F. Cavalli, MD, FRCP Director Oncology Institute of Southern Switzerland (IOSI), Bellinzona, CH

Cancer in the developing world: can the disaster be avoided ?

All experts agree: in the next 20 years the number of cancer patients in the developing world is going to increase exponentially. It has been calculated that in 2020 there will be 10 million deaths because of cancer, of which 7.5 million will be in the developing world. Currently, the world is ill-prepared to deal with this situation and we could soon have a repetition of the disaster which much of the developing world is today witnessing with AIDS.

In fact, most of the problems faced in developing countries are similar for both diseases: a rapid increase of the number of patients, a lack of sufficient resources to tackle the problems and soaring costs of care - treatment is generally devised with only the economic situation in the developed world in mind.

Moreover, the evolution of the global economic situation is very uncertain; the opinions of experts are at best controversial. The disaster could be even worse than is presently expected by most people if the next twenty years continue on the same track as the last two decades, in which worldwide poverty has not decreased and the economic differences between developed and developing worlds have markedly increased.

But current developments in the fight against AIDS could give us some hints on how to deal with the cancer problem. I feel that the following measures could be among the most important ones:

• Today many NGO's and professional societies are becoming increasingly interested in "doing something for cancer in the developing world”, but there is a tragic lack of coordination. Most probably, UICC would be best placed to provide a forum for achieving the necessary coordination to guarantee the rational use of resources.
• Different models for supporting the development of cancer care and above all, cancer control in countries with limited resources, should be devised. The overall goal should be to have a national cancer control plan in each country. But in the developing world the problems of lack of resources, poverty and illiteracy are obstacles to success, and different approaches may be necessary than those used in affluent countries.
• In this context, technology transfer must always take into account the local situation. This can be effectively achieved, e.g. via the so-called "twinning method,” which we have extensively used in our Central American projects (Lancet 1998; 352:1923-1926; Ann Oncol 1993; 4:37-40) Any attempt to enforce the use of inappropriate and expensive western technology should be avoided, while know-how should be continuously adapted through discussions which take the local situation into consideration.
• Strong political pressure must be mounted at all levels: from national governments to the World Bank and from G8 countries to the UN. But governments cannot succeed alone. Cooperation with major philanthropic organisations (e.g. Bill and Melinda Gates Foundation) must be actively sought.
• Political and social pressure should be brought to bear on pharmaceutical companies in order to move towards more equitable drug development policies, i.e., paying more attention to the circumstances and resources of developing countries.