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Confronting the Global Cancer Crisis: How Nuclear Technologies Can Help

New York USA
Laura and Isaac Perlmutter Cancer Center - NYU Langone Health
Yukiya Amano

IAEA Director General Yukiya Amano. (Photo: D. Calma/IAEA)

(As prepared for delivery)

Good afternoon, Ladies and Gentlemen.

I am very pleased to be with you today at the Perlmutter Cancer Centre. Your institution has a global reputation for excellence in cancer care and research.

People are sometimes surprised to hear the head of the International Atomic Energy Agency talking about cancer.

They ask me: Isn’t your work all about nuclear power and nuclear safety and preventing the spread of nuclear weapons?

Well, yes – those are important areas of our work. But, in fact, the IAEA is the centre for international cooperation in everything to do with peaceful nuclear science and technology.

Since the IAEA was established in Vienna 60 years ago, we have worked to help developing countries use nuclear science and technology in meeting their development goals.

Health is a priority area for our 168 Member States. It accounts for around a quarter of spending under our technical cooperation programme.

The IAEA’s work in human health is unique and covers four main areas: nuclear medicine, radiotherapy, dosimetry and nutrition.

We provide assistance in areas such as neurological disorders, including Alzheimer’s disease, and cardiovascular conditions. We make stable isotope techniques available to combat malnutrition so that, for example, doctors can assess children’s body composition.

Today, I will concentrate on cancer, which is a particular focus of our work.

Ladies and Gentlemen,

Cancer used to be regarded as a disease primarily of prosperous, developed countries. But it is now reaching alarming proportions in developing countries and many are ill-equipped to deal with it.

It is estimated that, by 2030, some 60 percent of all new cancer cases will be recorded in developing countries, and that is where around 70 percent of cancer-related deaths will occur.

In many of those countries, prevention, screening, early diagnosis and treatment services are either non-existent or totally inadequate. Twenty-eight African countries do not have a single radiotherapy machine.

The IAEA is working to change that. How? By offering various services that help countries to improve access to modern cancer treatment.  We operate at both the level of individual hospitals, and at the policy level.

We help countries to plan and build nuclear medicine and radiotherapy facilities. We advise on the choice of the most appropriate equipment for those facilities and how to build the bunkers that house radiotherapy equipment.

We arrange education and training for oncologists, radiologists, medical physicists and other specialists in hospitals and research centres in more developed countries. We also undertake training at our own nuclear applications laboratories near Vienna. 

Our Human Health Campus website is an information resource for professionals in medical physics, nuclear medicine, radiology, radiation oncology and nutrition, providing insight into modern clinical practice.

We help experienced medical practitioners and technologists to maintain and update their skills and to keep pace with technological advances.

The IAEA helped to establish the Africa Radiation Oncology Network (AFRONET).

It enables professionals in radiotherapy centres in a number of countries to discuss individual cancer cases online and share views on treatment. This Virtual Tumour Board has helped to strengthen clinical decision-making. 

The AFRONET model is being expanded to Francophone Africa and to other regions, including the Asia-Pacific region and Latin America.

Ladies and Gentlemen,

The IAEA also operates at the policy level.

We help governments to put national plans in place to offer comprehensive cancer care to their people. We send expert missions to assess the level of nuclear medicine and radiotherapy services in a country and offer recommendations on improvements.

We advise countries on putting the necessary nuclear laws on the statute book and creating effective nuclear regulatory bodies.

We establish global nuclear safety standards and security guidance and assist countries in implementing them. We offer dosimetry and quality assurance services and we help with the safe and secure disposal of disused radioactive sources at the end of their lifetime.

The IAEA is not a funding organization and our resources are limited. However, we assist countries in putting together proposals so they can get loans from regional banks and other funding agencies.

In short, the IAEA provides extensive services in order to make optimal use of nuclear technology in health care.

Ladies and Gentlemen,

Let me give you some concrete examples of the IAEA’s work.

Asia has the highest burden of cancer in the world. Some 55% of global cancer deaths occur in the region and the trend is rising. 

The IAEA is supporting dozens of national and regional cancer projects in nuclear medicine, radiotherapy, radiopharmacy, radiation oncology and medical physics.

There is a strong emphasis on capacity-building. For example, we have supported 15 Asian countries in using 3D image-guided brachytherapy, training more than 100 radiation oncologists and medical physicists in this important technique.

In Sri Lanka, we organised training on the use of new radionuclide-based procedures in lymphoma therapy and bone pain palliation. In Bangladesh, the IAEA helped to enhance national capacity to produce bone-seeking radiopharmaceuticals.

