwe
D
,
Zubizarreta
E
, et al
Status of radiotherapy resources in Africa: an international atomic energy agency analysis
.
Lancet Oncol
2013
;
14
:
e168
75
.
144.
Grover
S
,
Xu
MJ
,
Yeager
A
,
Rosman
L
,
Groen
RS
,
Chackungal
S
, et al
A systematic review of radiotherapy capacity in low- and middle-income countries
.
Front Oncol
2015
;
4
:
380
.
145.
Samiei
M
. 
Health systems strengthening for cancer control
.
In
:
Wild
C
,
Stewart
B
,
Ohgaki
H
,
editors. World cancer report 2014
.
Lyon, France
:
World Health Organization International Agency for Research on Cancer
; 
2014
.
146.
Shulman
LN
,
Wagner
CM
,
Barr
R
,
Lopes
G
,
Longo
G
,
Robertson
J
, et al
Proposing essential medicines to treat cancer: methodologies, processes, and outcomes
.
J Clin Oncol
2016
;
34
:
69
75
.
147.
World Health Organization
. 
WHO model list of essential medicines - 19th list
.
Available from
: http://www.who.int/medicines/publications/essentialmedicines/EML_2015_FINAL_amended_NOV2015.pdf?ua=1.
148.
Hesseling
PB
,
Molyneux
E
,
Tchintseme
F
,
Welbeck
J
,
McCormick
P
,
Pritchard-Jones
K
, et al
Treating Burkitt's lymphoma in Malawi, Cameroon, and Ghana
.
Lancet Oncol
2008
;
9
:
512
3
.
149.
Lopes Gde
L
 Jr
,
de Souza
JA
,
Barrios
C
. 
Access to cancer medications in low- and middle-income countries
.
Nat Rev Clin Oncol
2013
;
10
:
314
22
.
150.
Anderson
BO
,
Cazap
E
,
El Saghir
NS
,
Yip
CH
,
Khaled
HM
,
Otero
IV
, et al
Optimisation of breast cancer management in low-resource and middle-resource countries: executive summary of the Breast Health Global Initiative Consensus, 2010
.
Lancet Oncol
2011
;
12
:
387
98
.
151.
Adesina
A
,
Chumba
D
,
Nelson
AM
,
Orem
J
,
Roberts
DJ
,
Wabinga
H
, et al
Improvement of pathology in sub-Saharan Africa
.
Lancet Oncol
2013
;
14
:
e152
7
.
152.
Farmer
P
,
Frenk
J
,
Knaul
FM
,
Shulman
LN
,
Alleyne
G
,
Armstrong
L
, et al
Expansion of cancer care and control in countries of low and middle income: a call to action
.
Lancet
2010
;
376
:
1186
93
.
153.
Binagwaho
A
,
Wagner
CM
,
Farmer
PE
. 
A vision for global cancer medicine: pursuing the equity of chance
.
J Clin Oncol
2016
;
34
:
3
5
.
154.
Tapela
NM
,
Mpunga
T
,
Hedt-Gauthier
B
,
Moore
M
,
Mpanumusingo
E
,
Xu
MJ
, et al
Pursuing equity in cancer care: implementation, challenges and preliminary findings of a public cancer referral center in rural Rwanda
.
BMC Cancer
2016
;
16
:
237
.
155.
Obi
SN
,
Ozumba
BC
. 
Cervical cancer: socioeconomic implications of management in a developing nation
.
J Obstet Gynaecol
2008
;
28
:
526
8
.
156.
Gutierrez
H
,
Shewade
A
,
Dai
M
,
Mendoza-Arana
P
,
Gomez-Dantes
O
,
Jain
N
, et al
Health care coverage decision making in low- and middle-income countries: experiences from 25 coverage schemes
.
Popul Health Manag
2015
;
18
:
265
71
.
157.
Knaul
F
,
Horton
S
,
Yerramilli
P
,
Gelband
H
,
Atun
R
. 
Financing cancer care in low-resource settings
.
In
:
Gelband
H
,
Jha
P
,
Sankaranarayanan
R
,
Horton
S
,
editors
.
Cancer: Disease control priorities, third edition (volume 3)
.
Washington (DC)
:
World Bank
; 
2015
.
158.
Bredenkamp
C
,
Evans
T
,
Lagrada
L
,
Langenbrunner
J
,
Nachuk
S
,
Palu
T
. 
Emerging challenges in implementing universal health coverage in Asia
.
Soc Sci Med
2015
;
145
:
243
8
.
159.
Agyepong
IA
,
Abankwah
DN
,
Abroso
A
,
Chun
C
,
Dodoo
JN
,
Lee
S
, et al
The "universal" in UHC and Ghana's national health insurance scheme: policy and implementation challenges and dilemmas of a lower middle income country
.
