Communicable diseases have for long been the predominant health problem in developing countries and this remains the case in the poorest countries (such as Africa, where the AIDS epidemic has further tipped the balance), and in the most vulnerable populations in low and middle income countries. However, although the burden of infectious disease is high, slightly more people die of cancer in developing countries each year than die of tuberculosis, AIDS and malaria combined. The incidence of cancer overall is markedly lower in developing countries than in affluent countries (see Figure 1 for 2002 estimates), largely because of differences in the diet, smoking rates and life expectancy. However, since over 80% of the world’s people live in developing countries, the latter account for more than half of the global cancer burden (see Figure 2 for 2002 estimates). Smoking rates are at last beginning to decline in many affluent countries, but are increasing in the poorer nations. This, coupled to the fact that population growth is largely confined to developing countries, whose populations are aging as their socioeconomic circumstances improve, means that the global cancer burden will fall progressively upon the countries least able to deal with it (Figure 3). Clearly, the time to act, in order to lessen the impact of this avoidable catastrophe, is now!

Unfortunately, developing countries have limited human capital, facilities, equipment, and drugs, and although the design and implementation of cancer control programs has been advocated by the World Health Organization for some years, and a resolution to this effect is likely to be adopted by the World Health Assembly in 2005, the effective conduct of such programs will not be possible without major improvements in the resources available for cancer control. Approaches will also need to be developed to counteract the negative impact on capacity building that results from the loss of the most highly trained and educated members of such societies to the more economically privileged countries and to reduce the disparities in health service delivery that exist throughout the world, but which have a much greater impact in countries where a high proportion of the population is already living below the poverty line.