Cancer in the developing world: a call to action

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Abstract
Imagine this. You are a doctor in Tanzania. Annual health expenditure is $4 (£2.50) per head; malaria, tuberculosis, and maternal death are pressing problems; 150 000 people died from AIDS last year; and 9% of adults are infected with HIV.1 Life expectancy is 53 years. As an oncologist in the country's only cancer centre, you saw 1650 new cases last year. This probably represents about 10% of the total—your centre is inaccessible to the rest of the population. Around 90% of patients present with late stage, incurable disease. How do you begin to tackle cancer in such a context? This was the stark challenge posed by Twalib Ngoma of the Tanzania Cancer Center to a conference on “Cancer Strategies for the New Millennium.”2 This report synthesises selected themes from the discussion on how best to combat cancer in the developing world. #### Summary points By 2020, cancer incidence and mortality are set to double, and more than 70% of new cancers will arise in people in the developing world The public health potential of curative treatment seems limited as the cancers that will predominate—stomach, liver, and lung—are relatively unresponsive to current treatments Rational approaches identify cancer prevention as a top priority Tobacco control and hepatitis B vaccination are cost effective prevention strategies, with health benefits that reach beyond cancer Development of cancer vaccines and low technology approaches to early detection and treatment offer an alternative to transferring the resource intensive procedures used in richer countries Fig 1. The eight most frequent cancers in 1990, ranked by overall incidence world wide By 2020, new cancer cases will double to 20 million a year Already, over half of new cancers arise in people in the developing world; by 2020 the proportion will reach 70%. Cancer deaths are also set to increase, from 6 million to …