HEALTH: Lack of Radiotherapy Could Kill Millions

By Sanjay Suri Reprint | | Print |

Sanjay Suri

LONDON, Jun 26 2003 (IPS) - Millions who could be saved from cancer across the developing world will die unless they are given early access to radiation therapy, says an expert.

"The number of cancer patients in the developing world will double to 10 million," Bhadrasain Vikram, radiation oncologist in the Human Health Division of the International Atomic Energy Agency (IAEA) told IPS Thursday. "Most of them will have no access to radiation therapy that can save lives."

The IAEA, better known so far for its mandate to enforce nuclear non-proliferation particularly in countries like Iraq and North Korea, is now seeking to play a stronger role in the benefits of radiation for fighting cancer.

"This role makes up a relatively small part of the IAEA budget at present," Vikram said. "But we are stepping up our activities in this field now. It is only relatively recently that the magnitude of this problem has been recognised."

Radiation therapy is "the most important peaceful application of nuclear technology," he said. "We need to put this to greater use, or we will have a catastrophe on our hands."

An IAEA report says developing countries are home to 85 percent of the world population, but they have only about one-third of the total radiotherapy facilities, or some 2,200 radiation therapy machines. In contrast, the developed world has more than 4,500 treatment machines.

Fifteen African countries and several countries in Asia lack even one radiation therapy machine. Ethiopia with a population of 60 million has just one such machine, provided by the IAEA. Other countries have only one machine for several million people, compared to an average of one for 250,000 people or so in most developed countries.

The IAEA is seeking to promote funding from several national and international sources to get more of these machines into developing countries.

"A silent crisis in cancer treatment exists in developing countries and is intensifying every year," IAEA director-general Mohamed ElBaradei warned in a statement Thursday.

"Greater support from the international community is needed so that effective cancer treatment is more widely available in the less advantaged nations of the world," he said.

The IAEA estimates that 2.5 billion dollars are needed over the next ten years to provide adequate treatment facilities in the developing world, half to purchase machines, and half to train medical staff to ensure safe and effective treatment.

"Spread over ten years that is not a very large amount," says Vikram. But action must be taken now, he says, because about four years are required to train a doctor to use the machines, two to three years to train staff to maintain and use the machines and several months to train nurses to look after patients given treatment.

The medical establishment of many developing countries needs to wake up to the dangers from the spread of cancer, Vikram says. "Too many people think cancer is a problem of affluent countries. But many decision-makers are unaware that the incidence of cancer in developing countries is exceeding that in developed countries."

Patterns vary across countries and regions, but Vikram says high levels of certain kinds of cancers have been reported in developing countries. These include cervical cancer among women in most developing countries and high levels of cancer in the nose in Southeast Asia and North Africa. Incidence of breast cancer is "rising very rapidly in developing countries because women are living longer."

The developing world has also seen a high level of cancer in the mouth and throat among males because of soaring use of tobacco, Vikram says. The IAEA is planning to tackle these cancers in partnership with World Health Organisation (WHO) through promotion of radiation therapy.

WHO estimates that six million people died from cancer in 2000. Cancer deaths are expected to double to 12 million by 2020, according to latest estimates.

Radiotherapy seeks to destroy malignant cells in tumour tissue. The genetic material of these cells is damaged, making it impossible for them to continue to reproduce. If aimed accurately and delivered in the right dosage, the cancer cells are damaged irreparably, while the adjacent normal cells are able to repair themselves.

"In a very large number of cases, this treatment can provide cure, not just temporary remission," Vikram says. In advanced countries this technique has a record of curing 45 percent of all cancers.

Staff skills are crucial in effective treatment, and lack of training makes use of the machines difficult in developing countries, says Ana Maria Cetto, head of the department of technical cooperation at IAEA.

The agency, she says, will now support "provision of radiotherapy equipment, training, quality assurance and maintenance in developing countries."

The IAEA is promoting provision of Cobalt machines that cost no more than about a third of a million dollars each. The more advanced linear accelerator machines, which cost about one million dollars have several advantages but are difficult to maintain, Vikram says.

The IAEA already has radiation therapy programmes going in 80 countries, but with a budget of only a few million dollars a year. It is now planning to direct substantially more resources of its own to promote radiation therapy in developing countries.