Cancer in Developing Countries: Facing the Challenge
IAEA´s Role in Fighting Cancer in Developing Countries
Cancer threatens to be a major cause of morbidity and death in all developing countries in the future. The majority of these cancer sufferers will require radiation to treat and cure the disease. Indeed, over forty percent of cancer cures are directly attributable to the use of radiation.
The Scientific Forum discussed the experience of China, Egypt, Ghana, India, Saudi Arabia, South Korea and Tanzania as examples of developing countries in fighting cancer in partnership with the IAEA.
The participants presented their collaborative work with the IAEA´s technical cooperation programme in radiotherapy, nuclear medicine, quality assurance, medical physics and other related fields.
Prof. Mahmoud M. El-Gantiry, Professor of Radiation Oncology at the National Cancer Institute at Cairo University, detailed the IAEA´s role in fighting cancer in Egypt. His daily tasks include cancer diagnosis and treatment, as well as teaching medical staff. Prof. El-Gantiry collaborates with the IAEA as an expert in establishing and auditing cancer centres.
Emphasizing the importance of regional designated centres in combating cancer, Prof. El-Gantiry described the role played by the IAEA in auditing centres which seek to receive recognition as a designated centre of excellence. He presented an example of the National Cancer Institute of Cairo University, which was granted this recognition for Africa by the IAEA. He highlighted the value of the IAEA´s Quality Assurance Team for Radiation Oncology (QUATRO) auditing mechanism and the "integrated missions of PACT" or "imPACT" reviews implemented to facilitate the development of a designated centre of excellence.
Prof. El-Gantiry highlighted two of the most important components needed for the cancer centre´s success: infrastructure and capacity building in cancer care professionals. He discussed capacity building, stressing the importance of South-South collaboration, in order to avoid the challenges and even the disadvantages that have arisen from training cancer care professionals in the West. These disadvantages include "brain drain", the expense of re-locating to the West, as well as the differences in the environment and the training and educational culture. The National Cancer Institute of Cairo University collaborates with the IAEA and PACT, such as the provision of training fellowships, expert missions, technical missions and the establishment of VACCUnet (Virtual Cancer Control University Network) in its efforts to improve cancer control skills and capacity both nationally and regionally.
Dr. Belal Moftah, Chairman of the Biomedical Physics Department at King Faisal Specialist Hospital and Research Centre in Riyadh (KFSH&RC), and the counterpart for several IAEA technical cooperation projects, presented several examples of the IAEA´s role in fighting cancer in Saudi Arabia. KFSH&RC has collaborated with the IAEA to develop the national cancer treatment and diagnosis capacity within the Kingdom of Saudi Arabia, and in other neighbouring, developing countries in the fields of radiotherapy, nuclear medicine, quality assurance, medical physics and other related fields.
The IAEA undertakes several activities in Saudi Arabia such as conducting courses and workshops, establishing a comprehensive oncology centre in the Kingdom and helping to develop an advanced proton carbon-ion therapy facility. Saudi Arabia will become the third country in the world to have such a facility.
As an object of particular pride, Dr. Moftah underscored the regional pilot residency training programme for radiation oncology physicists as an example of the effective collaboration between KFSH&RC and the IAEA. With the IAEA´s support, participants are trained and graduate as qualified medical physicists in the field of radiation oncology. KFSH&RC also provides training for fellows in other developing countries, again through the IAEA´s technical cooperation programme. In addition, a major international conference on radiation medicine was organized in collaboration with the IAEA.
Dr. Moftah encouraged the IAEA to continue to provide guidance on radiotherapy techniques and machines, and on the choice between two cancer treatment modalities: single-energy liner accelerators or advanced telecobalt units. In addition, he stressed the importance of the IAEA´s guidance to developing countries on tender specifications and maintenance contracts, as although many developing countries have procured brachytherapy machines and radiotherapy simulators, yet these devices sometimes remain unused.
Reiterating his primary recommendation, Dr. Moftah´s stressed the need for the continuing establishment, empowerment and utilization of centres of excellence. There are many well-established centres like KFSH&RC that have capacities that should be utilized to the maximum to serve the region.
Dr. Joel Yarney is the Head of the National Centre for Radiotherapy and Nuclear Medicine in Ghana and Director of the cancer treatment facility in Accra. Among other specialized techniques, he initiated brachytherapy for prostate cancer in Ghana. He detailed the IAEA´s role in fighting cancer in Ghana.
