THE SIZE OF THE CANCER PROBLEM
Cancer is very common. In 2008, around 12.7 million people were diagnosed with cancer, of which 7.9 million died, accounting for around 13% of all deaths. Though there is a perception that cancer is a disease of the aged population in the richer economies, around 70% of these deaths occurred in low-or middle-income countries. Cancer affects genders, all races, rich and poor alike. The diagnosis is feared, as it is assumed (often correctly) to be a death sentence by those afflicted with it. Both the disease itself and its treatment are major causes of pain and distress. Treating cancer is a major burden on healthcare systems worldwide, and the disease is a significant cause of loss of productive capacity within the workforce due to premature death. Here it will be taken an overview of the cancer problem, focusing on some of the more common cancers to illustrate how numbers vary across the world. Any illness affecting so many people will also have major economic impacts, so here it will be also highlighted some of the ways in which the economy and health services interact, themes. Studying patterns in rates of cancer sheds very interesting light on the causes of cancer. Some of the most striking links will be highlighted here as well.
Cancer care and cancer research are also important components of industrial activity. Half of all drugs in clinical trials are for cancer; the global market for all cancer drugs was estimated at $48 billion in 2008, up from $34.6 billion in 2006. Analysts expect growth from 2010 to 2015 to be above 10% annually. Every year, the pharmaceutical industry spends between $6.5 and $8 billion on research and development of cancer drugs. This spends dwarfs that from government and research charities on drug development, potentially meaning that new drugs are concentrated in areas with maximum commercial rather than public health impact. Pharmaceutical companies with successful cancer drugs are among the biggest corporations worldwide. Biotech companies without marketable products but with a promising ‘pipeline’ cancer drug can be worth billions of dollars simply because of the possibility that the drug may be licensed at some future date for treating cancer. At least 19 anticancer drugs exceeded $1 billion in sales in 2009, a major strain for health systems in even the richest economies charged with purchasing these drugs for their patients.
At the other end of the spectrum, around one-third of cancer patients have very limited access to effective treatments, rising to over half in the poorest countries. Moving forward, with an ageing population and rising drug price trends, we may get to the situation when ‘state-of-the-art’ drug therapy will be available only to the richest strata in the richest economies. Alternatively, better prediction of response to therapy may allow individually targeted treatment choices, reducing costs from unnecessary or ineffective therapy. Unlike, say, cars or computers, which we expect to, work every time we use them, most cancer drugs work on only a proportion of patients. For those with advanced disease, for whom the aim is palliation of symptoms or improvement in the quality of life, this proportion may be much less than 50%, hence the majority of treatments may be pointless, or indeed worse than useless, as they may cause side effects with no benefit. Being able to identify patients who may benefit ahead of therapy would be much cost and clinically effective and this is, therefore, a major focus of current cancer research.