Fostering collaboration to prioritize women’s cancers and minimize cervical and breast cancer burden in Asia Pacific

Deepti Saraf

Deepti Saraf

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Deepti Saraf is the General Manager of Roche, the pharmaceutical division of Roche. She is also the Vice President of Pharmaceutical Association of Malaysia (PhAMA). Deepti brings with her 19 years of experience in the pharmaceutical industry in India and Thailand. She has worked across multiple disease areas including Primary care, Oncology, Comprehensive Genomic Profiling, I2O and Nephrology. She has worked to establish a rural healthcare commercial model in India and has developed a comprehensive and integrated access strategy for Roche in India. In the APAC region, Deepti is very passionate when it comes to women’s healthcare and women’s leadership. She is a part of the APAC Women’s Cancer Coalition, where the primary objective is to advance women’s’ oncology in the APAC region. The coalition’s focus lies on enhancing breast and cervical cancer care in emerging economies. She is also deeply committed to building a culture that empowers decision making, whilst encouraging innovation and experimentation that benefit patients. In the APAC region, Deepti is very passionate when it comes to women’s healthcare and women’s leadership. She is a part of the APAC Women’s Cancer Coalition, where the primary objective is to advance women’s’ oncology in the APAC region. The coalition’s focus lies on enhancing breast and cervical cancer care in emerging economies.

Dr. Heather White

Dr. Heather White

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Dr. Heather White is a global health specialist with over 20 years of experience across numerous practice areas, including non-communicable diseases, family planning, HIV, and cervical cancer prevention. Heather serves as the executive director at TogetHER for Health, a global advocacy organization dedicated to ending preventable deaths from cervical cancer. In this role, she collaborates with a global network of partners to underscore the need for innovation and financing, advocates for policies which promote equitable access to prevention and treatment, and shares stories of individuals, families and communities directly affected by this disease.

With the current gaps and urgent unmet need around diagnosis and treatment of women’s cancer in Asia, members of the APAC Women’s Cancer Coalition share why there is a need for a collaborative approach to drive change to improve equitable access in women’s cancer care.

At a moment when the world has coalesced around global goals to reduce breast cancer mortality and potentially eliminate cervical cancer as a public health threat, the respective burdens of these two cancers in the Asia Pacific region are currently trending in a deadly direction. Preventable disease and deaths from these two cancers needlessly tear apart family units, and their progression to advanced stages often results in catastrophic out of pocket costs for individuals and families and can overburden health systems and weaken national economies.

The Asia Pacific region already accounts for 45% of global breast cancer cases and 58% of global cervical cancer deaths, but without urgent action that burden is likely to grow. By 2030, breast cancer diagnoses in the Asia Pacific region are projected to rise by 20.9%, with breast cancer deaths increasing by 27.8%. In that same period, new cervical cancer diagnoses are projected to rise by 18.9% with deaths increasing by almost 25%. Unacceptably high rates of cervical and breast cancer are driven by insufficient access to care and treatment capacity, exacerbated by social stigma and low awareness around the need for prevention, early detection, and timely follow-up.

Recently, Member States of the World Health Organization (WHO) ratified global goals for the scale-up of effective prevention, treatment, and care for both breast and cervical cancer which, if achieved, could save millions of lives worldwide. WHO’s 60-60-80 goals for breast cancer aim to reduce mortality though risk reduction, regular screening, and comprehensive management of invasive disease, while its 90-70-90 goals for cervical cancer are built on projections showing that global scale up of HPV vaccination, preventive screening, and safe removal of pre-cancerous cervical lesions can effectively eliminate cervical cancer as a public health threat.

Countries in the Asia Pacific region stand to benefit tremendously from investing in reducing the burden of cervical and breast cancer. The moral imperative to save the lives of women is compelling on its own, preserving family units and communities alike. But these cancers also strike women in the primes of their lives, when they are most actively contributing to the financial well-being of their families – and in the aggregate, to their nation’s economies.

Insufficient uptake of effective preventive measures such as vaccination, screening and preventive treatment for cervical cancer and early screening/detection for breast cancer, increases the risk of late-stage diagnosis, when the costs of treating invasive cancer are significantly higher than the cost of prevention or early treatment. In Vietnam, out-of-pocket costs for breast cancer are actually 66% higher for Stage II disease and 148% higher for Stage III disease compared to Stage 0/I disease. Catastrophic out-of-pocket costs to treat invasive cancer at the individual level can create cycles of poverty and impact income levels for subsequent generations. In fact, the cost of treatment for cervical cancer patients in India results in nearly 62% of patients incurring catastrophic health expenditure.

At the national level, these avoidable cancer treatment costs create a huge burden on healthcare systems while sapping a country’s economic productivity. In Indonesia alone, an estimated 246,000 years of life were lost to cervical cancer mortality in the year 2018, resulting in a total productivity cost of US$1.7 billion.

