February 4th is a special day for cancer patients, survivors, and their families. Each year on this date, the world pauses in recognition of World Cancer Day, and in consideration of the growing burden which the disease represents to all people, in both developed and developing countries. February 4th is also a special day for the IAEA, which supports the global campaign against the cancer epidemic through its Program of Action for Cancer Therapy (PACT), technical cooperation (TC) programme and its Human Health program.
To mark this year's World Cancer Day, IAEA Director-General Yukiya Amano welcomed H.E. Roman Tesfay, the First Lady of Ethiopia, and a panel of expert speakers to the Agency's headquarters in Vienna, where a roundtable discussion took place to mark the day and raise awareness of the IAEA's contribution to the struggle against cancer.
Although defeating cancer is not easy, inexpensive or likely to happen quickly, it is nevertheless possible. This was the principal message of World Cancer Day 2015, which had as its theme the rallying call 'Not Beyond Us.' At the IAEA event this year, speakers emphasized that solutions and treatments exist across the entire continuum of cancers, and with a proactive and positive approach, they can be implemented.
The Agency has been broadcasting this message through PACT for more than a decade. Established in 2004, the programme works to support low and middle-income countries (LMICs) as they strengthen their national cancer control capacities. But how?
Cooperation is central to cancer control. Although many organizations work to alleviate the cancer burden in developing countries, an absence of coordination can often lead to a duplication of efforts or to less than optimal use of limited resources. Through PACT, the IAEA aims to build strategic partnerships with Member States, national cancer institutions, non-governmental organizations, and other UN agencies. One example is the recent signing of a Partnership Agreement between the IAEA and Pink Ribbon Red Ribbon (PRRR), an initiative of the George Bush Foundation which is working to reduce the toll which breast and cervical cancers exact in sub-Saharan Africa. Under this agreement, the two organizations will cooperatively support capacity-building initiatives to improve the availability of radiotherapy and nuclear medicine in LMICs. Specifically, the Partnership Agreement stresses the need to implement knowledge exchange schemes, cancer control assessments, and mentoring programmes, all with the aim of expanding women's access to timely, effective diagnosis and treatment services.
Comprehensive assessments are another powerful tool that PACT offers countries in their fight against the cancer epidemic. Since the programme started operations, 69 IAEA Member States have received assessments of their cancer control capacities and needs, known as imPACT Reviews. Organized and conducted in collaboration with the World Health Organization (WHO) and the International Agency for Research on Cancer (IARC), imPACT Reviews provide an analysis of a Member State's existing cancer control needs, and offer recommendations on how best to address those needs.
In 2014, imPACT Reviews were conducted in 10 Member States: Costa Rica, Croatia, Fiji, Georgia, Lao PDR, Mozambique, Panama, Peru, Rwanda, and Uzbekistan
Due a shortage of approximately 5,000 radiotherapy machines in low and middle-income countries, the IAEA estimates that up to 70% of cancer patients in these countries will not have access to this life-saving technology. The Advisory Group on increasing access to Radiotherapy Technology in low and middle income countries (AGaRT) was set up by PACT in order to address this service deficit. By facilitating meetings between equipment suppliers and radiotherapy users, AGaRT is able to chart the middle-ground to ensure that all parties understand each other's needs, and can work towards meeting them
The Programme of Action for Cancer Therapy is also a leader in cancer knowledge management, helping to address a lack of local capacity-building opportunities and the phenomenon of 'brain drain' that may prevent sustainable cancer control programmes from emerging. PACT's Virtual University for Cancer Control (VUCCnet) is being piloted in Africa with a focus on quality training, and is supported by Egypt and South Africa. Already, three e-learning modules are available on the platform, and by the end of 2014, over 500 students had successfully completed coursework in: Cancer Skills for Community Health Workers, Cervical Cancer Screening, and Early Detection and Palliative Care Practitioners.
The challenge of cancer is widespread and persistent, and PACT is not the IAEA's only mechanism to address cancer. PACT is joined in its cancer-fighting efforts by the Department of Nuclear Science and Application's Division of Human Health (NAHU), in addition to the IAEA's technical cooperation (TC) programme.
