Fighting Cancer around the World: A Framework for Action
2. Materials and Methods
3.1. The Regions’ Perspectives
United Arab Emirates
Kingdom of Saudi Arabia
3.1.3. LATAM Perspective
4. The Tools and Conditions for the Job
4.1. Uptake of Molecular Diagnostics
4.2. Uptake of Biomarkers
4.3. Uptake of Liquid Biopsy (LB)
4.4. Uptake of Real-World Evidence (RWE)
4.5. Reimbursement and Other Regulatory Issues
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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|Total Number of Experts||48 (100%)|
|United Arab Emirates|
|Countries||Funding of Cancer Treatment/Research||Genomics/Biomarkers||Cancer Incidence and Risk Factors||Cancer Strategic Plans||Primary Prevention Efforts|
|Angola||It is highly needed to invest in diagnostic facilities, pathology, surgical capacities, chemotherapy, radiotherapy and palliative care resources||Development of genomic surveillance center and lab||Infectious diseases are still of major importance, but mortality rate of oncological diseases is very high||A national plan will be needed to effectively mobilize resources, train staff and reinforce laboratory biosafety measures||More awareness programs and preventive measures need to be put in place|
|Brazil||National Health System (SUS) subsidizes cancer treatment for approximately 75% of the population; Brazil has the highest public funding for clinical studies||The need to increase access to next-generation sequencing in oncology is recognized, so agencies and payers will be required to collaborate in building data collection infrastructure||Estimations are there were 625,000 new cancer cases in Brazil in 2020||Brazil ranks very well in working to reduce smoking rates as a cancer prevention strategy||The primary care network is the patient’s entryway to the health system in Brazil, playing a decisive role in actions to promote health, prevention and tracking cancer|
|Cameroon||Funding is limited, and governance and political will to push personalized medicine are lacking||Genetic testing for breast cancer (BC) is out of reach for most patients, and targeted therapies are not available locally; there are unresolved issues on data sharing and on validation and regulatory approval of genetic tests and targeted therapies||Mortality of cancer is high, especially cervical cancer||Cameroon has a national strategic plan for prevention and cancer control, but it makes no reference to personalized medicine, genomics, or biomarkers||There is low patient awareness and education, and uptake of screening is low|
|Chile||Chile has, after Brazil, the second-highest public funding for clinical studies; Chile has radiotherapy coverage of more than 100%||Tumor sequencing is available in Chile; cancer genomics technologies are not fully implemented; efforts have been made to generate research in gastric, colon and breast cancer||Cancer is the second leading cause of death and accounts for 23.4% of all deaths in the country; most common are prostate, colon, breast, stomach, and lung cancers||Currently, there is no national registry of cancer in Chile, although there are five population-based provincial registries; major cancer survivorship programs are lacking||Access to the primary health-care system is universal and free in Chile. The country has invested in preventive measures such as Pap screening tests and an HPV vaccination program. It also has a program to screen those over 40 with a family history of stomach cancer and a current ulcer and is piloting a screening program for colorectal cancer|
|China||There are many investments in genome science and public health genomics-related programs and services||Research on biomarkers and big data is developing at a rapid pace within the country; technologies such as NGS and liquid biopsy are widely adopted||China is facing increased cancer rates where the top five commonly diagnosed cancer types in males are lung cancer (14.5%), prostate cancer (13.5%), colorectal cancer (10.9%), stomach cancer (7.2%) and liver cancer (6.3%)||China has national genomics policies to address a variety of genetic issues||Cancer prevention and early action measures are recognized as key projects in Chinese Government; there are many initiatives and guidelines launched|
|Colombia||There is a need to increase funding to develop innovative cancer technologies, medicines, and treatments accessible to all patients in need||Whole exome|
taltesting and tumor
sequencing are available in Colombia; there is an urgent need to expand the
use of NGS in breast, lung, and unknown primary cancers
|Colombia had an age-standardized rate (ASR) of 178.8 new cases of cancer per 100,000 people in 2018||Colombia has a National Cancer Control Plan that aims to: emphasize cancer prevention; improve early detection; improve quality of cancer care and recovery of cancer patients and survivors; strengthen national information systems; and improve the training and development of practitioners||There is a universal health care and a government-sponsored 10-year cancer control plan focused on prevention, early detection, and treatment in Colombia|
|India||Reforms have been put in place that aim to strengthen primary health care and move towards universal health coverage featuring cancer care benefit packages, with a standards-based, interoperable, national digital health information system||Some strengthening of molecular and genomic testing facilities has been triggered by the COVID-19 pandemic||The estimated prevalence of cancer is 2.5 million with an incidence of 0.7 million cases per year. There are some 800,000 new cancer cases in India every year, and tobacco is identified as the most important cause of cancer||India has created a National Cancer Programme envisaging control of tobacco||More efforts in prevention measures should be put in place since the late stage at presentation is very often the main reason for the poor survival from cancer|
