|
Advertisement |
|
|
||
 |
|
|||||
|
|||||
|
 |
||||||
|
||||||
|
||||||
|
Originally published as JCO Early Release 10.1200/JCO.2006.07.7750 on March 12 2007 © 2007 American Society of Clinical Oncology.
Childhood Cancer in a Developing Nation
Division of Pediatric Hematology/Oncology, National Institute of Pediatrics, National Council for the Prevention and Treatment of Childhood Cancer, Mexico City, Mexico
Department of Pediatric Oncology, National Institute of Pediatrics, National Council for the Prevention and Treatment of Childhood Cancer, Mexico City, Mexico To the Editor: We read with interest the article by Jones et al.1 Some of the issues addressed by the authors are correct in adults with cancer; however, we would like to outline some other points that are worth mentioning, especially in regard to children with cancer in Mexico. In some developing nations, including Mexico, the incidence trend of cancer in general, and of childhood cancer in particular, is increasing in a very significant way. As mentioned by Jones et al, this increase is secondary to a definite change in the epidemiology of cancer. Through different federal public health measurements in Mexico, childhood mortality has diminished. This is due to different medical approaches, such as the national program of immunization for children; a national program for oral hydration for diarrhea; a campaign for early diagnosis and treatment of pneumonia; and early medical care for high-risk newborns. All of these mortality factors are most commonly present in children younger than 3 years. Therefore, reduced mortality in all of these childhood diseases has resulted in a larger pediatric population that eventually reaches the age of maximum incidence of childhood cancer in Mexico. The incidence trend of childhood cancer in Mexico is similar to that of developed nations. Currently, the second cause of death in Mexico among children ages 5 to 14 years is cancer.2 However, the mortality trend is on the rise,3 probably related to limited tertiary care from medical institutions and human resources. Presently, there are only 105 pediatric hematology/oncology Mexican board-certified physicians nationwide. This problem is worse in the eight states that do not have medical institutions and professionals for the treatment of childhood cancer. Obviously, all this major fault is secondary to limited federal financial funds. Not everything is that grim. Since January 2005, the government has been creating new federal programs. One of these programs is the National Council for the Prevention and Treatment of Childhood Cancer, which was created with new financial funds.4 So far, this program has accredited 34 tertiary care medical institutions nationwide, developing a referral system for those states that do not have specialized medical facilities. This program also has sponsored new posts for pediatric oncology residency programs. Acute leukemia and solid tumors are included in this national treatment plan. Only children with acute lymphoblastic leukemia are centrally registered and treated in a risk category treatment program. Within a few weeks, we will start to treat patients with the national protocols for lymphomas and solid tumors. Why a national program? As cited by Jones et al, there is a need to develop strategies in developing countries in order to diminish disparities in the health care of patients with those of developed nations. Besides, our national program will improve and standardize the treatment care for childhood cancer. This is permitting the development of national research protocols with obvious positive results. Developing countries have to solve their problem with limited financial resources for cancer control. It must be clear that of 103 million inhabitants of Mexico in 2006, half of this population did not have any health medical insurance coverage. Therefore, the financial funds for this population, especially those for childhood cancer, come from different sources, including the federal government and a recent agreement with the Mexican tobacco industry. The contribution of this industry has caused controversy to the extent that some mention that their participation is "doing the wrong thing for the right reason,"5 declaring that linking payment to a health fund with sales of cigarettes, the tobacco industry is undermining international agreements to control smoking. The agreement with the Mexican tobacco companies ended in November 30, 2006. However, global action requires respect for diversity, especially in developing nations and sensitivity to Mexican realities. We would even dare to suggest that this link could be permissible in the developing world in order to improve cancer control. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The authors indicated no potential conflicts of interest. NOTES published online ahead of print at www.jco.org on March 12, 2007. REFERENCES
1. Jones LA, Chilton JA, Hajek RA, et al: Between and within: International perspectives on cancer and health disparities. J Clin Oncol 24:2204-2208, 2006 2. Rivera-Luna R: Oncología Pediátric: General concepts of childhood cancer in Mexico, in Rivera-Luna R (ed): Pediatric Oncology: Basic and Clinical Concepts. Mexico City, Mexico, Intersistemas SA de CV, 2002, pp 1-11 3. Abdullaev FI, Rivera-Luna R, Roitenburd-Balacortu V, et al: Pattern of childhood cancer mortality in Mexico. Arch Med Res 31:526-531, 2000[CrossRef][Medline] 4. Presidency of the Republic: The tobacco industry will provide 4 million pesos for the health system. Mexico, 2004. www.presidencia.gob.mx/contenido 5. Samet J, Wipfli H, Perez-Padilla R, et al: Mexico and the tobacco industry: Doing the wrong thing for the right reason? BMJ 332; 353-354, 2006
Related Article
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
|||||||||||
|
|||||||||||
|
|
Copyright © 2007 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
|
