The Challenges of Cancer Control Facing Argentina

Issue 23, Summer/Fall 2014

With 41 million inhabitants, Argentina is the fourth largest Spanish speaking country in the world and the third largest country in Latin America. Like other countries, Argentina faces a heavy cancer burden – over 110,000 new cancer cases annually, costing the nation more than $488 million US per year in medical and non-medical costs.

People waiting at a mobile clinic.

Multiple factors are conspiring to drive those numbers even higher. In fact, experts predict a 20 percent rise in annual cancer cases by 2020, due to tobacco use, cancer causing infections (primarily HPV), an aging population, and increasing Western lifestyles. Currently, Argentina’s most common cancers are breast, cervical, and colorectal cancer in women and prostate, lung and colorectal cancer in men.1,2

Tobacco is the most important cancer risk factor for Argentinians, accounting for 26 percent of all cancer deaths and 84 percent of lung cancer deaths. Argentina has a national smoking rate of 22 percent, with an especially high rate (38 percent) in Buenos Aires.3,4 Trends for the future are also alarming, with 28 percent of children aged 13-15 years now smoking.3,5 Despite recent anti-tobacco laws,6,7 tobacco-related cancers are expected to rise and continue to be a major public health issue for years to come.

Efforts at cancer prevention in Argentina face other challenges. HPV infection among adolescents is estimated to cause about 80 percent of the 3,000 cervical cancer cases occurring in the country each year, and 1,800 related deaths annually. The hope is that the recent initiation of HPV vaccination programs in girls will result in a future decline in cervical cancer mortality. However, expanding immunization to include boys, and focusing more attention on ongoing secondary screening, would help curb mortality even further.

Breast cancer screening, shown to reduce mortality in high-income countries, is offered to Argentinian women, but adherence remains low, particularly in remote areas. Improved public awareness, and patient-navigator programs that result in more cancers being diagnosed at an earlier stage, could each help to reduce overall deaths from breast cancer.

People waiting at a mobile clinic.

Regional disparities in health care add yet another challenge. In addition to socioeconomic disparities (eg, shorter waiting times and advanced technologies in the private versus public sector), there are significant regional differences in access to care between urban and rural areas. For example, while there is one doctor for every 95 residents of Buenos Aires, the ratio rises to 1 per 962 in the largely rural southern state of Tierra del Fuego.8 Long commutes from rural and remote areas for advanced cancers frequently result in costly and protracted hospitalizations for end-of-life care, and ambulatory palliative and hospice services are rarely available.9 With 57 percent of Argentina’s people living in rural areas, and 26 percent living in remote areas, these regional disparities affect a high proportion of the population.

Argentina is an upper-middle income country, however, and the resources to effect change are available.5 A total of 8.1 percent of the nation's 475 billion USD annual GDP is currently spent on healthcare – a rate just slightly below the 9 percent GDP spent in the European Union. About 55 percent of that expenditure comes from taxes and goes toward the public health system.10

People waiting at a mobile clinic.

Efforts toward effective cancer prevention strategies can be made. In 2012, Argentina launched a new National Cancer Institute (INC) to coordinate national cancer control policies.11 A representative national cancer registry for Argentina – devised from existing and new local and regional registries – could facilitate developing a comprehensive national cancer plan to address growing cancer control issues. Increasing funding for cancer and its share of the overall health care budget, as well as allocation of resources toward the socioeconomically disenfranchised, is essential.

An action plan for the future:

  1. Devise a relatively inexpensive national cancer registry to assess the extent and nature of the future cancer burden faced by Argentina.
  2. Adhere to the National Cancer Plan – including efforts to curb tobacco use and continuing to implement immunization of girls for HPV.
  3. Increase health care spending, and the relative contribution toward cancer control in the public sector.
  4. Re-distribute existing expenditures with an emphasis on the disenfranchised.
  5. Track and measure outcomes of a national cancer control plan.
  6. Assist neighboring Paraguay and Bolivia to design and implement their own National Cancer Plans to alleviate their own, and Argentina’s, cancer burden.
  7. Train more and incentivize health care personnel toward underserviced areas.
  8. Establish working committees to monitor metrics of progress.

Efforts like these should help prevent future increases in cancer-related suffering and expenditures in Argentina. However, any such progress requires a concerted effort by health professionals, policymakers, health economists and other stakeholders - and is urgently needed.

Professor Paul E. Goss, MD, PhD
International Cancer Research Program
Massachusetts General Hospital and
Harvard Medical School
Boston, MA

Mayra Ferreyra, MD
International Cancer Research Program
Massachusetts General Hospital and
Harvard Medical School
Boston, MA

Kathrin Strasser-Weippl, MD
Wilhelminen Hospital
Center for Oncology, Hematology, and Palliative Care
Vienna, Austria

References

  1. Mariana Belló LeP, M en C,(1) Victor M Becerril-Montekio, Lic en Ec, M en Soc.(2)(1) Universidad del Caribe. Cancún, Quintana, Roo, México., (2) Instituto Nacional de Salud Pública. Cuernavaca M, México: Sistema de salud de Argentina. Salud Pública Mex 2011; Vol 53(2):96-108 2011.
  2. Cancer ind: Principales datos epidemiológicos sobre cáncer según sexo, edad, localización del tumor primario y distribución geográfica. Argentina, febrero de 2013. http://www.msal.gov.ar/inc/index.php/acerca-del-cancer/estadisticas. Accessed on 01/09/2014.
  3. http://globocan.iarc.fr/Pages/fact_sheets_population.aspx:estimated cancer incidence, mortality and prevalence worldwide in 2012. Globocan 2012.
  4. Villarreal-Garza C, Garcia-Aceituno L, Villa AR, Perfecto-Arroyo M, Rojas-Flores M, Leon-Rodriguez E: Knowledge about cancer screening among medical students and internal medicine residents in Mexico City. J Cancer Educ 2010, 25:624-631.
  5. Torres-Vigil I, Aday LA, Reyes-Gibby C, De Lima L, Herrera AP, Mendoza T, Cleeland CS: Health care providers' assessments of the quality of advanced-cancer care in LatinAmerican medical institutions: a comparison of predictors in five countries: Argentina, Brazil, Cuba, Mexico, and Peru. J Pain Palliat Care Pharmacother 2008, 22:7-20.
  6. Muller F, Wehbe L: Smoking and smoking cessation in Latin America: a review of the current situation and available treatments. Int J Chron Obstruct Pulmon Dis 2008, 3:285-293.
  7. Champagne BM, Sebrie EM, Schargrodsky H, Pramparo P, Boissonnet C, Wilson E: Tobacco smoking in seven Latin American cities: the CARMELA study. Tob Control, 19:457-462.
  8. Pichon-Riviere A AA, Bardach A, Augustovski F, Caporale J CFwioa: Carga de Enfermedad atribuible al Tabaquismo en Argentina. Documento Técnico IECS N° 7 Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina Mayo de 2013.
  9. Goss PE, Lee BL, Badovinac-Crnjevic T, Strasser-Weippl K, Chavarri-Guerra Y, St Louis J, Villarreal-Garza C, Unger-Saldana K, Ferreyra M, Debiasi M, et al: Planning cancer control in Latin America and the Caribbean. Lancet Oncol 2013, 14:391-436.
  10. http://www.msal.gov.ar/tabaco/index.php/informacion-para-profesionales/tabaquismo-en-el-mundo-generalidades/prevale:control del tabaco. ministerio de salud.
  11. Material para la materia Medicina Social. Facultad de Trabajo Social -UNLP 2006.