But success should not be measured in terms of programs and committees established, in meetings held, in projects actively underway, or even in publications, although adding to the global knowledge base as well as to the infrastructure and human resources devoted to cancer in developing countries are essential to the achievement of INCTR's mission. The ultimate measure of success is the number of cancers prevented or cured, and the number of cancer patients - and their families - whose suffering has been relieved. INCTR has made an important start in this direction, with clear outcomes of this kind being documented in its ongoing projects. These include cervical cancer screening, in collaboration with the International Agency for Research in Cancer (IARC); early detection of retinoblastoma; treatment protocols in acute lymphoblastic leukemia, Burkitt lymphoma and osteosarcoma; as well as information-gathering projects on which to base future strategies, such as surveys of the characteristics and treatment of breast cancer and the reasons for late presentation of retinoblastoma. Treatment protocols for advanced breast cancer, cervical cancer and retinoblastoma, as well as lymphoma, are in the planning phases. All of these studies are managed by INCTR's Clinical Trials Office, directed by Melissa Adde.

The Educational Program, directed by Ama Rohatiner, has organized a variety of workshops, training courses and symposia. Visiting Experts have spent time in institutions in developing countries, several exchange fellowships have taken place, and a larger agenda is emerging with respect to formal professional education from medical students to the range of professionals involved in cancer control. Efforts are made to ensure that educational programs, as far as possible, take place in the developing countries themselves.

The Palliative Care Program, directed by Stuart Brown, has been functioning for only a year and a half, but already a coordinated program, involving several centers and a home hospice component, has been established in Nepal, and plans are being made to develop similar programs in other countries.

The Translational Research Program, directed by Kishor Bhatia, and based within the Research Center of the King Faisal Specialist Hospital, has been highly productive, particularly with regard to studying molecular genetic differences in acute lymphoblastic leukemia in India, and identifying genetic polymorphisms associated with an increased risk for cancer, or treatment outcome.

INCTR has now held four Annual Meetings, and given six awards to persons who have made major contributions to cancer in developing countries. In the course of planning its projects and activities, numerous committee and strategy group meetings have taken place in Brussels and in many other countries.

In five years, INCTR has acquired a past. What of the future? With so much enthusiastic support of the concept of INCTR and increasing interest in cancer in developing countries, the organization will surely continue to grow from strength to strength. INCTR is grateful to NCI for making the vision of INCTR a reality, but its future will depend upon the sustainability and size of its funding base and the quality of its staff, including the health professionals, necessary to stimulate and manage INCTR's activities and projects. It is essential to continue to build credibility and to sustain the progress made if funding bodies and donors are to be convinced that the organization is worthy of support. To be successful, INCTR must function not only as an institution but as a community - a far-flung community of dedicated professionals and volunteers, many of whom work in circumstances that most of their colleagues in more affluent nations cannot even imagine. It must continue to build a multi-dimensional network that includes not only doctors and nurses and allied health professionals, but also advocacy and support organizations, government departments, governmental and non-governmental agencies, academic and professional bodies, corporations, and even the friends and relatives of cancer patients and cancer survivors themselves. And INCTR must ensure that its efforts, and those of its collaborators, remain firmly rooted in the scientific method, for there is no room for assumption in dealing with as devious and malign an enemy as cancer. Attempting to improve the resources available for prevention, diagnosis, treatment and palliative care, and to overcome problems caused by the maldistribution of resources, is central to INCTR's strategy - for without a significant increase in the capacity for cancer control - human, financial and physical - the continuously increasing global burden of cancer, that is shifting more and more to the developing countries, will not only result in greater human misery arising directly from cancer, but will also create a steadily enlarging economic burden. Conversely, creating more effective means of controlling cancer will become an increasingly important element of economic development.

Cancer is a global problem which will be best overcome by using the global laboratory to understand better the factors which predispose to cancer, and to determine optimal approaches to its prevention and treatment. In this respect, the variations in cancer patterns throughout the world provide both valuable scientific opportunities to learn more about cancer, while at the same time requiring cancer control programs to be tailored-to the patterns observed, to the resources available, and to relevant cultural differences. Cancer is a deadly set of diseases, but many can be prevented or, particularly when detected early, effectively treated. It is essential that the world unites against this common foe, just as it must to deal with other global problems such as environmental pollution, climate change, terrorism and nuclear proliferation. Whilst we can be under no illusions with respect to the size and complexity of the problem, these serve only to emphasize the need for a multidimensional, cooperative approach, and one which at times may overlap into more general areas of disease prevention and control. This report demonstrates that by working together we can make a difference. We must now move to consolidate the accomplishments of the last five years and to develop a more sustainable funding base, enabling INCTR to steadily increase its contribution to the reduction of suffering and death caused by cancer.

Cancer in Women and Children Global Distribution of Cancer of the Uterine Cervix, (Crude Incidence Rates) from Globocan, IARC, 2002. The highest incidence rates are in Latin America, Africa and South Asia. INCTR is particularly focused on cancers in women and children – in part because of the particular vulnerability of these populations in developing countries, in part because of the critical role of women in the family and of children to the future of developing countries, and in part because there are effective methods for controlling these cancers. Breast and uterine cervical cancer alone accounted for almost one million of the close to six million cancer cases estimated to have occurred in developing countries in 2002, while the high proportion of children in the populations of developing countries ensured that their approx-imately 134,000 cases of childhood cancer (age 0-14 years) comprised over 80% of all children with cancer in the world. Both cervical and breast cancer can be cured if detected early. Inexpensive but sensitive screening methods for pre-cancerous lesions are available for cervical cancer, and effective vaccines for Human Papilloma Virus, likely to prevent cervical and other cancers, are in advanced stages of testing. Although rare, childhood cancer has been shown to be highly curable in affluent countries and a child cured of cancer has an entire, potentially highly productive life to lead.