Access to radiotherapy is a major problem in West Africa, especially in the sub-regions. Dr. Yarney explained the situation concerning cancer treatment in Ghana, where 12 million citizens share one radiotherapy machine. There are only two machines available for the total population. Dr. Yarney stated that the IAEA has played an indispensable role in the establishment of radiotherapy centres in Africa and in helping African countries to access loans to start or upgrade radiotherapy centres, which is often a capital intensive enterprise. In his view, Dr. Yarney believes that the most significant achievement for Ghana´s cancer control programme is the acquisition of a $13.5 million loan from the OPEC Fund for International Development and the Arab Bank for Economic Development in Africa (OFID/BADEA). The loan was acquired with the IAEA´s cooperation, following imPACT visits by the PACT team.
Through the IAEA, a QUATRO programme was introduced to enable comprehensive auditing of the entire radiotherapy process. In addition, the National Centre for Radiotherapy and Nuclear Medicine in Ghana has participated in the IAEA´s postal dose audit service, which ensures calibration of radiotherapy beams in Africa.
In addition, the IAEA sponsors a long-term training programme as part of the continuous professional development for oncologists, medical physicists, radiation therapy technologists and nuclear medicine physicians. Medical education is also provided through several regional projects under the African Regional Co-operative Agreement for Research, Development and Training related to Nuclear Science and Technology (AFRA).
Finally, the IAEA supports radiation protection institutes across Africa with equipment, legal instruments and technical expertise to ensure a safe operating environment in the use of radiation medicine. Dr. Yarney was grateful for the cost-sharing programme offered by the IAEA that enabled the acquisition of the 3D planning system for Ghana.
In diagnostic work, the IAEA has been instrumental in enabling nuclear medicine departments to function across Africa, for instance to ensure that they can perform bone scans. Dr. Yarney encouraged all donor agencies and other development partners to contribute to cancer care in Africa through the IAEA´s PACT programme.
Dr. Twalib. A. Ngoma, Executive Director of the Ocean Road Cancer Institute in Tanzania, Director of International Network for Cancer Treatment and Research, Tanzania and Immediate Past President of the African Organization for Research and Training presented the achievements of Tanzania´s collaboration with the IAEA.
Through the IAEA´s support, Tanzania receives technical assistance to strengthen and expand its capacities in the fields of radiotherapy, quality assurance and medical physics.
While cooperation began by focussing on radiotherapy and nuclear medicine, it has evolved, shifting the priority to cancer control, including cancer prevention, early detection, diagnosis and palliative care.
Taking pride in the Tanzanian government´s strong commitment to improving cancer control and care services for its citizens, Dr. Ngoma explained that this commitment resulted in Tanzania´s selection in 2006 as one of the PACT Model Demonstration Sites (PMDS). By working with PACT and engaging the government, the prioritization for cancer control and the visibility of cancer as a public health issue in Tanzania has increased.
According to Dr. Ngoma, PACT has made a tangible difference in the lives of Tanzanian cancer patients. Through PACT, Tanzania strengthened its cancer control capacities and doubled its capacity to provide radiotherapy. PACT has made three imPACT missions and reviews to assess Tanzania´s cancer burden and the status of national policies, strategies, plans, programmes and infrastructure related to all aspects of cancer prevention and control. Following the reports and recommendations from the imPACT reviews, a National Steering Committee for Cancer Control was established. As a result, an initial national cancer control strategy and an action plan have been crafted and are now being implemented.
Dr. Ngoma believes PACT is an ideal approach to fight cancer, and the IAEA has had a catalytic effect in this aspect. Therefore, he encouraged everyone to support IAEA efforts in cancer control in countries like Tanzania.
Professor Shengzu Chen, Chief Scientist and Consultant in the Department of Nuclear Medicine and Positron Emission Tomography/Computed Tomography Centre of the Chinese Academy of Medical Sciences´ Cancer Hospital, and President of the Chinese Society of Nuclear Medicine, described the IAEA´s role in supporting China´s cancer control programes. Prof. Chen is also a national coordinator for IAEA projects in nuclear medicine.