Turning to Africa, we provided diagnostic equipment for child cancers in Ghana. We helped Nigeria to develop its institutions and infrastructure for fighting cancer, and provided training for dozens of oncology, nuclear medicine and radiotherapy professionals.

We helped Lesotho plan its first radiotherapy centre and arranged training for local doctors in radiation oncology so that they can provide treatment when the new centre opens in a few years’ time.  

Ladies and Gentlemen,

I would like to say a few words about cervical cancer, the 4th most common cancer in women throughout the world. It is the biggest killer of women of reproductive age in Sub-Saharan Africa.

The IAEA is an active partner in the United Nations Joint Global Programme on Cervical Cancer Prevention and Control, which aims to reduce cervical cancer mortality in participating countries by 25% by 2025.

In Sub-Saharan Africa, because of the lack of systematic screening, cervical cancer is rarely detected in the early stages. Most women have advanced disease by the time they are diagnosed. 

Namibia is one of the African countries with high HIV prevalence in which cervical cancer has been on the rise.

The IAEA played a key role in helping to set up the first radiotherapy and nuclear medicine centre in Namibia, offering lifesaving treatment. We are now assisting this nation of 2.5 million people in expanding services in its Windhoek hospital, and establishing a new radiotherapy centre in the north of the country.

Despite the high demand, there is presently only one Namibian radiation oncologist working in the public sector. So we are supporting additional training efforts for nuclear medicine and radiotherapy specialists to urgently ramp up medical capacity.

Ladies and Gentlemen,

The IAEA also supports important research projects. Some years ago, we launched a project with researchers from 11 countries.

It involved 383 patients with a form of Non-Hodgkin’s lymphoma, who were monitored over two years using PET scans.

The project produced the largest database of these types of PET scan studies to date, as well as recommendations on how doctors can evaluate scans to effectively treat patients with this condition. The study received international recognition and an award from the Journal of Nuclear Medicine.

Other research activities cover the applications of radiation biology in areas such as clinical biological dosimetry, and the sterilisation of human tissue for tissue banking.

Ladies and Gentlemen,

Let me say a little more about safety.

It is estimated that around 10 million people undergo diagnostic, therapeutic or interventional procedures involving medical radiation every day. Ensuring that such procedures are safe is an integral part of our work.

The IAEA develops Fundamental Safety Principles and safety standards, which have established a strong framework for nuclear safety throughout the world.

Our Dosimetry Laboratory near Vienna is at the heart of a global network of dosimetry labs run by us in cooperation with the World Health Organization. It provides dosimetry auditing services for radiotherapy centres throughout the world, free of charge.

The Laboratory also supports the development of dosimetry codes of practice, conducts research to improve dosimetry and calibration techniques, and conducts specialized training in dosimetry for professionals in Member States. 

We recently announced the acquisition of our first medical linear accelerator at the Dosimetry Laboratory. When operational next year, this will significantly enhance the assistance we can provide to hospitals around the world in the safe and effective use of radiotherapy.

As I mentioned earlier, we help countries to draft nuclear legislation and to create effective nuclear regulatory bodies. These are essential for countries that seek to obtain radioactive sources on the international market.

I know of one developing country which had built a brand new cancer treatment centre, but was unable to buy radioactive sources to run its equipment because it did not have the necessary legal and regulatory infrastructure in place.

We helped this country to draft a nuclear law and establish a regulator and its cancer facility is now working.

Ladies and Gentlemen,

The IAEA’s cancer control activities have made a real difference to countless individual lives. By working with key partners such as the WHO, the International Agency for Research on Cancer, leading NGOs and others, we help countries to devise cancer programmes that include prevention, screening, diagnosis, treatment and palliation. But the needs remain great.

There is an estimated shortage of 5,000 radiotherapy machines throughout the world. To meet the cancer needs of developing countries, many thousands of radiation oncologists, medical physicists, dosimetrists and radiation therapists need to be trained.

This is a daunting challenge. But I believe much can be achieved if cancer in developing countries is given its rightful place at the top of the global development agenda.

Ladies and Gentlemen,

My message to radiation oncology and nuclear medicine professionals at top-class institutions such as the Perlmutter Center is:

Please send a message to influential organisations and people in your country that cancer in developing countries is the next global health agenda and that the IAEA is an active partner; and, please share your considerable expertise with your colleagues in developing countries.

Invite physicians, technologists, radiopharmacists and medical physicists as IAEA Fellows for training. Consider offering your services as a teacher or lecturer on IAEA training programmes, or take part in IAEA expert missions.

All of these activities have real impact in saving lives in developing countries.

Ladies and Gentlemen,

I hope I have given you some insight into the remarkable work of the IAEA in the field of human health. I will stop here to allow some time for discussion.

Thank you.

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