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The Role of Radiation Medicine in the Fight against Female Cancers

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The side event on 'Female cancers and the role of radiation medicine in diagnosis and treatment' was held on the margins of the 62nd IAEA General Conference. (Photo: K. Nikolic/IAEA)

In low- and middle-income countries, cancers in women are frequently discovered too late, due to limited access to diagnostic and treatment technologies and relevant expertise. While breast and cervical cancer are often treatable when diagnosed early, the chance for successful treatment is lower when diagnosed in a more advanced stage. An event held on the margins of the 62nd IAEA General Conference focused on the role of radiation medicine in the diagnosis and treatment of breast and cervical cancer.

With the aim to reduce the mortality rates among women with cervical cancer in six pilot countries by 25 per cent by 2025, two years ago seven United Nations agencies, including the IAEA, established the UN Joint Global Programme on Cervical Cancer Prevention and Control. In May 2018, World Health Organization (WHO) Director-General, Tedros Adhanom Ghebreyesus, issued a call to action for the elimination of cervical cancer as a public health problem. The role of the IAEA is to support the use of nuclear techniques in diagnosis and treatment and strengthen international cooperation in radiation medicine, said May Abdel-Wahab, Director of the IAEA’s Division of Human Health.

The commitment to addressing breast and cervical cancer was evident during a high-level panel discussion during the event. Belgium's Ambassador Ghislain D’Hoop highlighted the importance of support and funding and the commitment of Belgium to addressing these cancers. Bolivia's Ambassador Victor Alfredo Veltzé Michel, Kyrgyzstan's Ambassador Bakyt Dzhusupov, Mongolia's Ambassador Gankhuurai Battungalag and Myanmar's Ambassador San Lwin discussed the situation in their countries. The ambassadors highlighted the global implications of the UN Joint Global Programme for Cervical Cancer and Control, which their countries are participating in, and discussed the comprehensive coordination required to have a sustained and integrated approach to benefit women worldwide.

According to WHO, cervical cancer is the fourth most common cancer in women, with 570,000 cases in 2018. “One woman dies every 2 minutes, we need to keep that in mind,” said Rolando Herrero, Section Head at the International Agency for Research on Cancer. “Given the demographic change that is happening, and the ageing of the population, by 2040 we are going to have an enormous increase in cases.”

Several low- and middle-income countries lack basic resources and know-how in imaging and radiation therapy. Helping these countries acquire the right equipment and training their medical professionals are therefore a priority in addressing the global disparity in survival rates. Educating the wider population about the risks of cervical cancer and the importance of prevention through screening is also paramount.

“Female cancers are not only a medical issue, but also a gender parity and socioeconomic issue,” Abdel-Wahab said. “The prospect of the prevention of cervical cancer through HPV vaccination, as well as the advent of sophisticated radiotherapy approaches for treatment and eventual elimination are encouraging.”

Panellists from left to right: Belgian Ambassador Ghislain D’Hoop, Kyrgyzstan Ambassador Bakyt Dzhusupov, Mongolian Ambassador Gankhuurai Battungalag, Myanmar Ambassador San Lwin, Director of the IAEA’s Division of Human Health May Abdel-Wahab, Bolivian Ambassador Victor Alfredo Veltzé Michel and IAEA Director of the Division of Programme Support and Coordination Martin Krause.

Early detection

In breast cancer, improved outcomes are already seen thanks to screening and early detection, staging, advances in radiotherapy techniques, as well as a better understanding of underlying mechanisms and genetics, which enable more targeted therapies, Abdel-Wahab told the audience.

Juliano Cerci, President of the Brazilian Society of Nuclear Medicine, highlighted the role of mammography screening for breast cancer and PET/CT screening for both cervical and breast cancer.

Following diagnosis, staging the disease is essential to designing effective and patient-specific treatment, Cerci said.

Speakers also discussed recent developments in radiation therapy, which have led to the improvement of both the safety of treatment and chances of cure. Nuclear technologies which allow for increased tumour control through external beam radiotherapy and brachytherapy, in combination with chemotherapy for treatment of cervix cancer, are leading to greater survival rates worldwide, said Alina Sturdza, an oncologist at the Medical University of Vienna.  

“Modern machines are determining the correct radiation dose and sparing organs of damage,” she said. “This has improved treatment.” Sturdza also mentioned the important role of modern radiation techniques in treating patients with metastatic cancer, where the disease has spread to the bone.

Svenja Franke-Bruhn, breast cancer survivor and representative of Europa Donna, shared her story in treatment and diagnosis. “Without the mammogram, I would not be standing here,” she said. Despite regular screenings, her cancer was not diagnosed initially, and was only discovered when she visited a facility using more modern imaging technologies. “It is very important to become an educated patient,” Franke-Bruhn said in conclusion. It is important that women around the world have access to screening and treatment technologies, but also knowledge of services that exist, she said.

Worldwide, 92% of higher-income countries have access to pathology services, compared to only 25% of lower-income countries, said Elena Fidarova, Technical Officer at WHO. “Palliative care is almost non-existent in lower-income countries,” she continued, adding that 60% of lower-income countries run screening programmes without having treatment available.

Participants discuss the role of radiation medicine in the diagnosis and treatment of breast and cervical cancer. (Photo: K. Nikolic/IAEA)

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