title: Global cancer surgery: delivering safe, affordable, and timely cancer surgery.
abstract: Surgery is essential for global cancer care in all resource settings. Of the 15.2 million new cases of cancer in 2015, over 80% of cases will need surgery, some several times. By 2030, we estimate that annually 45 million surgical procedures will be needed worldwide. Yet, less than 25% of patients with cancer worldwide actually get safe, affordable, or timely surgery. This Commission on global cancer surgery, building on Global Surgery 2030, has examined the state of global cancer surgery through an analysis of the burden of surgical disease and breadth of cancer surgery, economics and financing, factors for strengthening surgical systems for cancer with multiple-country studies, the research agenda, and the political factors that frame policy making in this area. We found wide equity and economic gaps in global cancer surgery. Many patients throughout the world do not have access to cancer surgery, and the failure to train more cancer surgeons and strengthen systems could result in as much as US $6.2 trillion in lost cumulative gross domestic product by 2030. Many of the key adjunct treatment modalities for cancer surgery--e.g., pathology and imaging--are also inadequate. Our analysis identified substantial issues, but also highlights solutions and innovations. Issues of access, a paucity of investment in public surgical systems, low investment in research, and training and education gaps are remarkably widespread. Solutions include better regulated public systems, international partnerships, super-centralisation of surgical services, novel surgical clinical trials, and new approaches to improve quality and scale up cancer surgical systems through education and training. Our key messages are directed at many global stakeholders, but the central message is that to deliver safe, affordable, and timely cancer surgery to all, surgery must be at the heart of global and national cancer control planning.
authors.affiliation: Institute of Cancer Policy, King's Health Partners Comprehensive Cancer Centre, London, UK; King's Centre for Global Health, King's Health Partners and King's College London, London, UK. Electronic address: richard.sullivan@kcl.ac.uk.
authors.forename: Richard
authors.initials: R
authors.lastname: Sullivan
authors.affiliation: Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria.
authors.forename: Olusegun Isaac
authors.initials: OI
authors.lastname: Alatise
authors.affiliation: University of Washington School of Medicine, Seattle, WA, USA; Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: Benjamin O
authors.initials: BO
authors.lastname: Anderson
authors.affiliation: University of Liverpool, Liverpool, UK.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Audisio
authors.affiliation: International Prevention Research Institute, Lyon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Autier
authors.affiliation: Institute of Cancer Policy, King's Health Partners Comprehensive Cancer Centre, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK; London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Ajay
authors.initials: A
authors.lastname: Aggarwal
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Balch
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Murray F
authors.initials: MF
authors.lastname: Brennan
authors.affiliation: Centre for Global Health Research, St Michael's Hospital, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Anna
authors.initials: A
authors.lastname: Dare
authors.affiliation: Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.
authors.forename: Anil
authors.initials: A
authors.lastname: D'Cruz
authors.affiliation: Gustave Roussy Cancer Institute, Villejuif, France; University Paris Sud, Orsay, France.
authors.forename: Alexander M M
authors.initials: AM
authors.lastname: Eggermont
authors.affiliation: Green Templeton College, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Fleming
authors.affiliation: University Cheikh Anta Diop, Dakar, Senegal; Grand Yoff General Hospital, Dakar, Senegal.
authors.forename: Serigne Magueye
authors.initials: SM
authors.lastname: Gueye
authors.affiliation: Paediatric Surgery and Global Paediatrics, Department of Paediatrics, Lund University, Lund, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Hagander
authors.affiliation: Cabinet of the Minister, Ministry of Health, Santiago, Chile; Department of Public Health, School of Medicine, Pontificia Universidad Católica, Santiago, Chile.
authors.forename: Cristian A
authors.initials: CA
authors.lastname: Herrera
authors.affiliation: Paediatric Surgery and Global Paediatrics, Department of Paediatrics, Lund University, Lund, Sweden.
authors.forename: Hampus
authors.initials: H
authors.lastname: Holmer
authors.affiliation: University of Texas MD Anderson Cancer Centre, Houston, TX, USA; Union for International Cancer Control, Geneva, Switzerland.
