Cancer on the Move


“Location, location, location”— this is a popular maxim among real estate agents and home buyers, determining the price and desirability of a property. But it also has some relevance in the fight against cancer, with debates about which countries have the lowest cancer rates and/or the highest survival rates.

Can we increase our life­span by where we live? Prevent cancer by moving to a country with the lowest reported cancer rates?  Even if moving abroad is a practical option, the answer is not as simple as we might like.
If the reported rate of cancer in a particular country is very low, does it mean that fewer people develop cancer or that fewer people seek treatment for suspicious symptoms? Perhaps screening rates are less aggressive in one country than another, so that although the reported rate of cancer is not as high, many more may develop and die of undiagnosed cancer.  

Even with screening rates being equal, the chances of survival in a country with a lower cancer rate may lag behind that of one with a greater incidence of cancer but with more sophisticated facilities for treating the disease.
Is it worth living in a country with low cancer rates if, when you are diagnosed with cancer (despite your best efforts and healthy lifestyle), you may still have to move elsewhere for treatment?
Does any country offer the best of both worlds — that is, a relatively low rate of cancer per population and the best available treatment?
A look at the regions with the lowest cancer rates are the Gaza Strip and West Bank ((54.9 per 100,000 people), Syria (72.2), Namibia (78.3), Sudan (81.5), and Botswana (86.4).

But how successfully do these regions treat cancer so as to ensure survival of those diagnosed? The five-year survival rates could tell a different story. Moreover, how frequently are those living in areas stressed by war, poverty or both likely to undergo screening or early detection, which then might reveal a higher rate per 100,000.

Moreover, in poor, war-torn areas, living long enough even to develop cancer is a considerable challenge.

On the other hand, Denmark, an industrialized Western European country, shows the highest rate of cancer at 326 per 100,000, closely followed by Ireland (317), with the United States seventh (300.2) and Israel 11th (288.3). Do these high rates suggest more cancer or a more efficient system of reporting cancer?

Further, one would need to consider survival rates for patients once diagnosed. In a 2008 list (GLOBOCAN 2008 database), Norway’s rate of occurrence was eighth (299.1), but the Norwegian website, “Views and News from Norway,” announced on Nov. 20, 2011, that “Norwegian cancer patients have among the highest survival rates in the world.” A new report from the Organisation for Economic Co-operation and Development also ranks Norwegian cancer patients’ survival rates as the highest in Europe.
Consider that a country with more sophisticated reporting apparatus may also have more advanced treatments available.  But while the equipment may be available, it may not be evenly accessible. Does a country have universal health care? Does the country with universal health care necessarily offer the most advanced treatment and facilities?

The United States offers top-of-the-line cancer treatment facilities in its major cities. Indeed, in  a comment on Paul Krugman’s New York Times Blog, “The Conscience of a Liberal,”  one reader reported leaving Amsterdam for a Mayo Clinic in Arizona, to receive treatment for pancreatic cancer, after his Dutch medical staff gave him only 6 to 12 months  to live.

Finally, consider that cancer rates cover a wide range of malignancies. For example, in “Global Cancer Facts and Figures (2nd edition),” the American Cancer Society reports that “in 2008, the most common cancer site among males in most economically developed countries was prostate, with the exception of Japan where stomach cancer was the most common. Lung cancer predominated as the top cancer site in most of Eastern Europe and Asia.”
If your concern is with a specific kind of cancer, due to family history or lifestyle, you may want to choose your country accordingly.

While many developed countries have in place sophisticated medical staffs and treatment centers, should you develop cancer, one nation well worth considering for a visit is Israel, where Vaxil BioTherapeutics has developed a vaccine designed to prevent recurrences. While the vaccine is currently being tested on multiple myeloma (a cancer of the blood), it could, depending on the success of the tests, be used for other types of cancer as well.
With so many variables, how do you decide where to live based on cancer risk and cancer survival rates?  Rather than pulling up stakes and moving to another country, first thing to do — based on reports and evidence — is to research one’s options at home, practice healthy habits, get screened regularly — and stay tuned for further developments.

This article originally appeared in a special "Fighting Cancer" section of the Exponent.


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