|Kenya||Kenya has set universal health coverage as a priority||Patients have little to no access to genetic testing and counseling services||Cancer is the third leading cause of death after infectious and cardiovascular diseases||Kenya has developed a national cancer control strategy||Public health systems supported by modern technologies and promotion of healthier lifestyles, along with new technologies to enhance disease surveillance, prevention, early diagnosis and treatment are set as priorities|
|Kingdom of Saudi Arabia||Cancer care is offered free of charge for Saudi patients by a royal decree; more research funding on cancer screening, prevention, and care quality are needed in KSA||Within a period of 5 years, the Saudi Human Genome Program aims to sequence 100,000 samples (normal and disease) from the Saudi population||The incidence of cancer cases and costs of care are high||There are cancer screening programs for breast cancer, colorectal cancer and cervical cancer||The Ministry of Health has been advocating a healthy lifestyle with a healthy diet, physical activity, maintaining ideal body weight, and smoking cessation to decrease noncommunicable diseases, including cancer|
|Lebanon||Health and third-party payers are providing the financial coverage; cancer drugs are free of charge for uninsured patients, and this country has one of the most developed health care systems in the region||Lebanon is making progress towards implementing precision genetic and genomic research||Cancer rates are increasing and consequently the burden of cancer cost||Many programs put in place raise awareness about cancer screening and prevention through educating and counseling the population, and cancer research has been established by the health ministry||There are cigarette cessation and anti-smoking campaigns for lung cancer as part of preventive measures|
|Malaysia||Government needs to take a more robust approach to pharmaceutical companies when negotiating prices: at present nearly half of cancer patients experience financial catastrophe within a year of diagnosis||There are challenges regarding NGS testing||Tobacco and infections are reported as the principal causes of cancer deaths, which have a prevalence of close to 1/1000||Malaysia has developed the National Strategic Plan for Cancer Control||There is a need for better awareness and early diagnosis, particularly to enable remote communities to access equitable care with targeted therapies|
|Mexico||Seguro Popular (SP) was created to provide universal health coverage, including cancer care; 8% of SP’s resources were allocated to Fondo de Protrección contra Gastos Catastróficos (FPGC), of which 28% finances cancer care; about 50–60% of cancer patients in Mexico are fully covered||Mexico has a high number of NGS platforms; a small fraction of the population in Mexico has access to genetic analyses to identify factors associated with the development of some types of cancer, for the early detection of a tumor, or to take the option of chemotherapy or prophylactic surgery||The most common types of cancer among Mexican men are prostate, colorectal, lung, gastric, and testicular at younger ages. Among Mexican women, they are breast, uterine cervix, and colorectal||In 2008, a general law was approved for the control of tobacco and in 2009, in agreement with the General Law Regulation for Control of Tobacco, pictographs and warnings were implemented on the packaging||Genetic counseling and molecular diagnosis are routinely offered by family cancer clinics in a few levels 3 government and specialized private hospitals; citizens have access to a wide range of special cancer diagnostic preventive measures, such as Pap smears offered for women aged 25 to 34 every three years|
|Nigeria||Nigeria spent only around 0.5% of its 2017 budget on health care; there is a lack of funding||The genomics capacity in Nigeria has for many years been supported by bioinformatics at various institutions across the country||Around 100,000 new cases of cancer occur every year||Nigeria developed the National Cancer Control Plan to reduce the incidence and prevalence of cancer||Prevention measures are inadequate, there is a lack of proper access to basic health care, as well as health-related impoverishment|
|Nepal||Health care is underfunded, so the population suffers from financial risk in the case of using health services for diseases such as cancer||Genetic research in Nepal heavily relies on resources from international institutes||In 2020, Nepal had an estimated total of 20,508 cancer cases||There is a partially implemented health insurance policy that has several limitations and is not available to everyone and also lacks funding||There are delays in presentation, diagnosis and treatment that need to be tackled|
|Peru||There is a need for more provision and reimbursement of liquid biopsy (LB) in lung cancer, and more funding of studies of the genomics of cancer in the highly diverse Peruvian population||There is a lack of local genomic laboratories, which means samples requiring comprehensive genomic analysis have to be sent abroad; there is little medical familiarity with biomarkers and genetic tests||In 2020, there were a total of 69,849 cancer cases in Peru||Governmental cancer control program and development of a national tumor bank are underway||There is a need for more public education programs|
