War on Cancer

Lessening the global financial burden of cancer

Dr Christopher Wild - Director, International Agency for Research on Cancer, Lyon, France

Can you tell me about the discussion you are taking part in today?

That discussion is going to be, I guess, about the options we have for trying to reduce the cancer burden. I’m particularly interested from a global perspective, coming from the WHO’s cancer agency. What I’d like to bring to the table, really, is a balanced discussion both about the opportunities for improved treatment, which I think we’ll hear a lot about during the day, but also the opportunities for prevention of the disease and the early detection of cancer which can bring quite a lot of benefits if we invest in those areas.

What forms will these opportunities take?

First of all we always start with tobacco as a priority and I know people have heard this many, many times but that is the number one priority for reducing the burden of cancer. Trying to bring across this message that we have ways to achieve reduction in smoking, particularly through things like taxation, price control and bans on advertising, so I think that will be one of the things. Then I like to broaden the debate a little bit and explain how things like chronic infections account for so many cancers, in Africa it’s one in three cancers, and that we also have some approaches to combat those particular carcinogenic exposures.

Such as the HPV vaccine?

Yes, a couple of vaccines really, the hepatitis B virus, which has been around a little bit longer, that vaccine, and we’re now starting to see liver cancer rates drop in the countries that adopted that vaccine first, particularly in Taiwan and China. And also now, as you mentioned, the human papilloma virus vaccine which is starting to reach the low income countries that really need it most.

Why is prevention so important?

At the moment prevention is important because we see this escalating number of cancers in every part of the world. That’s mainly driven by aging populations and in some cases growing populations, just the number of people. So cancer, along with some of the other chronic diseases, is increasing. These are not small increases, these are quite dramatic – many countries are going to face twice as many cancer patients a year in just two decades compared to today. So if we look at that pressure on health systems, on cancer services, we really need to reduce some of that pressure and the way to do that is to prevent some of those cases from occurring.

How does IARC measure success?

For us, what we would like to look at is the incidence of cancer, so can we actually see reductions in the rates, the incidence rates, of the disease. But also we have to think about the total burden as well; because of the population growth and the aging, even if the incidence is dropping the actual total number of patients can still increase. So we need really some measures like that, some accurate measures, to track the impact of interventions. That we do through cancer registries, so what the agency is doing is trying to support countries to record accurately the number of cancer cases, the survivors from cancer, so that we can see whether the interventions really translate through to a positive effect.

Is it hard to get governments to implement things such as cancer registries when they have other priorities such as clean water?

It has been difficult, it has been difficult in the past and it’s been quite a lonely route for many years for agency staff, along with national colleagues. The change has come, really, with the United Nations focus on so-called non-communicable diseases, including cancer, and showing just what a barrier those diseases are to sustainable development, even in the low and the middle income countries. So that has been a top down message which has infiltrated into governments now and the governments are actually turning round and saying, ‘What’s the state of our cancer registry?’ That’s really transforming our opportunities to then build the technical capacity on the ground. So it’s an exciting time from that point of view.

Are there philanthropic organisations for cancer like these we’ve seen for other diseases? (Such as Bill Gates Foundation and malaria).

Less so, I would say. What we saw first of all was the numbers of cancers increasing and projected to increase. That has been followed by a political awareness and prioritisation. I would say it has not yet been followed by the development aid going into these areas. If you look at the amount of aid going into non-communicable disease, combatting those diseases, it’s tiny. So I’m hoping that that will come through; the Gates, for example, have invested in things like the human papilloma virus vaccine research and that’s been extremely positive but there’s more that needs to be done in that respect.

What’s the take-home message from your discussion today?

My key message would be this need for a really balanced, integrated approach to cancer control that uses all the tools we have available – primary prevention, early detection and more effective treatment of the disease as well as, of course, continuing to try to improve the treatments that we have and the palliative care for cancer patients. If we put those together we may also solve some of the economic challenges in providing more expensive cancer medicines because we have less patients to treat with those medicines. It seems to me this integrated approach has been a little neglected in the past and I’d like to see that change.