Articles Lancet

Cancer is one of the leading causes of death in humans worldwide. Research suggests that new worldwide cancer cases rose by more than 28% from 2012 to 2018, an increase of 4 million cases. And global incidence is expected to rise by a further 62% between 2018 and 2040. Imaging techniques play an essential role in the detection, diagnosis, treatment and monitoring of almost all cancer types. Use of screening can improve management decisions and reduce costs of cancer care. It’s no surprise then that its use is ubiquitous across the majority of high-income countries.

But, what of low- to middle-income countries? Research suggests that imaging is often deprioritised in these regions, with many countries reporting severe shortages in equipment and personnel. And with only 5% of global funding for cancer control and care available to them, it’s little wonder that low- to middle-income countries account for ~80% of disability adjusted life-years lost to cancer worldwide.

Lancet Oncology Commission conducted a global assessment of imaging and nuclear medicine resources to understand the current position and model whether increased availability of imaging could alleviate this rising burden. Such improvements would include enhanced access to imaging equipment, increased workforce capacity and improved access to digital technology, radiopharmaceuticals, and research and training programmes.

Their microsimulation model of 11 cancers demonstrated significant benefits of upscaling imaging in low- to middle-income countries. By investing $6.84 billion between 2020 and 2030, the model estimates that 3.2% of the 76 million deaths caused by the modelled cancers could be avoided. Furthermore, a more robust scale-up of imaging, treatment and care quality could avert 9.55 million of all deaths for modelled cancers worldwide, saving 232.3 million life-years and resulting in lifetime productivity gains of $1.23 trillion worldwide.

The outcomes from their modelling show positive returns across every local region even with conservative investments, with the returns growing exponentially as more is invested in improving imaging and nuclear medicine resources.

While modelling suggests lives will be saved and countries will receive a return on investment in screening technology, the question has to be – where will the money come from? The Commission argues that the largest proportion of funding would likely come from domestic sources within the individual countries, such as public financing and investment from private companies. In addition, countries may seek donations from development banks and non-governmental and UN organisations, such as the World Health Organization.

The possible benefits to health and economic outcomes make a compelling case for investing in improving access to imaging techniques and the surrounding infrastructure in low- to middle-income countries, where the aim is to enhance care and reduce the global burden of this disease.

Read the full study in The Lancet: https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(20)30751-8/fulltext
https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(21)00068-1/fulltext