The rallying call was “no patient should be left behind” at the recent War on Cancer Asia conference. Without action, cancer mortality is set to grow in tandem with the rapid increase in cancer incidence worldwide. The March conference, in Singapore, reviewed practical aspects such as implementing early detection measures, where to put limited funding dollars, patient outreach and advocacy. With cancer estimated to be responsible for one in six deaths, and the second leading cause of death globally, according to the World Health Organisation, public and private sector collaboration is critical. Here are four main takeaways from the conference. 1. Cancer incidence is worsening in low-income countries A health care report from The Economist Intelligence Unit advisory body reviewed different countries’ “national readiness” for tackling the disease. While cancer incidence remains higher in wealthier countries, lower-income ones are now closing the gap as they suffer from poor cancer control. The hotspots of mortality are Africa, Southeast Asia, Central Asia, and Eastern Europe. Why the liver is a multipurpose marvel and how we can help keep it healthy 2. Australia, Taiwan leading the way Australia leads the way in care delivery, policy implementation and cancer control. Taiwan was also highlighted as an example of successful planning, spending about US$1 billion yearly for early detection and prevention, according to Wang Ying-Wei, director general for health promotion administration at Taiwan’s Ministry of Health and Welfare. He says free screening for some groups is yielding good results, and advocacy plays an important part. At the other end of the spectrum, the Mongolian government currently has no cancer programme. A decade-long cancer programme, which began in 2007, has now ceased, with funds shifted to include a broader spectrum of diseases, according to Tsetsegsaikhan Batmunkh, founder and chief executive of the National Cancer Council of Mongolia. She also attributes the lack of cancer control to political instability. There is little focus on early detection. As a result of notoriously high rates of hepatitis B and C in Mongolia, there continues to be a high incidence of liver cancer there. The same is true for Southeast Asia, where high incidence of liver cancer is linked to its elevated hepatitis cases. Chinese doctor’s near-miracle recovery after cancer immunotherapy shows the promise new treatment holds 3. Plans, registries crucial to controlling cancer Having comprehensive national cancer plans and cancer registries is crucial. Population-based cancer registries (PBCRs) provide an overview of all cancer across a given group of people. Higher income countries currently have better registries. The information in these valuable data sets, including data on mortality, critically help with cancer planning and control. In 2015, PBCRs were estimated to cover 95 per cent of North America’s population, but only 1.9 per cent of Africa’s. Sarbani Chakraborty, a senior health systems strategy leader for pharmaceutical company Roche, says there is a need to change the attitude that cancer is fatal, and have people enter the health care system for treatment earlier. It is heartening to see China leapfrogging [other countries] and how fast it is moving with regard to creating a registry for [cancer] screening. Sarbani Chakraborty She gave the example of Ghana, where most women with breast cancer enter the system late because of a lack of money. They believe it’s “better to not seek treatment so that the meagre family money can be used for the children’s education,” Chakraborty adds. China, though, is reportedly upping the ante on its battle against cancer. Chakraborty says although it has entered the fight against cancer late, China has been rapidly broadening and strengthening its registry networks. “It is heartening to see China leapfrogging [other countries] and how fast it is moving with regard to creating a registry for screening,” she says. 4. Children’s cancers are mostly curable Another key emphasis of the conference is that childhood cancers are mostly curable. Ironically, when it comes to childhood cancer, policies and cancer control initiatives are often neglected, says Carlos Rodriguez-Galindo, executive vice-president and chair of the Department of Global Paediatric Medicine at St Jude Children’s Research Hospital in the United States. Each year, about 50,000 children are diagnosed with cancer in China, about 12,000 of whom have acute lymphoblastic leukaemia (ALL), a common form of childhood cancer, he says. Before 2010, fewer than 10 per cent of children with cancer received treatment because individual families were required to shoulder the financial burden of therapy. Cancer survivors and their parents should be engaged as they are the best advocates and have a vital voice for planning, decision making, and advocacy efforts. Carlos Rodriguez-Galindo In partnership with local hospitals, St Jude launched a pilot programme to treat these children with ALL, and now sees the number of children receiving cancer treatment in China “skyrocketing”. The Chinese government now covers childhood cancer care, and 90 per cent of children in China with cancer are reported to survive, says Rodriguez-Galindo. In 2017, the Chinese government approved the creation of the first National Children’s Medical Centre. Shanghai Children’s Medical Centre and St Jude are developing a framework for cancer treatment, training and research for the centre. St Jude is also forming partnerships with Guangzhou Women and Children’s Medical Centre, and Tianjin Institute of Haematology and Blood Diseases Hospital for research on childhood cancer and blood diseases in China. “Developing strong health systems that support delivery of quality childhood cancer care requires the integration of many stakeholders,” says Rodriguez-Galindo. “Cancer survivors and their parents should be engaged as they are the best advocates and have a vital voice for planning, decision making and advocacy efforts.” Hong Kong’s battle against cancer Widespread cancer awareness education, lifestyle advice on cancer prevention and early detection are on Iris Leung’s wish list. As chief executive of the Hong Kong Anti-Cancer Society, she says the government should discourage alcohol consumption and smoking, and ban e-cigarettes. Founded in 1963, the society is one of the city’s oldest cancer organisations, with a mission to advocate, empower and support. Hong Kong has some successes in its battle against cancer, including an active non-governmental organisation scene and cancer survivor support groups. Leung adds that cancer treatments are advanced and efficient – once they commence. Young cancer survivors’ challenges: staying positive, making friends, returning to school The hitch, she says, is that there is a long wait for public-sector diagnostics such as CT and PET scans and treatments such as chemotherapy. Another positive note is that more cancer treatment drugs are being covered by the Hong Kong Community Care Fund to help financially disadvantaged patients. Leung, who has been with the society for 13 years, says her wish list also includes more affordable (or free) prevention and screening services. These include screening for colorectal cancer, Pap smears, HPV DNA tests for high-risk groups, hepatitis B tests and vaccinations, and free or subsidised mammograms, particularly for high-risk groups.