authors.forename: André M
authors.initials: AM
authors.lastname: Ilbawi
authors.affiliation: Paediatric Surgery and Global Paediatrics, Department of Paediatrics, Lund University, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Anton
authors.initials: A
authors.lastname: Jarnheimer
authors.affiliation: Peking University Cancer Hospital and Institute, Beijing, China; Chinese Anti-Cancer Association, Tianjin, China.
authors.forename: Jia-Fu
authors.initials: JF
authors.lastname: Ji
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: T Peter
authors.initials: TP
authors.lastname: Kingham
authors.affiliation: McCabe Centre for Law and Cancer, Melbourne, VIC, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Liberman
authors.affiliation: King's Centre for Global Health, King's Health Partners and King's College London, London, UK.
authors.forename: Andrew J M
authors.initials: AJ
authors.lastname: Leather
authors.affiliation: Program in Global Surgery and Social Change, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: John G
authors.initials: JG
authors.lastname: Meara
authors.affiliation: Program in Global Surgery and Social Change, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Swagoto
authors.initials: S
authors.lastname: Mukhopadhyay
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard School of Public Health, Boston, MA, USA; Department of General Surgery, Indiana University, Bloomington, IN, USA.
authors.forename: Shilpa S
authors.initials: SS
authors.lastname: Murthy
authors.affiliation: Cairo University, Cairo, Egypt.
authors.forename: Sherif
authors.initials: S
authors.lastname: Omar
authors.affiliation: Department of Obstetrics and Gynecology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA; University of Zambia, Lusaka, Zambia.
authors.forename: Groesbeck P
authors.initials: GP
authors.lastname: Parham
authors.affiliation: Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.
authors.forename: C S
authors.initials: CS
authors.lastname: Pramesh
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Riviello
authors.affiliation: Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
authors.forename: Danielle
authors.initials: D
authors.lastname: Rodin
authors.affiliation: INCA (Brazilian National Cancer Institute), Rio de Janeiro, Brazil.
authors.forename: Luiz
authors.initials: L
authors.lastname: Santini
authors.affiliation: Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.
authors.forename: Shailesh V
authors.initials: SV
authors.lastname: Shrikhande
authors.affiliation: Program in Global Surgery and Social Change, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Shrime
authors.affiliation: Department of Health & Human Services, Melbourne, VIC, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Thomas
authors.affiliation: Gyne-Oncology Department, Barretos Cancer Hospital, Barretos, Brazil.
authors.forename: Audrey T
authors.initials: AT
authors.lastname: Tsunoda
authors.affiliation: Department of Surgical Oncology, Endocrine and Gastrointestinal Surgery, Leiden University Medical Centre, Leiden, Netherlands.
authors.forename: Cornelis
authors.initials: C
authors.lastname: van de Velde
authors.affiliation: European Institute of Oncology, Milan, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Veronesi
authors.affiliation: Department of Gynaecological Oncology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
authors.forename: Dehannathparambil Kottarathil
authors.initials: DK
authors.lastname: Vijaykumar
authors.affiliation: Deakin University, Geelong, VIC, Australia; Barwon Health, Geelong, VIC, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Watters
authors.affiliation: Peking University People's Hospital, Beijing, China; Chinese College of Surgeons, Beijing, China.
authors.forename: Shan
authors.initials: S
authors.lastname: Wang
authors.affiliation: Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangzhou, China; Guangdong Academy of Medical Sciences, Guangzhou, China; Chinese Society of Clinical Oncology, Beijing, China.
authors.forename: Yi-Long
authors.initials: YL
authors.lastname: Wu
authors.affiliation: Sadeq Institute, Tripoli, Libya; Trauma and Orthopaedic Rotation, North-West Deanery, Manchester, UK.
authors.forename: Moez
authors.initials: M
authors.lastname: Zeiton
authors.affiliation: Institute of Cancer Policy, King's Health Partners Comprehensive Cancer Centre, London, UK; King's Centre for Global Health, King's Health Partners and King's College London, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Arnie
authors.initials: A
authors.lastname: Purushotham
mesh_terms: D003695:Delivery of Health Care; D014943:Global Health; D006301:Health Services Needs and Demand; D006801:Humans; D009369:Neoplasms / Q000601:surgery*