BMC Health Serv Res
2016
;
16
:
504
.
160.
Guinto
RL
,
Curran
UZ
,
Suphanchaimat
R
,
Pocock
NS
. 
Universal health coverage in ‘One Asean’: are migrants included?
Glob Health Action
2015
;
8
:
25749
.
161.
Wagstaff
A
,
Dmytraczenko
T
,
Almeida
G
,
Buisman
L
,
Hoang-Vu Eozenou
P
,
Bredenkamp
C
, et al
Assessing Latin America's progress toward achieving universal health coverage
.
Health Aff
2015
;
34
:
1704
12
.
162.
Hernandez-Avila
JE
,
Palacio-Mejia
LS
,
Gonzalez-Gonzalez
L
,
Morales-Carmona
E
,
Espin-Arellano
LI
,
Fernandez-Nino
JA
, et al
Utilization of hospital services for cancer care in Mexico
.
Salud Publica Mex
2016
;
58
:
142
52
.
163.
Bray
F
,
Ferlay
J
,
Laversanne
M
,
Brewster
DH
,
Gombe Mbalawa
C
,
Kohler
B
, et al
Cancer incidence in five continents: inclusion criteria, highlights from volume x and the global status of cancer registration
.
Int J Cancer
2015
;
137
:
2060
71
.
164.
Antoni
S
,
Soerjomataram
I
,
Moller
B
,
Bray
F
,
Ferlay
J
. 
An assessment of globocan methods for deriving national estimates of cancer incidence
.
Bull World Health Organ
2016
;
94
:
174
84
.
165.
Bray
F
,
Znaor
A
,
Cueva
P
,
Korir
A
,
Swaminathan
R
,
Ullrich
A
, et al
Planning and developing population-based cancer registration in low- and middle-income settings (IARC technical publication 43)
.
Lyon, France
:
International Agency for Research on Cancer
; 
2014
.
166.
International Agency for Research on Cancer
. 
Global initiative for cancer registry development (GICR)
.
Available from
: http://gicr.iarc.fr/.
167.
Sitas
F
,
Egger
S
,
Bradshaw
D
,
Groenewald
P
,
Laubscher
R
,
Kielkowski
D
, et al
Differences among the coloured, white, black, and other South African populations in smoking-attributed mortality at ages 35–74 years: a case-control study of 481,640 deaths
.
Lancet
2013
;
382
:
685
93
.
168.
Oduro
AR
,
Wak
G
,
Azongo
D
,
Debpuur
C
,
Wontuo
P
,
Kondayire
F
, et al
Profile of the Navrongo health and demographic surveillance system
.
Int J Epidemiol
2012
;
41
:
968
76
.
169.
Dalinjong
PA
,
Welaga
P
,
Azongo
DK
,
Chatio
S
,
Anaseba
D
,
Kondayire
F
, et al
A retrospective analysis of the association between tobacco smoking and deaths from respiratory and cardiovascular diseases in the Kassena-Nankana districts of Northern Ghana
.
Tob Induc Dis
2015
;
13
:
12
.
170.
Sullivan
R
,
Eckhouse
S
,
Lewison
G
. 
Using bibiometrics to inform cancer research policy and spending
.
In
:
Burke
MA
,
Matlin
SA
, editors.
Monitoring financial flows for health research
.
Geneva, Switzerland
:
Global Forum for Health Research
; 
2008
.
p.
67
78
.
171.
Wild
CP
. 
The role of cancer research in noncommunicable disease control
.
J Natl Cancer Inst
2012
;
104
:
1051
8
.
172.
Demment
MM
,
Peters
K
,
Dykens
JA
,
Dozier
A
,
Nawaz
H
,
McIntosh
S
, et al
Developing the evidence base to inform best practice: a scoping study of breast and cervical cancer reviews in low- and middle-income countries
.
PLoS One
2015
;
10
:
e0134618
.
173.
Kamangar
F
,
Chow
WH
,
Abnet
CC
,
Dawsey
SM
. 
Environmental causes of esophageal cancer
.
Gastroenterol Clin North Am
2009
;
38
:
27
57
.
174.
Molyneux
EM
,
Rochford
R
,
Griffin
B
,
Newton
R
,
Jackson
G
,
Menon
G
, et al
Burkitt's lymphoma
.
Lancet
2012
;
379
:
1234
44
.
175.
Rowe
M
,
Fitzsimmons
L
,
Bell
AI
. 
Epstein-barr virus and Burkitt lymphoma
.
Chin J Cancer
2014
;
33
:
609
19
.
176.
Goldie
SJ
,
Diaz
M
,
Constenla
D
,
Alvis
N
,
Andrus
JK
,
Kim
SY
. 
Mathematical models of cervical cancer prevention in Latin America and the Caribbean
.
Vaccine
2008
;
26
Suppl 11
:
L59
72
.