Noting that China utilizes both nuclear and the other non-nuclear technologies for treating cancer, Prof. Chen highlighted the role of the IAEA in fighting cancer using nuclear technology. Nuclear medicine and radiation oncology play a key role in cancer prevention, diagnosis and treatment. Adding that training medical specialists in developing counties is a further, very effective method to combat cancer, Prof. Chen underlined the importance of IAEA´s role in supporting that training thus contributing to the fight against cancer.
In China, the IAEA has initiated many projects and programmes in nuclear medicine and radiotherapy. In 1985 the IAEA organized a regional training course on radioimmunoassay, which had a long term impact on promoting radioimmunoassay technology in developing countries. Today, radioimmunoassay technology continues to be used in cancer diagnosis and treatment as a tumour marker. Since 1991, China participates in IAEA activities through Coordinated Research Projects, Regional Cooperation Agreement projects and Regional Training Courses including quality control and the preventive maintenance of gamma cameras, as well as tumour imaging using radio isotopes by single photon emission computed tomography on the positron emission tomography.
China has had a long-term cooperation with the IAEA, which has helped promote nuclear medicine in fighting against cancer. Prof. Chen recommended that the IAEA continue to introduce new technologies in developing countries and encourage developing countries to help each other through South-South cooperation.
Dr. Jong-Inn Lee, the President of the Korean Institute of Radiological and Medical Sciences (KIRAMS), provided an overview of South Korea´s collaboration with IAEA in fighting cancer. Dr. Lee noted that through the advances made in radiation technology, cancer´s early diagnosis and cure is now possible.
Acknowledging the IAEA´s technical cooperation programme mission to support Member States utilize nuclear technologies to treat cancer, as well as PACT´s role to improve cance control in developing countries, Dr. Lee presented an example of KIRAMS´ support for a human resource development programme in radiation medicine in Vietnam. Using Korea´s advanced resources, over the last three years KIRAMS trained 37 medical doctors and engineers in radiation machine, including oncology, nuclear medicine, radiopharmaceuticals and radiology in Vietnam. In addition, intensive workshops, on-the-job training and scientific visits were carried out as part of the programme.
Dr. Lee stressed that cultivating properly trained personnel to handle radiation equipment requires long term planning and investment. Human resource development´s is an essential component in a long-term approach to preparing for the future.
Through its collaboration with PACT, KIRAMS has focused on reinforcing human resource development programmes in developing countries that have no access to nuclear technology in medicine. KIRAMS is ready to provide more training opportunities for radiotherapy medical staff from newly industrialized and developing countries to support the IAEA´s mission and to fight cancer.
Prof. Rajiv Sarin is the Director of the Advanced Centre for Treatment Research and Education in Cancer at Tata Memorial Centre, Mumbai, professor of Radiation Oncology at the Tata Memorial Hospital, and also in charge of the Cancer Genetics Unit. He explained how India and the IAEA work together to fight cancer.
Prof. Sarin highlighted the gap between patient needs and their access to treatment in the developing world, proposing that the PACT´s role lies in bridging this gap.
In his own experience in working with the IAEA in the development of India´s capacities in the field of radiotherapy, nuclear medicine, quality assurance and medical physics, Prof. Sarin noted that he had witnessed the benefits that many countries and regions have gained from IAEA programmes.
The IAEA has played a crucial role in providing training on a range of technologies from simple to the most advanced form of radiotherapy. In addition, the IAEA plays a very important role in capacity building and quality assurance. According to Prof. Sarin, the IAEA has had a role in every aspect of the development of cancer treatment in India. He mentioned the IAEA´s efforts to provide services to developing countries and praised the IAEA´s technical publications, describing them as absolutely factual, practical and pragmatic. Prof. Sarin said that PACT is "punching below its weight", while with its wealth of accumulated knowledge and networks, PACT and the IAEA should give a bloody nose to cancer.
- Mahmoud Mohamed El-Gantiry, National Cancer Institute (NCI), Cairo University, Egypt.
- Belal Moftah, Chairman of Biomedical Physics Department, King Faisal Specialist Hospital and Research Centre, Saudi Arabia.
- Joel Yarney, National Centre for Radiotherapy and Nuclear Medicine, Ghana.
- Twalib Ngoma, Department of Radiotherapy and Nuclear Medicine, Ocean Road Hospital, Tanzania.
- Shengzu Chen, President of Chinese Society of Nuclear Medicine, China.
- Jong-Inn Lee, President, Korea Institute of Radiological and Medical Sciences, South Korea.
- Rajiv Sarin, Director, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), India.