Ecuador outperforms richer countries in cancer survival rates, new studies show; lifestyle and food could be contributing factors

By Makiko Kitamura

Ecuador has one of the highest survival rates for cancer, beating out richer countries that spend much more money on preventive and medical care.

Examples include colon cancer, where it rates higher than countries such as Switzerland and Norway, according to a global survey showing wide differences in how well nations tackle various cancers. Ecuador also rates high in survival rates for other types of cancer.

Variations in rates of survival are most striking for leukemia in children and lung cancer, said researchers led by Claudia Allemani, a cancer epidemiologist at the London School of Hygiene & Tropical Medicine. The study was published in the Lancet medical journal. The survival rate five years after diagnosis for leukemia ranged between 16 percent in Jordan and 90 percent or higher for Canada, Belgium and Austria for the period from 2005 to 2009.

“In the 21st century, there should not be such a dramatic gulf in survival,” Allemani said in a statement. “The findings can be used to evaluate the extent to which investment in health-care systems is improving their effectiveness.”

The study, which analyzed data from cancer registries in 67 countries including 25.7 million adults and 75,000 children, highlights the importance of early diagnosis and access to treatments. In the case of prostate cancer, dramatic increases in survival rates in Latvia and Denmark can be attributed to wider adoption of PSA testing, the authors said. With stomach cancer, widespread early diagnosis in Japan and South Korea probably explain high rates of survival in those countries, they said.

Worst Prognosis
Lung and liver cancers have the worst prognosis among the 10 cancers examined, with survival rates of less than 20 percent in both developed and developing countries. Even in some European countries, such as the U.K., the rate is below 10 percent, compared with 29 percent in Ecuador and 17 percent in Switzerland.

Ecuador is second only to Israel in colon cancer, with a survival rate of 68 percent, compared with 62 percent in Norway and 63 percent in Switzerland. As with other cancers, early diagnosis and availability of treatments such as pre-operative radiotherapy help improve chances of survival, the authors said.

No clear reason is available to explain Ecuador’s high rates across several cancers, which are mostly taken from the cancer registry of the capital Quito, said Michel Coleman, one of the study authors at the London School of Hygiene and Tropical Medicine. It has been suggested that the country’s less stressful lifestyle and access to fresh fruits and vegetables could be factors in the rates.

Big Spending
While performance in the U.S. is generally high, it isn’t significantly higher than many poorer countries, suggesting that increased spending on the latest chemotherapy regimes or therapies personalized for patients aren’t necessarily paying off, he said.

“The most important reasons for good survival are adequate level of investment in health-care systems but also a high level of organization so that it’s uniformly and equitably accessible to everybody,” Coleman said by phone. Availability of the “bedrock” tools of surgery, radiotherapy and chemotherapy may be more important than advances in new drugs, he said.

While the study is a valuable assessment of cancer trends by country, it also highlights the scarcity of data available for some countries, said Linda Harlan and Joan Warren of the U.S. National Cancer Institute in Bethesda, Maryland.

“Undoubtedly, the availability of better data provides a clearer picture of the effect of cancer control programs on the ultimate goal of improving survival,” they said in a comment accompanying the study publication.