I’m the President of the International Network for Cancer Treatment and Research which is an organisation established in 1998 under Belgian law, we’re based in Brussels, but started activities in the year 2000. We focus on cancer in developing countries which is a rather vague term. We can sometimes call them emerging countries or whatever other term one would like but countries which have limited resources for controlling cancer. We cover the full spectrum of activities from prevention to palliative care, prevention through diagnosis, treatment, and palliative care, but we focus particularly on treatment.

How does it function? Do you actually work within those countries?

We actually do projects and work directly with the people in the developing countries that we’re working with on a specific project. So, for example, one that we’re currently involved with is the treatment of Burkitt’s lymphoma in Africa so we actually go, ourselves, to Africa, talk to the people; visit their premises; help with training and education of the people who participate in the project; develop funding for it and maintain involvement so that we look at the data that’s being collected and make sure it’s of sufficient quality and so on so we work side by side with them. This, of course, is very valuable because it gives us a true insight into what the problems are, at least in that particular institution in that part of the world. We tend to work mostly with cancer institutes or people who are running cancer units so they’re already doing certain things but most of the people that we’re working with are unused to research so we have to get the idea that research is critically important, even to the lowest income countries, if they’re going to improve their cancer care. We have to get that idea across.

What are the needs of these people? Is it education?

It’s a very broad spectrum. The resources are limited in almost every respect. One of the problems, for example, is that the education is limited. In recent years the World Bank has improved quite a lot education for infants, young children at least, up to the age of 11 or so but still secondary school education is very limited in the developing world. This means that there are very few people who are educated sufficiently to go to university, there are very few universities, there are very few teachers. So, in a sense, you can see that that is really the essence of almost everything because everything relating to business and engineering and so on and so forth is limited in these countries. Not surprisingly their ability to take care of cancer patients is limited; limited because they have very few facilities where people can be looked after; very few people trained in the use of cytotoxic drugs, for example, and the side effects; very few facilities for radiation therapy, in fact in some countries, I think it’s about 18 or 19 in the world, there is no radiation available whatsoever for the treatment of cancer patients. Even in Africa I think it’s said that 80% of people in Africa who need radiation therapy cannot get it because there’s just a shortage of both machines and people able to deal with it. Even surgery, there are very few surgical oncologists; there are, of course, other kinds of specialist surgeons who sometimes are able to deal with cancer but there is a deficit in almost every area that you want to mention and cancer control being one of them.

The forecast is that there’s going to be a dramatic increase in the number of cancer cases in developing countries. So how do you see that we can start to attack the problem?

I think one of the problems is that there are limited resources outside the countries with limited resources, if you see what I mean, in the Western or Northern world, whatever you want to call it, to actually be applied to this problem in the developing countries. There are very few people who are interested in this problem from the Western world; unfortunately, some of those who are are interested in getting specimens and things for their sophisticated research and that doesn’t help very much the people in those countries. But if things go on the way they are there’s going to be an even greater catastrophe than there already is in terms of treating patients with cancer. It’s important to look across the spectrum of approaches to cancer control and try to improve them all if you can. Now, it’s difficult for one organisation to do that so obviously we work in close collaboration with a number of other organisations which have different skills and abilities and so on.

You need to prevent cancer to the extent possible; that requires education of the public. Prevention of cancer is done by very different people than treatment of cancer because they’re public health specialists or even the general public, if they know what causes cancer they can avoid it. Now they may or may not like cigarettes and so on and so forth but it’s amazing that even in India, I visited Chennai a couple of years ago and was told that it’s something like 40% or so of people living in Chennai were unaware of the fact that tobacco is dangerous to your health. So I think one can at least educate people about safe living, eating lots of vegetables, not smoking. Some people in India, the women, actually brush their teeth in tobacco solutions because they like the taste. So educate the population to be able to do things for themselves; educate the physicians there about the signs of cancer so it’s detected early. Early detection is critically important because there are some patients that can be treated, even in the lowest resource countries. For example, those with small cancers that can be surgically excised completely and they’ve not spread or those who are treated with radiation therapy. So the more we can diagnose cancer at the earliest possible point when it’s not disseminated, the more likely is the cancer to respond to treatment. That message needs to go out to people in developing countries who presently, for the most part, even the medical profession there, assume that cancer is not a treatable illness.

Now, bear in mind that the things I say apply to the lower end of the resource limited countries but even if you go to Brazil or places like that there are large numbers of people who have limited access to modern facilities and so 75% of the world’s poor live in the middle income countries. One shouldn’t ever forget that there’s a lot of heterogeneity and that when we talk about low income countries we might better be talking about low income people, even within regions. If you go to Brazil and you see these favelas scattered throughout the city where very, very poor people live in dreadful circumstances. But you need to treat those that can be treated and cured, and we’re able to cure, for example, something like 60% of children with Burkitt’s lymphoma in some centres in Africa we’ve been working with. Then, of course, for those for whom there is no specific treatment for cancer because their cancer is too advanced or whatever then palliative care needs to be made available. I’m sure that’s an issue, I know ecancer has been very interested in palliative care.