In January, the American Cancer Society (ACS) reported the second consecutive annual decline in US cancer deaths since recordkeeping began in 1930.1 Three thousand fewer Americans died from cancer in 2004 than in 2003. This recent announcement, in addition to the decline in US cancer mortality rates that has been observed over the past 15 years, provides further evidence of the slow but steady progress being made in the war against cancer. There is, however, another rarely reported side to this story: the numbers of death from cancer in many lowand middle-income countries have been rising rapidly. This increase in cancer cases and deaths in lowand middle-income countries is part of a pronounced shift in the global disease burden. Over the next 10 years, deaths from infectious or communicable diseases are expected to decline by 3%, while those from chronic or noncommunicable diseases will increase by 17%.2 By 2030, there are projected to be 50 million deaths from noncommunicable diseases—more than 3 times the 15.5 million deaths projected for communicable, maternal, perinatal, and nutritional conditions.3 In all regions of the world, with the exception of Africa, the number of deaths from noncommunicable diseases will be significantly higher than those for communicable diseases. And while the death toll alone is staggering, the morbidity and economic impact on those affected, their caregivers, and society at large is also profound. According to the World Health Organization(WHO), people in lowand middle-income countries tend to develop chronic diseases “at younger ages, suffer longer—often with preventable complications—and die sooner than those in high income countries.”2 Despite the dramatic increase in chronic disease mortality and morbidity in lowand middle-income countries, public awareness of the problem is low. Moreover, recognition of the problem among policy makers, the press, and even the public health community has been muted. The agenda for the G8 Group of industrialized nations emphasizes infectious diseases, but does not address chronic disease.4 The UN Millennium Development Goals single out HIV/AIDS and malaria, but only broadly reference “other diseases,” and the Millennium Goals 2006 Report focuses exclusively on HIV/AIDS and tuberculosis. Infectious diseases remain a threat to the health and well-being of millions of individuals throughout the world, and their control should be a top priority, but we must also begin to elevate awareness and support for controlling chronic diseases. Robert Beaglehole, former Director of WHO’s Chronic Disease Program, and Derek Yach, Director of Global Health at the Rockefeller Foundation, paint a distressing picture of the current situation: “The growing global burden of noncommunicable diseases in poor countries and poor populations has been neglected by policy makers, major multilateral and bilateral aid donors, and academics. Despite strong evidence for the magnitude of this burden, the preventability of its causes, and the threat it poses to already strained health care systems, national and global actions have been inadequate.”5 Cancer comprises a major part of this chronic disease burden. Today, cancer—grouping all types of the disease— is the second leading cause of death worldwide, accounting for 7.6 million (13%) of the world’s 58 million total deaths in 2005. Already, more than 70% of cancer deaths occur in lowand middle-income countries, and this proportion will likely grow as deaths from cancer continue to rise. Worldwide, an estimated 9 million people are projected to die from cancer in 2015, and 11.4 million in 2030.6 Cancer Control Opportunities in Lowand Middle-income Countries

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低收入和中等收入国家的癌症控制机会

1 月，美国癌症协会 (ACS) 报告称，自 1930 年开始记录以来，美国癌症死亡人数连续第二年下降。 2004 年，美国人死于癌症的人数比 2003 年减少了 3000 人。过去 15 年观察到的死亡率进一步证明，在抗癌战争中取得了缓慢但稳定的进展。然而，这个故事还有另一个鲜为人知的一面：许多低收入和中等收入国家的癌症死亡人数一直在迅速上升。低收入和中等收入国家癌症病例和死亡人数的增加是全球疾病负担显着转变的一部分。未来 10 年，传染病或传染病的死亡人数预计将下降 3%，而慢性病或非传染性疾病导致的死亡人数将增加 17%。2 到 2030 年，预计非传染性疾病死亡人数将达到 5000 万——是传染性、孕产妇、围产期和营养状况导致的 1550 万人死亡人数的 3 倍多。3在世界所有地区，除非洲外，非传染性疾病导致的死亡人数将明显高于传染性疾病的死亡人数。虽然仅死亡人数就令人震惊，但对受影响者、他们的照顾者和整个社会的发病率和经济影响也是深远的。根据世界卫生组织 (WHO) 的说法，低收入和中等收入国家的人们往往“在更年轻的时候患上慢性病，遭受的时间更长——通常伴有可预防的并发症——并且比高收入国家的人更早死亡。” ”2 尽管低收入和中等收入国家的慢性病死亡率和发病率急剧上升，但公众对该问题的认识却很低。此外，政策制定者、新闻界甚至公共卫生界对这个问题的认识一直处于沉默状态。G8 工业化国家集团的议程强调传染病，但没有解决慢性病。 4 联合国千年发展目标将艾滋病毒/艾滋病和疟疾单独列出，但仅广泛提及“其他疾病”，千年目标 2006 年报告重点关注专门针对艾滋病毒/艾滋病和结核病。传染病仍然威胁着全世界数百万人的健康和福祉，控制它们应该是重中之重，但我们也必须开始提高对控制慢性病的认识和支持。世卫组织慢性病规划前主任罗伯特·比格尔霍尔和洛克菲勒基金会全球卫生主任德里克·亚赫描绘了一幅令人沮丧的当前局势：“贫穷国家和贫困人口日益增长的全球非传染性疾病负担被忽视了由决策者、主要的多边和双边援助捐助者以及学术界提供。尽管强有力的证据表明这种负担的严重性、其原因的可预防性以及它对已经紧张的医疗保健系统构成的威胁，但国家和全球行动一直不够。”5癌症是这种慢性疾病负担的主要部分。今天，癌症——包括所有类型的疾病——是全球第二大死亡原因，占 2005 年全球 5800 万总死亡人数中的 760 万（13%）。超过 70% 的癌症死亡发生在低收入和中等收入国家，随着癌症死亡人数的持续上升，这一比例可能还会增加。全球范围内，预计 2015 年将有 900 万人死于癌症，2030 年将有 1140 万人死于癌症。6 中低收入国家的癌症控制机会