In a recent seminar at the European Institute of Oncology, Franco Cavalli, MD, past president of the International Union Against Cancer (UICC), stated that cancer in the developing world is a disaster waiting to happen. Today cancer kills more people worldwide than human immunodeficiency virus (HIV), tuberculosis and malaria combined and it is estimated that by 2020, cancer will kill more than 10 million people in the world, a great majority of these will occur in countries with low resources. In developing countries tumours related to Western lifestyles (e.g. breast, prostate and colon-rectal cancers) are increasing in addition to poverty-linked tumours (e.g. cervical and liver cancer). In this powerpoint presentation Cavalli focuses on paediatric cancer and discusses some initiatives to reduce the burden of paediatric cancer in developing countries.

Children with cancer in developing countries (80% of global childhood cancer) generally have potentially curable diseases yet because of limited available resources for diagnosis and therapy the majority do not have access to adequate care and often present with advanced disease. The two primary issues are cost of care and the limitations of presently available facilities. International collaboration, as demonstrated by several model programs, is capable of improving this situation.

Cavalli cites projects such as La Mascota Project ¹, a twinning program between La Mascota paediatric hospital in Managua, Nicaragua, and hospitals in Italy and Switzerland, the aim of which was to reduce the gap in mortality from cancer in childhood between developed and less developed countries. He stresses that long-term commitment to a comprehensive strategy that guarantees the supply of drugs, training and supervision of health professionals, and the care of the children and of their parents is essential for the continuation of such programs. Some smaller local initiatives in developing countries as examples of how non-governmental agencies can fight the global war against cancer are also touched on.

He goes on to outline the targets of the World Cancer Declaration, a tool to help bring the growing cancer crisis to the attention of government leaders and health policymakers in order to significantly reduce the global cancer burden by 2020. It represents a consensus between government officials, public health experts and cancer advocates from around the world who are committed to eliminating cancer as a life-threatening disease for future generations. 
 

The Declaration outlines 11 targets to be achieved by 2020 including: significant drops in global tobacco consumption, obesity and alcohol intake; universal vaccination programs for hepatitis B and human papilloma virus (HPV) to prevent liver and cervical cancer; dramatic reductions in the emigration of health workers with specialist cancer training; universal availability of effective pain medication; and dispelling myths and misconceptions about cancer.

In summary Cavalli asks "so where are we in the fight against cancer?” and answers: "Scientifically we are making significant headway but from a social point of view we have a long way to go".

Reference: 1. Masera G, Baez F, Biondi A, Cavalli F, Conter V et al. (1998) North–South twinning in paediatric haemato-oncology: the La Mascota programme, Nicaragua. The Lancet (1998) 352 1923-1926. doi:10.1016/S0140-6736(98)07077-9