In industrial nations, more than 60% of cancer can be cured by either surgery, radiation therapy or chemotherapy. Unfortunately, a high fraction of patients diagnosed with cancer in developing countries, including those with potentially curable cancers, receive inadequate or no therapy - many never reach specialized treatment centers. Moreover, even in such centers, the accumulation of a body of data which could provide a foundation on which to build better treatment approaches has been hampered by incorrect or incomplete diagnoses, inconsistent treatment, and poor documentation of results.

These problems, caused by a lack of resources will be improved automatically as countries develop economically, but progress, resulting from the development of infrastructure for cancer treatment and research, will be much more rapidly made through collaboration with socioeconomically advanced countries, improved communication, and the sharing of expertise at a global level. The transfer of relevant technology and research methodology will be most efficiently accomplished through international cooperation among academic centers, professional societies, governmental and private organizations which are involved, directly or indirectly, with the epidemiology, pathology and treatment of cancer. It should also be recognized that international collaboration will provide new opportunities for cancer research that, if effectively utilized, will benefit all patients with cancer.

The Importance of Cancer Research in Developing Countries

Research of one kind or another provides the scientific foundation of the practice of medicine. Cancer research begins with the patient. Empirical studies based on accidental observations have led to present day chemo and radiation therapy, but cancer can only be prevented by a knowledge of causal factors. Epidemiologic research is devoted to acquiring such an understanding. Basic research in the laboratory is leading to the unraveling of the abnormalities in genes which lead to the aberrant behavior of cancer cells. These genetic abnormalities provide targets for new, much more specific treatment approaches, that will minimally effect normal cells and therefore be much less toxic. The genetic abnormalities also provide markers for cancer cells that can be used to improve diagnostic precision - an essential prerequisite to the development of effective treatment.

Because of differences in the genetics of different ethnic groups and differences in the exposure of various populations to cancer causing agents in the environment, the pattern of cancer, i.e., the annual incidence, the relative frequency and the subtypes of various cancers, differ markedly from one country, or population subgroup, to another (Figure 4).

FIGURE 4

Relative incidence of 5 cancers in different world regions

Source: International Agency for Research on Cancer

Moreover, the availability of particular treatments, as well as patients' tolerance to treatment, varies from one country or population group to another. Thus, an improved ability to control cancer in developing countries and more efficient use of available resources will only be achieved by performing research in the developing countries themselves. Yet until now, the lack of resources - both human and financial, has hindered the optimal design, efficient conduct, and meaningful analysis of studies conducted in such a setting. The overcoming of these deficiencies represents an immense challenge to those dedicated to cancer control throughout the world.

The paucity of cancer research in developing countries is a loss not only to patients with cancer in developing countries, but to all patients with cancer. The vast panoply of environments, lifestyles, and ethnic differences, provides a spectrum of opportunities, which, if taken advantage of, would lead to a much more rapid increase in our understanding of the causes of cancer, and, consequently, in our ability to control cancer. Moreover, the greater the number of patients who participate in well conducted clinical trials anywhere in the world, the more rapidly is progress likely to be made everywhere in the world.