Tackling Cancer Control Worldwide: Report From the 2008 World Cancer Congress

December 11, 2008

logo-world-cancer-congress.gifCommentary by Antonella Surbone MD PhD FACP, NYU Department of Medicine and Clinical Correlations Ethics Section Editor

On Tuesday December 9th 2008, leading global cancer organizations met in Atlanta to discuss the 2008 WHO World Cancer Report predicting that cancer will overtake heart disease as the world’s top killer by 2010, and that global cancer cases and deaths will more than double by 2030. They called on governments to act, by ratifying an international tobacco control treaty and by asking the US to also invest in cancer vaccines and research. A “global health diplomacy” approach, making good use of past US experiences in the field of cancer control and advocacy, was suggested also for developing countries.

The 2008 World Cancer Congress was hosted in Geneva from Thursday August 27th to Sunday August 31st by the International Union Against Cancer (UICC), a leading international non-governmental organization dedicated to the global control of cancer. This event was unique due to its comprehensive approach to all dimensions of cancer control, from medical to social and political. The thrust of the 2008 Congress is especially significant due to the rapidly increasing number of cancer patients and survivors in developed and developing countries and the existence of major health care disparities worldwide. In order to adequately represent the global situation and to foster cancer advocacy on the global political scene, UICC funded the participation of 250 delegates from poorer countries.

Approximately 25 million persons are living with cancer throughout the world. Cancer is the second leading cause of mortality worldwide, killing more people than AIDS, tuberculosis and malaria combined. In 2007 about 8 million people died of cancer, accounting for about 13% of all deaths. It has been estimated that approximately 72% of these deaths occurred in developing countries. If current trends continue, annual global cancer mortality will rise to about 11.5 million persons by 2030. About one-third of cancer cases can be prevented and another third can be cured if detected early and treated properly.

The results of a three-year study conducted by policy makers, academics, former heads of states and ex-ministers of health, were presented by Dr. Margaret Chan, Director General of the World Health Organization (WHO). Data from the study report, “Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health”, showed that life expectancy is linked to the social environment where persons are born, live, grow, work and age. The WHO report stressed that wealth alone is not sufficient to determine the health of citizens and that a majority of people in the world suffer of poor health due to a “toxic combination” of bad policies, economics and politics. As global health systems will not naturally move towards equity, Dr. Chan insisted on the need for all stakeholders to show unprecedented leadership in order to overcome existing social iniquities.

A global plan to tackle the growing cancer crisis in developing countries was presented on the last day of the UICC meeting, during a summit of more than 60 high-level policymakers, leaders and health experts. Mary Robinson, former President of Ireland (1990 – 1997) and former United Nations High Commissioner for Human Rights (1997 – 2002), now president of Realizing Rights, a New York-based human rights organization, chaired the summit. Ms. Robinson argued that cancer control is both a development priority related to the right of every person to health care through access to an effective health care system, and a matter of human rights and human dignity.

The plan, contained in the 2008 World Cancer Declaration, recommends 11 cancer-busting targets for 2020 and outlines priority steps that need to be taken in order to meet them. It is intended as a guide to tailored local efforts to meet different priorities, such as sustainable delivery systems to ensure availability of cancer programs in all countries; measurement of the impact of cancer control interventions worldwide; significant reduction in global tobacco consumption, obesity and alcohol intake; universal vaccination programmes for hepatitis B and HPV in affected areas to prevent liver and cervical cancer.

To meet the targets in the declaration, some priorities were emphasised, including the importance to reduce myth and misconceptions about cancer; to provide access to pain relief and supportive and palliative care to cancer patients worldwide; and to substantially decrease the emigration from developing countries of health workers specialized and trained in delivering cancer care, to assure an oncology work force that is familiar with local realities.

We may question the feasibility of the goals of this year’s World Cancer Congress and the impact they will have on policy making in developing countries, most of which have limited economic and health resources. We need to consider, however, that in the past the WHO has already achieved major goals in developing countries, particularly in South America and Asia, by creating a list of essential cancer drugs, promoting the use of morphine for cancer pain, establishing pathology centres, and progressively making radiation therapy more available.

Many of the initiatives and protocols that have been proposed during the 2008 World Cancer Congress may turn out to be too expensive to implement. Yet high level advocacy has been shown to be effective in determining shifts at the policy making level in industrialized countries. It is to be hoped that most governments will join the struggle to save millions of lives through available options of cancer control, now that cancer kills more people worldwide than malaria, AIDS and TB combined. In fact, a global fund for cancer, similar to the existing Global Fund to fight those three diseases, may become in the near future an attainable goal.

The World Cancer Declaration can be found online at www.uicc.org, where it can be endorsed by individuals and institutions. Five hundred organizations and over 4,000 individuals have already signed the declaration.

Sources: www.uicc.org, www.who.int/en

Cavalli F. The World Cancer Declaration: a roadmap for change. Lancet Oncol 2008; 9, 810 – 811.

Collingridge D. World Cancer Declaration: a need for partnership. Lancet Oncol 2008; 9: 915.

Stobbe M. Cancer to be world’s top killer by 2010, WHO says. Associated Press, Tuesday December 9th 2008

Dr. Surbone has contributed to the 2008 World Cancer Congress, chairing a session, developed in collaboration with the International Society of Psycho-Oncology (IPOS), on “Communication, families, physicians: exploring the boundaries of cultural diversity in cancer care” and speaking on the role of cultural competence in overcoming health care disparities worldwide.