|Philippines||Government is pushed to extend financial and other forms of assistance to impoverished cancer patients and to provide funds for cancer research||There are many genetic tests and services that are available and delivered to the whole country, such as cytogenetics, molecular genetics, biochemical genetics, and newborn screening||Cancer was the second leading cause of death in 2020||Effective screening and prevention strategies exist for many cancers; in February 2019, the National Integrated Cancer Control Act was signed into law||Screening programs and public health education need more efforts|
|Qatar||Qatar is investing a lot in cancer research; they are bringing in top researchers from all over the world and establishing institutes of research||Cancer molecular genetic boards to integrate PM and genomics into cancer care are now in place.||Projections are that the cancer incidence in Qatar will triple between 2010 and 2030 due to aging and population growth||A National Cancer Research Strategy, Qatar Biobank (QBB) and the Qatar Genome Program (QGP) have been put in place||The aims for the future are to include evidence-based approaches for public engagement, prevention and early detection, especially the use of personalized approaches|
|South Africa||There are many projects in South Africa that aim to provide better allocation of research funding; the SAMRC is the largest local health research funder in South Africa||There is a lack of population-level genomic data and lack of access to targeted therapies||South Africa has a high burden of noncommunicable diseases (NCDs)||South Africa has established funding of PM, with a genome program and a PM think tank, aiming at a research strategy and product pipeline with an NCD focus on cancer||Cancer prevention guidelines have been put in place; cervical cancer prevention and control policy have been developed|
|Tunisia||PerMediNA-Precision Medicine in North Africa is linking the Instituts Pasteur in Tunisia, Algeria, Morocco and Paris with EUR 1 million funding from the French government||More sequencing and genotyping facilities along with biobanks are needed||There was a total of 19,446 cancer cases in Tunisia in 2020||Tunisia runs human genome programs, and the Oncogenetics Unit at the Institut Pasteur in Tunis, is conducting research-based genetic diagnosis||Primary prevention strategies remain insufficient as evidenced by the high prevalence of smoking in 2018 (26%)|
|United Arab Emirates||The top-up funding scheme currently covers breast, colorectal and cervical cancer||There are genomic projects, including the genomic and pharmacogenomic research of the Emirates Genome Program||Cancer is the third leading cause of death in the UAE, right after cardiovascular disease and trauma||National Cancer Control Plan for 2022–2026 has been proposed-and will require accurate data, a reliable cancer registry and periodic monitoring and evaluation||There is a colon cancer prevention program that includes primary preventive strategies and secondary prevention by stool fit test every 2 years or colonoscopy every 10 years|
|Venezuela||Overall health care spending is around 5% of GDP in Venezuela||Infrastructure in terms of biobank organization is improving||In 2020, there were a total of 58,424 cancer cases in Venezuela||A national cancer plan or strategy needs to be developed||Greater efforts are needed in adoption and awareness of PM; availability of education, training and outreach activities are low|
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Horgan, D.; Mia, R.; Erhabor, T.; Hamdi, Y.; Dandara, C.; Lal, J.A.; Domgue, J.F.; Ewumi, O.; Nyawira, T.; Meyer, S.; Kondji, D.; Francisco, N.M.; Ikeda, S.; Chuah, C.; De Guzman, R.; Paul, A.; Reddy Nallamalla, K.; Park, W.-Y.; Tripathi, V.; Tripathi, R.; Johns, A.; Singh, M.P.; Phipps, M.E.; Dube, F.; Whittaker, K.; Mukherji, D.; Rasheed, H.M.A.; Kozaric, M.; Pinto, J.A.; Doral Stefani, S.; Augustovski, F.; Aponte Rueda, M.E.; Fujita Alarcon, R.; Barrera-Saldana, H.A. Fighting Cancer around the World: A Framework for Action. Healthcare 2022, 10, 2125. https://doi.org/10.3390/healthcare10112125
Horgan D, Mia R, Erhabor T, Hamdi Y, Dandara C, Lal JA, Domgue JF, Ewumi O, Nyawira T, Meyer S, Kondji D, Francisco NM, Ikeda S, Chuah C, De Guzman R, Paul A, Reddy Nallamalla K, Park W-Y, Tripathi V, Tripathi R, Johns A, Singh MP, Phipps ME, Dube F, Whittaker K, Mukherji D, Rasheed HMA, Kozaric M, Pinto JA, Doral Stefani S, Augustovski F, Aponte Rueda ME, Fujita Alarcon R, Barrera-Saldana HA. Fighting Cancer around the World: A Framework for Action. Healthcare. 2022; 10(11):2125. https://doi.org/10.3390/healthcare10112125Chicago/Turabian Style
Horgan, Denis, Rizwana Mia, Tosan Erhabor, Yosr Hamdi, Collet Dandara, Jonathan A. Lal, Joel Fokom Domgue, Oladimeji Ewumi, Teresia Nyawira, Salomé Meyer, Dominique Kondji, Ngiambudulu M. Francisco, Sadakatsu Ikeda, Chai Chuah, Roselle De Guzman, Anupriya Paul, Krishna Reddy Nallamalla, Woong-Yang Park, Vijay Tripathi, Ravikant Tripathi, Amber Johns, Mohan P. Singh, Maude E. Phipps, France Dube, Kate Whittaker, Deborah Mukherji, Hadi Mohamad Abu Rasheed, Marta Kozaric, Joseph A. Pinto, Stephen Doral Stefani, Federico Augustovski, Maria Eugenia Aponte Rueda, Ricardo Fujita Alarcon, and Hugo A. Barrera-Saldana. 2022. "Fighting Cancer around the World: A Framework for Action" Healthcare 10, no. 11: 2125. https://doi.org/10.3390/healthcare10112125