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Scientific Forum

Cancer in Developing Countries: Facing the Challenge

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Preventing an Impending Disaster

by Dr. Margaret Chan, Director General, World Health Organization (WHO)

Margaret ChanI thank IAEA Director General, Yukiya Amano, for making the problem of cancer in the developing world a high priority issue for the IAEA. For an Agency that received the Nobel Peace Prize in 2005, I find this a truly noble peaceful use of nuclear energy.

The IAEA´s Programme for Action for Cancer Therapy, launched in 2004, builds on a long collaboration between our two Agencies.

A complex disease like cancer must be tackled. It must be tackled on multiple fronts by multiple partners. IAEA offers unparalleled expertise in radiation medicine, a vital component of cancer diagnosis and treatment. This collaboration to jointly fight cancer was formalized in May 2009 when the IAEA and the WHO launched the Joint Programme on Cancer Control focused on the needs of developing countries.

The problem with cancer in the developing world is so huge; it is difficult to find the right way to measure it. For public health, the complexity of cancer control increased enormously following the shift of the disease burden from wealthy to less affluent societies.

According to the latest International Agency for Research on Cancer (IARC) statistics, cancer causes around 7.9 million deaths worldwide each year. Of these deaths, around 70%, that means 5.5 million deaths, are now occurring in the developing world.

A disease once associated with affluence now places its heaviest burden on poor and disadvantaged populations. Many powerful global trends contributed to the rise of cancer in the developing world. Let me mention three: population aging; rapid, unplanned urbanization; and the globalization of unhealthy lifestyles.

Although many cancers develop slowly, life style changes are taking place with a stunning speed and sweep. These trends are not easily reversed. This is why international treaties, such as the WHO Framework Convention on Tobacco Control, are so important as strategies for prevention. But much more needs to be done. If no action is taken, deaths from cancer in the developing world are forecast to grow to 6.7 million in 2015 and 8.9 million in 2030.

In contrast, cancer deaths in wealthy countries are expected to remain fairly stable over the next 20 years. But numbers of cases and deaths do not say enough. You also need to measure the problem in terms of needless suffering. On average: 70% of cancer patients in developing countries are diagnosed at a very late stage of illness, when treatment is no longer effective. The only possible intervention is palliative care, including pain relief. Even this intervention fails to reach more than 5 million terminally ill cancer patients every year.

You can also measure the problem in terms of an almost total lack of response capacity in the developing world. This is a lack of capacity for prevention, public education, screening and early detection, diagnosis and treatment. Whether involving surgery, radiotherapy or chemotherapy. In large parts of Africa, such treatments are usually reserved for those rich enough to seek specialized care abroad.

What does this say about fairness: fairness in access to essential, lifesaving care?

The demands of chronic care for disease like cancer are simply crippling. They also contribute to poverty, as most patients pay for care directly out of pocket. Throughout the developing world most health systems are designed to cope with episodes of infectious disease. Most developing countries do not have the financial resources, facilities, equipment, technology, infrastructure, staff or training to cope with chronic care for cancers. As the IAEA has brought to world attention, some 30 developing countries, including 15 in Africa, do not possess even a single radiation therapy machine.

In some African countries only 20% of patients survive cancers, such as cervical cancer, that are highly curable elsewhere in the world. These are shocking statistics, with huge implications for human suffering, health systems, health budgets and the international drive to reduce poverty - they are also a strong call to action.

I fully agree with the wording in the 2008 World Cancer Declaration, which describes the rise of cancer in the developing world as an "impending disaster".

Cancer needs to be given a much higher place on the development agenda.

I welcome your approach, which aligns so well with the WHO and its emphasis on comprehensive national cancer control programmes. You are seeking to improve fundamental capacity for cancer care by ensuring that investments and technologies for cancer diagnosis and treatment are part of a comprehensive national plan anchored in a wider strategy. You begin with an expert assessment of needs and this contributes to national ownership, and thus to sustainable solutions. You recognize that technology means nothing without well-trained and motivated staff to use it. You are developing innovative training and mentoring networks and innovative public-private partnerships also with relevant industry. In addition to your operational role within countries, IAEA is garnering international attention, generating resources and building collaboration. As I said, cancer is a complex disease that must be tackled on multiple fronts by multiple partners.