Most of Latin America is somewhere in between the extremes of cancer «moonshot» and cancer «groundshot» when it comes to cancer programming in the region. There are significant gaps in basic services and access, but also very advanced cancer care sometimes within miles of each other. While working to address basic capacity and infrastructure needs, there is no good reason for any Latin American country not to want to also be better prepared to harness the benefits of precision oncology.
Advancements in precision oncology continue at a rapid pace to offer new options for physicians, patients, and health systems to more accurately diagnosis cancer, personalize treatment, and improve long-term disease management. In rich countries, precision advancements have contributed to extending lives while allowing greater numbers of cancer patients to circumvent unnecessary care. And while cancer remains an incredibly complex public health problem everywhere, steady progress on multiple fronts in resource-rich settings has led to increased survival rates and raised the overall standard for what it means to provide quality cancer care. In fact, this relative success has led to more calls for cancer «moonshot» programs in rich world settings with incredibly ambitious society-wide goals to dramatically reduce the impact of cancer on families and communities (Ref: White House resources USA).
In not-so-rich countries where cancer incidence, prevalence, and mortality rates are growing the fastest, the story is of course much different. The benefits of precision are generally out of reach except for in a handful of mostly urban clinical and academic settings in some middle- and upper-middle income countries. In more resource-poor settings, the penetration of precision oncology is nearly entirely absent. In fact, some international experts are encouraging not a «moonshot» for cancer in lower-income settings but a cancer «groundshot» focused on ensuring «the best of the basics» rather than being preoccupied with expensive innovations. In this view, making available essential cancer medicines as designated by the World Health Organization (WHO) or expanding the basic clinical and educational infrastructure for cancer care are overriding priorities in lower-resource settings. (Ref: ASCO 2022 groundshot materials – editorial and article).
The problem is that Latin America is mostly somewhere in between «moonshot» and «groundshot» when it comes to the current state of cancer care and public policy. Yes, essential goods and services for appropriate cancer care are fundamental and any analysis in the region is going to identify gaps in availability and accessibility of the basics. These gaps can be significant and must be addressed. Nevertheless, many countries in the region have also managed to develop at least some capacity in precision oncology. And while thus far limited mostly to the private sector health systems, there is a lot of simmering interest, enthusiasm and expertise to bring the benefits of precision to many more patients across the region.
In Latin America, it’s not moonshot and its not groundshot but probably both at the same time and there are simply no good reasons for governments or other cancer stakeholders in Latin America to not want to eventually expand precision oncology capacity given its potential to extend lives and improve outcomes the same way it has been shown to do in rich-world settings.
