The enormous and growing impact of the internet
on healthcare in general, and cancer in particular, has been well described in medical literature. In additionto the truly vast quantities of information about cancer available to patients, caregivers, and other healthcare consumers (searching Google on February 19, 2008 using the term “cancer” retrieved more than 232,000,000 results), Web-based approaches have begun to revolutionize communication between providers, providers and patients, and patients themselves. Infrequently discussed in the existing literature is the specific influence of the Internet on global cancer communication, particularly in countries of the developing world and other environments where access to more traditional sources of healthcare information
(eg, medical journals, newspapers, television) remains quite limited. The issue is profoundly relevant in light of the potential for cancer-related information to be easily disseminated, and for communication to be rather dramatically enhanced, in any setting where Internet access is available.
According to Internet World Stats
, access to the Internet varies greatly based on geographic location, in one estimate (December 2007) ranging from as high as 71% of the population of North America to less than 5% in Africa. Of considerable interest is the recent growth in the use of the Internet, even in regions of the world where the overall availability remains far behind that of the United States. For example, in one analysis, although only 17% of the population in the Middle East was reported to currently have access to the Internet, growth in Internet users in this region increased 900% between 2000 and 2007.
Web-based communication strategies can serve roles in international communities that are similar, or identical, to those now routinely observed in the United States. For example, the Internet can be used to provide quantitative data regarding the experience of individual physicians and hospitals with particular cancers or procedures, including how successful these entities were in achieving objectively measured quality of care standards. Also, information regarding individual drugs to be administered in specific clinical settings, their side effects, and rational therapeutic options can be presented in a variety of languages. Further, Web-based, cancer-related support groups may also be helpful to patients and their families throughout the world.Cancer in the Developing World
To fully understand the truly unique capabilities of the Internet when it comes to global cancer communication, it is relevant to discuss cancer in the developing world
. Following cardiovascular and diarrheal diseases, cancer is the third leading cause of death in developing world countries. Of the approximately seven million deaths due to malignant disease worldwide in 2007, nearly five million were predicted to occur in regions of the developing world. In these countries, the leading cause of cancer-related mortality in males is (as expected) lung cancer (500,000 deaths), while cervical cancer (275,000 deaths) is the most common fatal malignancy in females.
In the developing world, approximately 10% of all cancer-related deaths
are believed to be related to tobacco use, and this percentage is certain to increase as the epidemic of cigarette smoking advances in these countries. Recognizing the role played by tobacco and preventable infectious disease (eg, human papilloma virus, H. pylori, hepatitis B virus, human immunodeficiency virus, etc) in the pathogenesis of multiple cancer types
, it has been estimated that more than 50% of all malignant diseases
could be prevented by implementing systemic health initiatives and reforms (eg, effective tobacco control, infection prevention initiatives, active vaccination programs). Considering the morbidity, mortality, and substantial costs associated with malignant diseases in developing world countries with extremely limited funding available for all health-related initiatives, the profound importance of educational and other public health eff orts focused on cancer prevention simply cannot be overemphasized.Internet-Based Cancer Communication in the Developing World
Developing world countries will likely have major, and often quite distressing, limitations on the availability of oncology specialists, opportunities for consultative services, medical libraries, and educational materials directed to cancer patients. It is realistically possible that Web-based strategies can assist in a highly meaningful manner in overcoming some of these serious deficiencies.