It is widely accepted that radiation medicine is a critical component in the diagnosis and treatment of more than half of all cancers, yet many developing countries still lack these basic technologies. A new initiative of the International Atomic Energy Agency promises to bring nuclear technologies for peaceful purposes to underserved countries, and to build comprehensive cancer control programs in the process.

Five years ago, a cancerous lung tumor left Mr. Wisdom Nutakor of Accra, Ghana, paralyzed from the waist down. Today, thanks to treatment at the Korle Bu Teaching Hospital, he is walking again.

Massoud Samiei, a nuclear engineer in IAEA’s Department of Technical Cooperation for 15 years, was recently appointed to lead the agency’s Programme of Action for Cancer Therapy (PACT). In its first year, Dr. Samiei secured support from a dozen key organizations, has received support through a WHO resolution acknowledging the urgent need for a comprehensive and integrated approach to fighting cancer, and is now working to develop public/private partnerships that will mobilize and direct resources to regions of the world where nuclear technology can have a measurable impact on cancer control. In addition to funding from IAEA’s member states, PACT is looking to private sources for funding, particularly manufacturers and pharmaceutical companies.

“IAEA has long history with nuclear technology in the diagnostic and treatment areas, and we have over two dozen companies we deal with,” Dr. Samiei says. “If the company produces equipment and technology in relation to cancer, for screening, treatment or palliative care, we encourage them to consider a donation to PACT .”

Samiei tells prospective donors that, as the number of patients increases and as their capacity for cancer treatment grows, emerging countries will be in a position to ask bilateral organizations to build and develop cancer systems requiring additional machinery, to the benefit of the donor.

The first Cobalt-60 machine, a gift from a private corporation that produces Cobalt-60 machines, is on its way to Tanzania as part of a demonstration project funded by IAEA. Three more machines - also gifts are in the queue.

The cost of radiotherapy includes capital costs of the building and equipment, maintenance costs, and staff salaries (and the initial training and education costs). A single Cobalt-60 radiotherapy machine costs well under $1 million but with the addition of buildings, treatment planning and quality control, trained staff and maintenance expenses, the price tag climbs to $2 to $3 million for a center. Still, if radiotherapy is used effectively - that is, for early treatment rather than palliative care - it is money well spent. Unfortunately, over 70% of cancers are detected too late in developing countries for an effective curative treatment.

“The current shortage is huge,” Dr. Samiei says. “Although over 100 countries have been involved in the IAEA radiotherapy program in the past 20 years or so, still many countries have just one machine. To treat current cancer patients in developing countries, we need nearly 7,000 more machines, at a cost of several billion dollars. We could reduce that number by half if we also focused on prevention and widespread screening and early detection.”

Around the world, the need is great. Only 20% of the population in Africa has access to radiotherapy cancer treatment; in Asia, only 40% and, in Latin America, only 50%.

Within the next three years, PACT is committed to building partnerships in as many as six countries where the prospects for success and sustainability are high. That means identifying cancer organizations with good leadership in countries that are committed to the idea of comprehensive cancer control.

“We want to encourage using radiotherapy to build a cost-effective cancer system that’s longer term and to think about the need for trained professionals,” he says.

PACT is looking first at cancer organizations in Africa and Latin America. “In Africa, the shortfall of radiation oncologists has been identified as the most significant limitation to radiation oncology service delivery in developing countries - more significant than even the paucity of available equipment. For instance, we’ve analyzed how many staff they can train [a few hundred] and how many we need to train across Africa [a few thousand] in order to bring existing capacities to a level at which they can provide training for the region. The longer-term concept is development of cancer training through virtual universities and networking. This could partially address the issue of losing trained staff to more affluent countries.”

PACT is working with the Institut Català d’Oncologia and the Universitat Oberta de Catalunya, which have developed an online e-ocology training program, to explore the possibility of using the IAEA-developed training material in radiation oncology or medical physics for future online courses. After completing coursework through e-oncology, participants would travel to recognized regional centers to complete their certification.

Figure 1. Between 2000 and 2020, some 260 millions people will develop cancer worldwide, 150 million in developing countries of which about 100 million will need radiation therapy as part of their treatment. As things stand on average less than 40% have access to services.

One of PACT’s first pilot projects is slated for Nicaragua. “We are working on agreements and have discussed plans that focus on the long-term control of cervical cancer by vaccination, while continuing to treat patients for some decades until the effects of the immunization program can make an impact,” Dr. Samiei says. This project has piqued the interest of the Gates Foundation, as well as the National Cancer Institute and WHO’s Pan-American Health Organization. “My biggest concern is that there is not enough awareness of the world’s growing cancer crisis at the political level,” he notes, and he hopes that the international financial institutions will begin investing in cancer prevention. “When the G-8 begins talking about controlling cancer in developing countries, we’ll know that we are moving forward.”

Marcia Landskroener for INCTR