Cancer medicine continues to face major challenges: tumor diseases remain the second leading cause of death in Germany. There are over half a million new diagnoses here every year. Almost half of all cancer cases could be avoided.
A surgeon looks at the MRI scans of a lung patient.
Photo: Alamy/Beton studio
In addition, the consequences of the corona pandemic will be particularly noticeable in this area: because many people in Germany too are neglecting precautionary measures due to fears of infection. But colonoscopies or HPV vaccinations (which are designed to prevent cervical cancer) were not part of the general prevention habit even in the absence of a pandemic. To make matters worse, cancer therapies were also postponed during the course of the pandemic – perhaps only by a few weeks, so that clinics could be relieved. But even such short periods can have devastating effects when tumors grow rapidly.
The motto of this year’s World Cancer Day »Closing gaps in care« is once again given special weight. This day of admonition is taking place for the 22nd time – the focus is set by the International Association Against Cancer.
On the one hand, gaps in coverage arise where people are not so particular about their provision – or where they have no access to it at all. If diagnosed too late, this also applies to cancer, one falls ill more severely, with poorer prospects of recovery. Anyone who only goes to the doctor in an emergency anyway, cannot make themselves understood in the healthcare system and does not feel understood is at a disadvantage. This applies to people whose native language is not German, who have low incomes and are overburdened with work or family, or who only have a low level of education. The group could be expanded.
Conversely, data from the AOK Rhineland/Hamburg shows who, for example, takes advantage of statutory colon cancer screening: The majority of these are socially and financially well-off citizens, as pointed out by the professional association of resident gastrointestinal doctors. On average, these people are less likely to develop colon cancer, and their existing tumors are detected at such an early stage that they can be easily treated. In people from precarious backgrounds, on the other hand, often associated with lower health literacy, colorectal cancer would only be diagnosed at a later stage.
The Federal Center for Health Education refers to a similar problem with regard to nicotine and alcohol. Associated risks also include certain cancers. In 2020, respiratory cancers, often caused by smoking, were the most common type of cancer causing death, killing more than 46,000 people. That’s more than one in five cancer deaths.
Smokers who also drink alcohol at high risk are particularly at risk of developing cancer. This combination obviously promotes tumors of the upper respiratory tract and the upper digestive tract in particular – i.e. cancer of the oral cavity, pharynx, larynx and esophagus.
Tobacco, which is certainly still one of the most widespread drugs in Germany, is by no means consumed equally across all income groups: a study by the Heinrich Heine University in Düsseldorf found that it was primarily the poorer and less educated who smoked in 2016/17. 41.6 percent of people without school qualifications smoke. For those with a high school diploma, it is half less at 20 percent. In households with a net income of up to 1,000 euros, 36.5 percent smoke, while among the wealthy with at least 5,000 euros it is 23.2 percent.
The German Cancer Aid is currently pointing out gaps in care that are also likely to affect people with low incomes the most, including in outpatient psycho-oncological and psychosocial care. When poor families lose income due to illness or death, this often has extreme and traumatic consequences for the bereaved.
A completely different dimension of gaps in care can be lamented internationally: The World Health Organization (WHO) estimates that by 2040 the relatively largest increase in cancer will be in low-income countries; it assumes a doubling. Here it is above all the cancer drugs, which are still too expensive despite long expired patents, that are not available to the majority of the population.