Cancer prevention, detection, and treatment are getting short shrift in many low- and middle-income countries, a new report from the Institute of Medicine says, and global health agencies must beef up resources to fight the disease in these areas. The document provides strategies even the poorest countries can begin using to reduce the toll cancer takes.

That toll is enormous and growing, according to Cancer Control Opportunities in Low- and Middle-Income Countries. Each year, there are 11 million cases of cancer worldwide, and 6 million of those occur in low- or middle-income nations. Some 4 million people die from cancer in these countries each year -- 1 million more than die of AIDS, the report says.

The IOM report was sponsored by the American Cancer Society and the National Cancer Institute and released in time for World Cancer Day on Feb. 4.

"Low- and middle-income countries have many unique but also surmountable challenges when it comes to fighting cancer," said Elmer Huerta, MD, president-elect of the American Cancer Society and a native of Peru. "Their risks are increasing due to aging populations, increased tobacco usage, aggressive tobacco industry marketing, lack of basic health information, and the unfortunate behaviors often accompanying rapid economic development — unhealthy Western lifestyle habits, including poor diet and inadequate exercise."

ACS supports numerous international initiatives aimed at helping other countries develop programs to fight cancer through prevention and early detection efforts, advocacy, patient services, fundraising, and tobacco control, among other strategies.

In fact, controlling tobacco is one of the most important ways developing nations can attack cancer, the report says. Smoking has made lung cancer the most common cancer and the most common cause of cancer death in low- and middle-income countries, as it is in wealthier nations. The report urges countries to ratify the Framework Convention on Tobacco Control, a global tobacco control treaty, and implement key provisions:

• Increase tobacco taxes to raise the price of cigarettes and other tobacco products
• Ban advertising and promotion of tobacco products
• Pass laws making public spaces smoke-free
• Put large, explicit health warnings on cigarette packages
• Publicize the health risks of tobacco use and the benefits of quitting

Vaccines can also have a huge impact, the IOM report says. More than a quarter of all cancers in low- and middle-income countries are caused by infections; in wealthy nations, just 8% are. Certain vaccines could narrow that gap.

For instance, vaccinating children against hepatitis B could prevent many cases of liver cancer, a disease that kills some 500,000 people worldwide each year. According to the report, a 3-dose series of the vaccine costs less than $2 through UNICEF, the United Nations Children's Fund, and additional subsidies are available. Yet fewer than 10% of children in Southeast Asia and Africa receive this lifesaving vaccine.

The report calls on international health groups to help countries make the hepatitis B vaccine a routine part of childhood immunizations.

Countries also need a plan to access and implement the new vaccine against human papilloma virus (HPV), the report says. HPV causes most cases of cervical cancer, which kills nearly 300,000 women each year, most of them in low- and middle-income nations.

The IOM report also offers suggestions for more effective use of the limited resources many of these nations have to fight cancer. It calls for countries to set up at least 1 government-funded cancer center. They should also take steps -- like changing narcotics regulations -- to make it easier for patients to get pain control medications and other palliative care. More than 70% of cancer patients in these nations are incurable at diagnosis.

The report also calls for treatment guidelines for certain cancers that outline feasible options, depending on what's available in a particular country. For instance, in places where there are few radiation facilities, women with breast cancer still can be effectively treated with mastectomy, rather than breast-conserving surgery, which requires radiation. Similar guidelines can be developed for cervical, colorectal, and head and neck cancers, the report says.

But low- and middle-income countries need the help of wealthy nations and global health organizations to turn these ideas into reality, the report emphasizes.

It says groups like the World Health Organization, the US Agency for International Development, and the US National Cancer Institute should do more to make cancer a priority and provide guidance, as well as money. Universities with global health programs should make cancer control a part of those programs. And advocacy groups need to expand their reach into these lower-income areas, the report says.

The full report can be read for free or downloaded for a charge on the Web site of the National Academies Press; a PDF of the Executive Summary is also available for free. The National Academies offers free PDFs of its reports to people in certain countries.