NCI’s Office of International Affairs Addresses Global Burden of Cancer

> Dr. Joe Harford at INCTR's Cancer Control Meeting.

The U.S. National Cancer Institute (NCI) is the largest cancer research entity in the world. Positioned within the U.S. Government’s Department of Health and Human Services and representing the largest institute of the National Institutes of Health, NCI managed a budget of $4.8 billion in 2008. NCI has both an Intramural Research Program with laboratories in Bethesda and Frederick, Maryland, and an Extramural Research Program that funds cancer research at nearly 650 universities, hospitals and other sites in the U.S. and abroad. The scope of NCI-funded cancer research includes basic science, epidemiology and clinical research that spans the cancer continuum from prevention to end-of-life care.

The U.S. Congress passed the National Cancer Act of 1971. This and subsequent legislation specifically emphasize an international presence in directing that NCI supports:
a) research in the cancer field outside the United States by highly qualified foreign nationals;
b) collaborative research involving American and foreign participants;
c) the training of American scientists abroad and foreign scientists in the United States.

This legislative language reflects the idea that cancer research undertaken anywhere can benefit people everywhere; a position that underpins NCI’s international activities. NCI's Office of International Affairs (OIA) is administratively located within the office of NCI Director, Dr. John Niederhuber, who has expressed his strong personal support for NCI's international engagement. OIA seeks to track NCI's international activities and manages certain projects. OIA has been directed since 2002 by Dr. Joe Harford.

Among his many duties, Dr. Joe Harford serves on the executive steering committee on NCI’s Breast Health Global Initiative, which endeavors to develop economic-based, culturally appropriate guidelines for developing countries.

"Cancer does not recognize geopolitical borders, and already more than 90% of cancer cases and deaths are outside the U.S,” notes Dr. Harford. “For the NCI, the international burden of cancer not only represents an opportunity to assist, by sharing our existing knowledge in helping to build capacity for cancer research and care, but it also provides a broad range of opportunities to add to that base of knowledge through collaborative research."

OIA seeks to build capacity in cancer research where that is currently lacking and, in this regard, shares the vision of INCTR. Indeed, OIA is a major supporter of INCTR activities through core funding of the organization and additional funding for selected educational and training activities.

OIA’s training activities extend around the globe. One example is the sponsorship of participants in the NCI’s Summer Curriculum in Cancer Prevention. Courses on Principles of Cancer Prevention and Molecular Prevention are offered in Bethesda each July and August. Although the Summer Curriculum began as a U.S. domestic activity, over the years it has become progressively international with more than half of the participants in the last two years being from outside the U.S.

This international representation has added richness to the courses with an “international day” becoming a feature. On this day, participants from around the world share the situation regarding cancer prevention in their home countries. OIA has been supporting the attendance of participants from low- and middle-income countries for a number of years. In the last two years, OIA has partnered with the International Atomic Energy Agency (IAEA) in bringing participants to the Summer Curriculum. The IAEA’s Programme of Action for Cancer Therapy nominates participants who are then reviewed and supported by NCI through OIA.

Each year, the NCI supports nearly 1,000 international health professionals who come to the Bethesda campus for four-year post-doctoral training or shorter-term positions. Nearly half represent four countries: Japan, China, Korea and India.

Forty-seven participants from 22 countries have been thus supported over the past two years. OIA has also provided scholarships to 37 other participants from low- and middle-income countries outside the IAEA collaboration. In addition to the Summer Curriculum in Cancer Prevention, OIA assists individual scientists with short- to medium-term visits to the U.S. in the context of collaborative research involving NCI intramural scientists or NCI grantees.

OIA also provides support for thematic workshops and conferences held around the world. The INCTR’s own meetings represent a major commitment on the part of OIA/NCI via the provision of sponsorship of participants from low- and middle-income countries. Another recurring meeting that has had OIA support for many years is that of the African Organization for Research and Training in Cancer (AORTIC). OIA has also participated in numerous thematic workshops that overlap with the interests of INCTR, including, for example, two that took place in 2008 - one on breast cancer in Morocco and another on Burkitt's lymphoma in Uganda.

OIA also engages in projects that have been termed “health diplomacy.” For example, the Middle East Cancer Consortium (MECC) has as its members Cyprus, Egypt, Israel, Jordan, Turkey and the Palestinian Authority - countries with a history of conflict. Launched in 1996 with assistance from the NCI, MECC has sought over this 12-year period to bring together cancer researchers and health care workers from these countries to work together for the good of all people in the region. The flagship project of MECC is a joint cancer registry project that supports population-based cancer registries in each of the membership jurisdictions. In 2006, NCI published a monograph comparing cancer incidence in Cyprus, Egypt, Israel, Jordan and the U.S. SEER registries.

A second MECC project involves palliative care. Arguably, says Dr. Harford, the three most important features of cancer in the Middle East are “late presentation, late presentation and late presentation.” When cancer is detected late, curability drops dramatically, and often palliation is the only remaining option. Too many people experience poor-quality deaths with pain and other symptoms going unrelieved. The MECC palliative care project involves training and equipping of health care workers from the MECC membership in the principles and practice of palliative care. Among other resources, the INCTR Palliative Care Handbook is utilized in MECC-sponsored training activities.

NCI’s support of INCTR is a means by which the agency can reach researchers around the world. Within NCI’s mission, INCTR is a conduit to build capacity for cancer research in resource-constrained settings.

Research on palliative care is also being encouraged. In 2008, NCI published an inventory of palliative care services in the region represented by MECC that was commissioned by OIA and conducted by the Observatory on End-of-Life Care of Lancaster, UK. Both the MECC monograph on cancer incidence data and the MECC monograph on palliative care can be seen along with other MECC-related publications on the Web site maintained by OIA (http://www.mecc.cancer.gov/publications.html#pc).

In 2007, the Arab Medical Association Against Cancer recognized Dr. Harford for his role in MECC as well as other work in the Arab world. The award cited his “significant contributions to enhance the status of cancer care and cancer research in the region and unwavering efforts to support needed infrastructure and create opportunities in cancer education, training and capacity building to help cancer patients and their families throughout the Arab world.”

Dr. Harford serves as the NCI liaison to a number of global organizations, including the International Agency for Research on Cancer (IARC) and the International Union Against Cancer (UICC). He has also been instrumental in the encouragement of U.S.-based entities to extend their reach around the globe. He serves on the International Affairs Committee of the American Association for Cancer Research (AACR) and works closely with colleagues from the American Society for Clinical Oncology (ASCO), the Oncology Nursing Society (ONS) and the American Cancer Society (ACS), to name but a few.

“It is clear that the world has gotten smaller in terms of our ability to communicate and to do business globally,” says Dr. Harford. “However, dealing with the burden of cancer that exists now and that is growing is a very big job. No single entity is equipped to address all of the issues, and so cooperation is not optional but essential.”

Marcia Landskroener for INCTR