Through NAHU, the IAEA works to enhance the capabilities of its Member States to safely apply nuclear techniques to prevent, diagnose and treat diseases. Among those diseases, considerable attention is paid to cancer, whose prevalence continues to grow annually.
NAHU supports cancer control worldwide by enhancing training, advancing knowledge of professionals and guiding management of cancer and quality assurance of treatment delivery.
NAHU has implemented programs in response to the realization of the importance of training and education in allowing countries to build up their own national capacity. The programs make full use of modern technology in helping to share knowledge and experience among medical practitioners in developing countries. For example, inter-country consultations on cancer patients are facilitated through virtual tumour boards. Tumour boards involve a number of doctors, who are experts in different medical specialties, coming together to discuss the condition of an individual patient and consider the best treatment options, a common feature of cancer treatment in developed countries. The African Radiation Oncology Network (Afro-NET), which was established by the IAEA's Division of Human Health, enables doctors to conduct tumour boards online, in real time. Physicians from Canada, the United States and African countries - for example - can get together to discuss the appropriate care for a patient. They can review X-rays, scans and biopsy slides - just as if they were in the same room, instead of on different continents. This service can be used on mobile phones as well.
Similarly, through the IAEA Human Health Campus, offers complete, interactive online training courses in radiation oncology, physics, nutrition and nuclear medicine. Since its launch in 2010, more than 700,000 pages of specialist material have been viewed by users from over 170 countries. The Campus has an average of 4,500 visitors per month, which is a lot for such a specialized site. All of this helps developing countries to build up the well trained, multi-disciplinary, professional teams needed for a sustainable cancer programme.
In addition, NAHU also helps enhance cancer control through implementing Coordinated Research Projects (CRPs) that allow advances in cancer treatment and include randomized trials of cancer therapies to determine the optimal approach to cancer treatment. In addition these projects help countries implement newer, more complicated treatment techniques such as stereotactic body radiotherapy (SBRT or radiosurgery), in addition the NAHU program organizes expert meetings to help develop guidelines for the medical use of radiation, produce reference materials and teaching manuals and advise the Agency and its Member States in radiation medicine.. Moreover, NAHU contributes to quality and safety of radiation medicine by offering dosimetry calibration services through the IAEA's Seibersdorf laboratories and the network of Secondary Standards Dosimetry Laboratories (SSDLs).
The Division of Human Health also provides critical technical expertise for all the project design, planning and implementation phases of the Agency's TC programme, which designs and executes projects around the world to build sustainable capacities in the areas of radiotherapy and nuclear medicine.
In the last decade alone-between 2005 and 2014-the technical cooperation programme has established more than 550 cancer control projects, whose objectives range from the implementation of entire radiotherapy units to the training of healthcare and nuclear medicine professionals. Despite their varying methods and aims, all of these projects seek to alleviate the burden that cancer presents to national health services. In financial terms, the programme has expended more than €320 million since 1985 in the fight against cancer.
Viet Nam, among the first Member States to accede to the IAEA, provides a robust example of the work conducted by the TC programme in cancer control. Currently, cancer is the second leading cause of death in the country, and is detected in approximately 90,000 new patients annually. Yet despite the mounting concerns related to cancer and malignant growths, only 2,500 PET/CT scans are conducted in Viet Nam each year, far below the rate needed to evaluate response to treatment and aid in staging!.
An ongoing TC project in Viet Nam has brought together the resources of the Vietnamese government and the IAEA in order to establish three on-site cyclotrons and PET centres in Hanoi, Danang and Ho Chi Minh City. The project incorporates scientific visits and IAEA Fellowships into its design, and aims to train at least 13 physicians, pharmacists and physicists to complement the newly-inaugurated facilities.
In a recent interview, Professor Vong Hu Tan, the Director General of BARANS (Viet Nam's Agency for Nuclear Safety), expressed his appreciation for the Agency's support and acknowledged the effectiveness of cooperation with the TC programme. "We thank the IAEA for its support in Viet Nam across many kinds of applications, particularly in healthcare and cancer therapy."
Without losing sight of the costs which cancer imposes on society, we should commemorate World Cancer Day by allowing ourselves to have hope-for solutions, for access to treatment, and for tomorrow.
