Building a French-Speaking Cancer Control Network

Cancer is not yet a public health priority for the governments of many developing countries. In fact, it remains a taboo subject for many people, and in Africa, most languages have no name for the disease. A high fraction of patients see traditional healers in the absence of access to standard medical care. Many patients never reach a competent facility, while others may be sufficiently delayed as to leave little possibility of treatment beyond palliative care. There is a lack of information, infrastructure and properly trained medical staff, and very low government expenditure on healthcare. Thus, policy makers have little incentive or even the possibility of addressing the problem - even to develop programs on prevention and palliation. Therefore, non-governemental cancer control organizations have a particularly important role.

There is also a clear lack of communication and coordination with respect to support for cancer control provided by industrialized countries and international organizations to developing countries compared to what exists for HIV/AIDS. In part, this is due to the lack of a global fund equivalent to the several that exist for AIDS, tuberculosis and malaria, such that there is a chronic shortage of financial aid – a major problem given the complexities of cancer control programs. Given the severity of the problems in francophone Africa, the INCTR's branch in France (AMCC) is focused particularly on French-speaking Africa. AMCC tries to share both knowledge and methods, provide training and participate in research. AMCC is helping to develop a network of African centers and European cancer organizations to facilitate this process.

With this in mind, the AMCC organized a colloquium entitled You speak about the financial crisis: let us speak about cancer! at the CRLC Val d'Aurelle (Regional Cancer Center) in Montpellier, on April 3rd, 2009. This was the second colloquium of this type to be held in Montpellier and will be adopted as a regular event in AMCC's calendar. Medical experts and civil society representatives attended from Africa, Asia and Europe. AMCC's major purpose is to expand its network both within Europe and in French-speaking developing countries.

Among the 100 participants, two major questions emerged: how to expand the cancer control network in French-speaking countries and how to answer requests for information, training and partnerships from countries that wish to invest in cancer control.





In the morning, the AMCC and INCTR reports for 2008 were presented. African representatives and various NGOs discussed their cancer control efforts and difficulties they are encountering. The status of the three-year course on pain control and palliative care, developed in a partnership between the AMCC and the Bobo Dioulasso Hospital Cancer Committee in Burkina Faso, was discussed. This program, supported by the French National Cancer League and to the IAEA/PACT program, began with Burkino Faso and three neighboring countries - Senegal, Mali and Niger. More recently, Gabon, Ivory Coast, Mauritania and Benin were added. All participants in the training sessions stressed the need to organize additional training sessions on surgery, chemotherapy and radiotherapy. However, at present, among the West African francophone countries, radiotherapy is available only in Senegal, although it should be soon introduced in Niger.

In the afternoon, several workshops focused on topics raised by AMCC partners and collaborators in Africa. These included tobacco control, pediatric oncology, radiotherapy and pain management in developing countries.

A number of important points were made (see panel):

Tunisia is the first francophone country to ban smoking in the workplace. Obtaining affordable anti-cancer drugs is a problem - even generic drugs can be beyond the financial means of many patients, although they are much less expensive. In addition to financial constraints, many problems still exist with respect to drug procurement practices. The delivery of radiotherapy can be immensely difficult in view of the shortage of equipment and trained personnel. Data collection, e.g., by cancer registries is extremely limited.

One of the most successful workshops was on situation analysis, where participants were given a chance to learn how to conduct an initial assessment of the general health status of the population and the health system in their respective countries. A constructive debate on several key issues, such as why conduct an analysis, how to prepare for an analysis and how to take advantage of opportunities and address challenges were addressed.

In the course of the colloquium, side-meetings took place between participants, AMCC and the French National Cancer League to follow up on preliminary plans to form a network of African and Mediterranean French-speaking cancer leagues. Participants felt it very important to create a network based on a common language, and francophone countries in Africa often lag behind Anglophone countries. AMCC and the newly formed Francophone cancer network plan to change this. There is strength in numbers: by banding together in the cause for improved cancer control, and calling for greater capacity-building with one voice, we are more likely to be heard by the various political authorities whose support is a key requirement for the improvement of health services, training and education as well as the availability of needed drugs and equipment. At present, cancer is largely considered an incurable disease by the African public. The only way to change this attitude is to demonstrate that this is not necessarily so: that for some cancers, incidence can be reduced by prevention, while for others, early detection will lead to better results, assuming prompt access to competent care is available. Even when there is no curable option, palliative care can provide comfort, and it will be critically important to ensure that these messages are delivered in a culturally sensitive way to the general public, as well as to primary health care providers and political authorities in developing countries.

Report of a meeting held in the Epidaure Department of Cancer Prevention, Val d'Aurelle Cancer Center, Montpellier in January 2009.

Sabine Perrier-Bonnet,
AMCC/INCTR, Montpellier, France
Julie Estal, INCTR,
Brussels, Belgium