Global Collaboration to Eradicate Women’s Cancers | Future of Health Summit 2024

Strategic Priorities and Global Landscape

• Rising Incidence Trends: Global cancer incidence is projected to double over the next two decades, with 75% of this increase concentrated in low- and middle-income countries (LMICs) due to infectious disease-related malignancies like cervical cancer.
• US National Goals: The US Cancer Moonshot initiative aims to reduce the age-adjusted cancer death rate by at least 50% over 25 years, focusing heavily on prevention and early detection as primary drivers of mortality reduction.
• WHO Alignment: Eradicating HPV-driven cervical cancer has been established as a World Health Organization goal, serving as a potential model for systematic cancer control.

Diagnosis and Screening Challenges & Innovations

• Nigeria (LMIC Context):
  • Infrastructure Gap: Nigeria possesses only 11 radiotherapy machines for a population of over 200 million; the National Institute of Cancer Research and Treatment (NICRAD) is procuring six new units to be deployed across six geopolitical zones.
  • Mobile Solutions: NICRAD is partnering with Siemens Healthineers to deploy mobile screening vans equipped with ultrasound, mammography (POSCOP), and HPV testing kits to reach the 80% of the population in rural and sub-urban areas.
  • Screening Uptake: Behavioral barriers related to socioeconomic status and tradition have been addressed through awareness campaigns, leading to increased patient flow to six newly established preventive oncology clinics.
• China (Private Sector/High-Income Context):
  • Systemic Inefficiencies: Despite government screening quotas since 2005, cervical cancer mortality remains high (60,000+ deaths/year in China vs. 4,000 in the US) due to delays in result reporting (2 weeks) and lack of patient education, causing high rates of loss to follow-up.
  • Innovative Model: United Family Healthcare utilizes mobile PCR/DNA labs to deliver results within three hours, employs self-sampling techniques, and conducts same-day follow-up for positive screens to prevent women from being lost to the system.
  • Project Scope: A new initiative targets a rural province to screen 15,000 women annually while vaccinating young women and screening migrant populations in urban centers.
• United Kingdom (National Health System Context):
  • Disparities in Care: Significant inequities persist despite free healthcare; only 30% of women in the South Asian community are up to date with cervical screening compared to ~80% in other populations.
  • Barriers: Cultural inappropriateness of the system, caring responsibilities, and lack of trust are primary drivers of missed screenings; in the most deprived areas, parental consent rates for HPV vaccination are half that of affluent areas.
  • Data Utilization: Macmillan Cancer Support is partnering with Boots pharmacy to leverage loyalty card data (identifying purchases related to bloating or skin changes) to develop risk checkers for ovarian cancer.

Treatment Access and Equity

• Financial Barriers in Nigeria: With only 5-7% of the population covered by the National Health Insurance Scheme, NICRAD launched a "Cancer Health Fund" targeting indigent patients, aiming to secure $20–50 million in 2025 and negotiating 50–60% price reductions on medications with partners like Roche and Johnson & Johnson.
• US Care Navigation: Reimbursement for care navigation services (covering over 250 million Americans via Medicare/Medicaid) has been implemented to guide patients through the healthcare system, reducing ER visits for treatment complications to zero in early data.
• UK Inequities:
  • Sexual Health: Clinicians discuss sexual function with 98% of prostate cancer patients but only 11% of women with cancer, highlighting a systemic gap in holistic care.
  • Clinical Trials: Black women with breast cancer are significantly less likely to be offered clinical trials due to prejudiced assumptions by clinicians and lack of trust in the health system.
  • Targeted Intervention: Macmillan is collaborating with the NHS Race Observatory and pharmaceutical partners to increase trial access for underrepresented communities in England and Wales.

Research, Technology, and Future Directions

• Rare Disease Focus: The US Orphan Drug Act is cited as a successful catalyst for treating rare gynecological cancers (e.g., advanced BRCA ovarian cancer); panelists advocate for similar global incentives and regulatory harmonization to prevent fragmentation of R&D.
• AI and Precision Medicine:
  • Screening: AI is being leveraged to democratize screening by assisting in the analysis of imaging (X-rays, CTs) to offset workforce shortages.
  • Drug Repurposing: ARPA-H is funding AI-driven research to match approved drugs with rare diseases, addressing the data scarcity issue where individual physicians rarely see enough cases of specific rare cancers.
• Biobehavioral Gaps: A significant portion of ovarian cancer cases lack a clear genetic driver (e.g., BRCA), necessitating research into non-genetic drivers and less invasive detection methods using blood-based testing.
• Geopolitical Friction: Concerns were raised regarding the US BioSecure Act, which threatens to sever clinical trial collaborations between US, European, and Chinese researchers, potentially limiting global access to cutting-edge therapies.

Final Recommendations for Policymakers

• Nigeria: Closing the disparity gap in research participation is critical; current clinical trial participation by Black Africans is less than 5% despite the continent's demographic growth.
• United States: The Cancer Moonshot will continue as a bipartisan effort sustained by over 200 private and public partners; the focus must remain on national cancer control plans as a top priority.
• Global Consensus: National cancer control plans must remain a top legislative priority across all nations, ensuring that geopolitical tensions do not hinder international R&D collaboration.
• Equity Principle: All interventions must be designed starting with the populations least likely to benefit, rather than designing for the majority and attempting to adapt later.