The International Atomic Energy Agency’s Programme of Action for Cancer Therapy: Treating Cancer in the Developing World

The International Atomic Energy Agency (IAEA) is well known for its role in safeguarding nuclear material and preventing nuclear proliferation. Less well known is the IAEA’s second mandate: advancing the peaceful application of nuclear sciences and technology, which are now used extensively around the globe to support industrial applications and to combat disease, poverty, hunger, and shortages of drinking water.

Transfer of radiation medicine to developing nations, including the diagnosis and treatment of cancer, is an area in which the IAEA has excelled. Nuclear techniques are central to modern medicine. They are important tools for the diagnosis and treatment of many diseases and are indispensable in cancer care, where radiation therapy plays a fundamental role.

The IAEA has worked in developing countries over the past 30 years to deploy essential elements of sound cancer management programmes. Since 1980, the IAEA has delivered $150 million of cancer-related assistance under its Technical Cooperation Programme to developing countries. This assistance has involved more than 100 countries and has enabled many to establish safe and effective radiotherapy capabilities (Figure 1).

Figure 1. World map showing IAEA assistance in RT transfer.

Cancer is a global problem today, and its prevalence will increase dramatically over the next decade, especially in the developing world. According to the World Health Organization (WHO), 12.5% of all deaths worldwide are currently caused by cancer, a greater percentage than caused by HIV/AIDS, tuberculosis and malaria combined. The International Agency for Research on Cancer (IARC) predicts that cancer rates will increase by 50%, from 10 million new cases in 2000 to 15 million new cases by 2020. The largest rates of increase of new cases are foreseen in developing countries, where governments are least prepared to address the growing cancer burden.

In 2003, WHO issued a global call to action to address rising cancer needs. The IAEA answered this call in June 2004 by establishing the Programme of Action for Cancer Therapy (PACT). While the IAEA resources for strengthening cancer programmes will remain at about $15 million per year, this level of funding will fall short of what is needed in developing countries. As a result, PACT will seek additional funding from private sources such as foundations, charities and industry to assist developing countries in building capacity to prevent, treat and cure cancer patients.

PACT offers a crucial element in the global response to the growing cancer burden. Radiotherapy is a mature, robust and cost-effective technology that can, depending on the stage of clinical presentation, cure many cancer patients and relieve others’ suffering. Patients with various stages of cervix, breast, larynx and prostate cancer can be cured, for instance, while a single dose of radiotherapy can relieve malignant bone pain for weeks or months, thereby decreasing or eliminating the need for opioids. Currently, however, radiotherapy is not available to most cancer patients in the developing world.

PACT is designed to respond to the needs of developing countries by addressing the technical, human resource, legal, and regulatory needs to establish, improve, or expand radiotherapy programs in the context of sound national cancer control strategies. PACT, in collaboration with partners, will develop a systematic, global, sustainable and accountable programme to prevent and treat cancer throughout the developing world.

Specifically, PACT will: (1) build an international, public-private coalition of interested parties committed to addressing the challenge of cancer in developing countries in all of its aspects; and (2) mobilize resources from foundations, charitable trusts, industry and others in the public and private sectors for the benefit of cancer patients. PACT will build partnerships among countries, with other UN institutions such as WHO and IARC, and other international stakeholders including NGOs such as UICC and INCTR. In addition to securing resources for radiotherapy centres, PACT will respond to the most frequent problems encountered by developing countries in building effective cancer control infrastructure.

In order to assist countries in the analysis of options and to build cancer therapy programmes appropriate to needs, PACT will:

• Increase capacity within ministries of health and other health sector institutions to formulate policies and set priorities for investments in radiotherapy. According to WHO, “many policy makers do not attach enough importance to the provision of good radiotherapy. Although it has a strong clinical background, its role has not been understood as well as other cancer treatment modalities such as surgery and chemotherapy.”
• Provide training, management skills and other resources that will help institutions leverage the initial investments in trained staff and equipment towards safe, effective, and sustainable operations.
• Promote the development and implementation of effective, well balanced national strategies for cancer control, including the generation of surveillance data to ascertain local cancer disease burden, care needs, and outcomes.
• Enhance technical, legal and administrative capabilities to establish and implement regulatory systems, including those appropriate for radiation protection, safety and security.