It’s clear that investments in prevention, screening and timely treatment of breast and cervical cancer save lives and preserve a country’s economic health. For every one US dollar invested in the global cervical cancer elimination targets, an estimated $3.20 is returned to the economy due to the increased participation of women in the workforce. Increased funding for these interventions must first and foremost be understood not as an expenditure but as an investment in the health and economic well-being of a country’s populace. But financial resources alone won’t put the Asia Pacific region on the path to achieving goals to reduce these women’s cancers.

These investments must also be guided by situational information, including an analysis of the current status of disease burden and relevant health policies. Effective policies must be incorporated into national cancer control plans in line with global targets as well as tailored to each country’s specific context. That context should also influence programs ensuring access to these interventions as well as their affordability. Finally, collaboration between stakeholders across health systems – and even between countries – must be a core principle for promoting breast and cervical health in a holistic, and patient-centric manner to decrease stigma and improve access to effective and equitable care for all.

The challenges facing us are multifaceted, with no single partner or sector capable of tackling these complex problems alone. These considerations guided this year’s launch of the APAC Women’s Cancer Coalition, a multisectoral partnership dedicated to identifying areas for collaboration to advance prevention, early detection and timely treatment in the Asia Pacific and align regional priorities with the WHO’s global targets for breast and cervical cancer, starting with six focus countries: India, Indonesia, Malaysia, the Philippines, Thailand, and Vietnam.

The Coalition’s members – Roche, CAPED India, Jhpiego, Crowell & Moring International, and TogetHER for Health – each contribute essential perspectives and distinctive capabilities. Jhpiego leverages extensive experience in successfully implementing cervical cancer prevention projects in diverse settings, notably through the use of HPV DNA testing. TogetHER for Health brings strong global advocacy experience in aligning country policies and implementation with global goals for cervical cancer. CAPED India’s significant patient advocacy and engagement skills provide the Coalition with a strong understanding of patients’ needs. Crowell & Moring International acts as Secretariat of the Coalition and brings global government affairs expertise to the table. And Roche’s investment in strategic partnerships with health systems seeks to address system-level barriers and root causes that women encounter in accessing needed care.

The APAC Women’s Cancer Coalition’s first order of business involved commissioning Economist Impact to produce the “Impact and opportunity: the case for investing in women’s cancers in Asia Pacific repot”, an analysis of cervical cancer prevention and breast cancer prevention and care in the Coalition’s six focus countries that also included individual country scorecards on key activities.

This in-depth report has served as a point of entry for conversations with country-level policymakers and advocates seeking to generate momentum toward improving breast and cervical cancer prevention and treatment. The report also highlights the powerful potential that a collective vision of improved control of these two women’s cancers can have in driving effective health policies across the region.

A great example is the Philippines, where key stakeholders - including the Department of Health, National Integrated Cancer Control Council, Philippine Cancer Center, Department of Labor and Employment and patient groups such as Philippine Society for Breast Cancer Care Inc. - used the report as the basis to discuss key actions toward integrating elimination and prevention of cervical and breast cancer into national health plans. Some key takeaways for next steps included the need to establish population and hospital-based registries, expanding Philhealth coverage to include reimbursement to broaden access to cervical and breast cancer patients and implementing screening campaigns in workplaces by the National Integrated Cancer Control Act (NICCA).

In Indonesia, a Coalition-led workshop in Jakarta on November 8th focused on women’s cancer control in the country. The recent launch of the National Cervical Cancer Elimination Plan represents a fantastic opportunity for the Coalition to partner with the government and support implementation of relevant activities, such as expanding the scope of HPV DNA testing beyond ongoing efforts in Jakarta, and collaborating with civil society organizations such as Lovepink and the Indonesian Coalition to Prevent Cervical Cancer on sharing of best practices, strengthening patient advocacy and awareness efforts.

The opportunity of increased regional focus to protect women in the Asia Pacific region from breast and cervical cancer isn’t just tied to global WHO goals for each cancer. Collaboration in the fight against women's cancer can also serve as a real-world example of advancing the Sustainable Development Goals, in particular Goals 3 (“Ensure healthy lives and promote well-being for all at all ages”) and 5 (“Achieve gender equality and empower all women and girls”).

Rapid progress in these lifesaving cancer control efforts can position the Asia Pacific as the vanguard region in achieving global health goals and an inspiration to the entire world. The APAC Women’s Cancer Coalition is committed to supporting regionwide efforts to share resources, promote best practices, and generate the necessary leadership to change the trajectory of breast and cervical cancer rates.

“We are cognizant of the intricate challenges in cancer care and is committed to forging strategic partnerships with health systems and their key stakeholders. Partnering with APAC WCC, we aim to address the structural barriers that impede women's access to the highest standard of care, ensuring they receive the best possible outcomes for their health and well-being.”

But we can’t do it without new partners and ideas. The Coalition extends an invitation to new partners to strengthen our advocacy efforts on the ground. Join us on this journey and reinforce our collective commitment to combating women's cancer in the Asia Pacific Region.

--Issue 63--