Cancer in developing countries: facing the challenge

Dr Margaret Chan
Director-General of the World Health Organization

Address at the IAEA Scientific Forum 2010 (video message)
Geneva, Switzerland

21 September 2010

Excellencies, distinguished scientists, Dr Amano, ladies and gentlemen,

I am sorry I cannot participate in this scientific forum in person.

I thank your Director-General, Dr Amano, for making the problem of cancer in the developing world a high-priority issue for IAEA. For an agency that received the Nobel Peace Prize in 2005, I find this a truly noble peaceful use of nuclear energy. Your Programme of Action for Cancer Therapy, launched in 2004, builds on the long collaboration between our two agencies.

A complex group of diseases like cancer must be tackled on multiple fronts, by multiple partners. IAEA offers unparalleled expertise in radiation medicine, a vital component of cancer diagnosis and treatment.

This collaboration to jointly fight cancer was formalized last May, when IAEA and WHO launched a Joint Programme on Cancer Control, focused on the needs of developing countries.

The problem of cancer in the developing world is so huge it is difficult to find the right way to measure it.

For public health, the complexity of cancer control increased enormously following the shift of the disease burden from wealthy to less affluent countries. According to the latest WHO statistics, cancer causes around 7.9 million deaths worldwide each year. Of these deaths, around 70%, that means 5.5 million, are now occurring in the developing world. A disease once associated with affluence now places its heaviest burden on poor and disadvantaged populations.

Many powerful global trends contribute to the rise of cancer in the developing world. Let me mention three: population ageing, rapid unplanned urbanization, and the globalization of unhealthy lifestyles.

Though many cancers develop slowly, lifestyle changes are taking place with a stunning speed and sweep. These trends are not easily reversed. This is why international treaties, such as the WHO Framework Convention on Tobacco Control, are so important as strategies for prevention. But much more needs to be done.

If no action is taken, deaths from cancer in the developing world are forecast to grow to 6.7 million in 2015 and 8.9 million in 2030. In contrast, cancer deaths in wealthy countries are expected to remain fairly stable over the next twenty years.

But numbers of cases and deaths do not say enough. You also need to measure the problem in terms of needless suffering. On average, 70% of cancer patients in developing countries are diagnosed at a very late stage of illness, when treatment is no longer effective. The only possible intervention is palliative care, including pain relief. Even this intervention fails to reach more than 5 million terminally ill cancer patients every year.

You can also measure the problem in terms of an almost total lack of response capacity in the developing world. This is a lack of capacity for prevention, public education, screening and early detection, diagnosis and treatment, whether involving surgery, radiotherapy, or chemotherapy. In large parts of Africa, such treatments are usually reserved for those rich enough to seek specialized care abroad. What does this say about fairness in access to essential, life-saving care?

The demands of chronic care for a disease like cancer are simply crippling. They also contribute to poverty, as most patients pay for care directly out-of-pocket.

Throughout the developing world, most health systems are designed to cope with episodes of infectious disease. Most developing countries do not have the financial resources, facilities, equipment, technology, infrastructure, staff, or training to cope with chronic care for cancers.

As IAEA has brought to world attention, some 30 developing countries, including 15 in Africa, do not possess even a single radiation therapy machine. In some African countries, only 20% of patients survive cancers, such as cervical cancer, that are highly curable elsewhere in the world.

These are shocking statistics, with huge implications for human suffering, health systems, health budgets, and the international drive to reduce poverty. They are also a strong call to action.

I fully agree with wording in the 2008 World Cancer Declaration, which described the rise of cancer in the developing world as an “impending disaster”. Cancer needs to be given a much higher place on the development agenda.

Ladies and gentlemen,

I welcome your approach, which aligns so well with that of WHO and its emphasis on comprehensive national cancer control programmes. You are seeking to improve fundamental capacity for cancer care by ensuring that investments in technologies for cancer diagnosis and treatment are part of a comprehensive national plan, anchored in a wider strategy. You begin with an expert assessment of needs, and this contributes to national ownership and thus to sustainable solutions.

You recognize that technology means nothing without well-trained and motivated staff to use it. You are developing innovative training and mentoring networks, and innovative public-private partnerships, also with relevant industry.

In addition to your operational role within countries, IAEA is garnering international attention, generating resources, and building collaboration.

As I said, cancer is a complex group of diseases that must be tackled on multiple fronts, by multiple partners.

I wish you a most successful meeting as you look at challenges and opportunities and, most especially, at the vast unmet needs that compel us to take action.

Thank you.