© Oxford University Press 2006.
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Developing Countries Face Growing Cancer Burden
Growing concerns about cancer in the developing world dominated this year's World Cancer Congress, held in Washington, D.C., in July.
"Cancer in the developing world is a disaster waiting to happen," said Franco Cavalli, M.D., president of the International Union Against Cancer (UICC), the meeting's sponsor. He cited estimates showing that by 2020 cancer will kill more than 10 million people per year worldwide, with 7 million of those deaths occurring in countries that can least afford health care.
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According to UICC, a more Westernized diet and lifestyle—high in fat and low in exercise—increasing tobacco use, and weak pollution controls all will push cancer rates higher in the developing world. And about 75% of cancer diagnoses in poor countries are made too late for treatment to do much good, said John Seffrin, Ph.D., chief executive officer of the American Cancer Society.
"The good news is that most cancer deaths in the developing world are preventable," said Twalib Ngoma, M.D., executive director of Ocean Road Cancer Institute in Tanzania. Some 25% of cancers in the developing world result from viral infections, contrasted with 10% in the developed world, according to UICC.
A world cancer declaration issued at the meeting aims to "avert the looming disaster," said Cavalli. The declaration calls for a series of steps:
- national cancer control programs and cancer registries;
- adoption of evidence-based guidelines for early detection and treatment;
- implementation of the World Health Organization's Framework Convention on Tobacco Control; and
- universal access to palliative care.
The declaration also places a high priority on international human papillomavirus and hepatitis B vaccination programs.
Although governments clearly have a role in meeting the declaration's goals, the document's drafters squarely placed responsibility on nongovernmental organizations, nonprofit and for-profit alike. Thomas Novotny, M.D., M.P.H., professor of epidemiology and biostatistics at the University of California in San Francisco, said that "the new philanthropy"—donations in the billions by the likes of Bill Gates and Warren Buffett—should also play a key role in combating cancer in the developing world.
"We need to exploit this trend. Unfortunately, cancer is pretty far down on their list of priorities," said Novotny.
Partnerships Are Key
Isabel Mortara, UICC's executive director, said that effective government–nongovernment partnerships are the key to controlling cancer in the developing world. At a session devoted to the topic, a panel explored the challenges of such partnerships.
"Simply making partnerships does not equal success," said Ngoma. "Partners have to be equals from the start, and partnerships should be driven by the needs of the local community, not the needs of the outside partner."
Mortara pointed to the UICC's International Cancer Technology Transfer fellowships as a model for success. Each year the program funds 120 scientists, clinicians, and public-health professionals from the developing world to learn state-of-the-art techniques in Europe and the United States. Fellows must agree to return to their home country and implement their new knowledge.
"This helps the brain drain problem so many countries have, where the brightest and most talented end up somewhere else," said Mortara.
However, several audience members said that grabbing the ear of government officials in the developing world is a huge challenge.
"In Bangladesh, we have 150 million people, but the government does not consider cancer to be its responsibility," said Manowar Hossain, M.D., executive director of the Bangladesh Cancer Foundation, a volunteer group dedicated to improving cancer care. "Those who can afford it go to India or someplace else [for treatment]. We are trying to set up a cancer hospital, but there's no [government] support—we have no doctors, lab technicians. There's nothing there."
Princess Niki Onyeri, a breast cancer survivor and founder of the Cancer Foundation in Nigeria, said that her group has spent "years and years trying to get the attention of our government. We're breaking our heads trying to work with them. They haven't done anything for cancer control; they just shuffle paper."
Corruption and mistrust of any group asking for government assistance poisons potential relationships, she said. "The [government] ministers don't trust us—they think we're just trying to get money from them."
Onyeri's group, which fans out across Nigeria to provide cancer prevention education, has run into another problem: People expect to get paid to attend educational workshops. "This is a direct result of the HIV model. They pay people to come out and listen to their message, and so they want money from us too. We can't compete."
Paul Levine, M.D., professor of epidemiology and biostatistics at George Washington University, said that measuring the success of partnerships is often overlooked in the face of educational efforts.
"There are soft measures, such as increased screening," he said. "But to really know whether programs are effective, [countries] need cancer registries." Registries also highlight trends that might otherwise go unnoticed, said Levine. In North Africa, for instance, researchers from the National Cancer Institute noticed an unusually high incidence of inflammatory breast cancer, a trend that NCI has been studying alongside the governments of Tunisia and Egypt. He said that the NCI program shows that "the best partnerships are those where a strong local partner relies on the NIH or CDC or WHO for expertise."
Before wrapping up the congress, Cavalli encouraged attendees to make the declaration a "living document." The UICC will evaluate progress on its goals at their next congress, scheduled for Geneva, Switzerland, in 2008.
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