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Mary Gospodarowicz, Medical Director of UHN's Cancer Program, explains why you should support the World Cancer Declaration.
UHNews: Tell me about the International Union Against Cancer (UICC) and your involvement with the organization.MG: I am on the UICC's Cancer Stage Committee and board of directors. UICC is the largest non-governmental cancer organization in the world. It has varied membership, comprising of cancer-research institutions and cancer-control organizations. There are some ministries of health, cancer societies and volunteer organizations that also belong. UICC has 375 organization members from 103 countries, so it combines all aspects of professionals, volunteers and customers or patients engaged in the war against cancer.
UHNews: What are the UICC's goals and mission?MG: Knowledge transfer, advocacy, putting cancer on the international agenda – on the agenda of the World Health Organization – and promoting standards of care and the dissemination of research and cancer-control efforts, such as screening and prevention. It is profoundly engaged in tobacco control, in the exchange of information, and supporting many organizations that are engaged in decreasing tobacco consumption around the world.
UHNews: The UICC has launched an initiative to reduce the global cancer burden. Tell me about that.MG: Correct, the UICC four years ago launched a World Cancer Declaration, which is a call to action to substantially reduce the global cancer burden by 2020. We are now in 2010, so it is a very ambitious agenda. It has targets that address having effective delivery systems in all countries to improve the measurement of the cancer burden. We are very fortunate in Canada because we have a Canadian cancer registry that gives us good data on the incidents of cancer. Many countries don't have such a thing. The third point on agenda is to decrease tobacco consumption. At the present time, there is a big push to increase the sales of cigarettes by tobacco companies in developing countries, because the consumption has decreased considerably in the developed world. There is also an agenda to promote and ensure cancer prevention with the new HPV vaccine and the Hepatitis B vaccine, which is a factor and causes liver cancer. So having effective vaccination for Hepatitis B is a very effective measure. It promotes programs for effective cancer screening and early detection, it talks about improving access to diagnostic treatment, rehabilitation, and palliative care, and then addresses some of the particular issues that we don't face in Canada, but are faced around the world, such as misconceptions around cancer.
UHNews: What kind of misconceptions?MG: In some countries, patients who have cancer are shunned and treated like they have an infectious disease. People equate getting cancer with dying. So there is lots of problems patients face. The other issue is a lack of availability of opioids and morphine and effective drugs for pain control. That's a problem we don't have as much in this country. It is known that some countries have a high incidence of advanced cancers and don't have adequate medications for pain control and cancer. So those are the two issues that need to be singled out when talking about the worldwide problem of cancer.
The other problem is lack of healthcare professionals. The Declaration addresses the issue of training cancer professionals and reducing the emigration of healthcare professionals – [for example,] if Canada is short of healthcare professionals and goes and recruits them from South Africa and other countries that actually have a greater need for healthcare professionals who understand cancer.
And eventually the Declaration talks about if you meet all the targets you should be seeing improved survival rates for cancer. There are great disparities in the success of cancer care around the world. For example, in Canada around 80% of cancer in children is cured. That number is 20-30% in developing countries, so children die unnecessarily because of a lack of access to good quality care. To raise awareness and promote cancer as a major healthcare issue, the UICC has put out this World Cancer Declaration and is asking for a billion signatures in support of it. If you have support, you have greater ability to persuade government agencies to take it on the international agenda. At the present time, there is 200,000 signatures.
UHNews: Isn't cancer already at the forefront of people's minds when you talk about public health?MG: Well, that is what we think. But for example, the WHO divides health problems into communicable and non-communicable diseases. The effort is currently to eliminate TB, malaria and HIV. In fact, cancer kills more people in the world than all of these three infectious diseases combined. And as we eliminate death from malaria, TB and HIV, the proportion of people dying from cancer will increase…because if people are not dying from infections, life expectancy in the developing world will improve.
So what UICC is trying to bring to the forefront is the idea that if you want to prevent the epidemic of cancer that will occur in developing world, you should act now in trying to put forward the measures for prevention, screening, early detection and other treatments, so we are not surprised 10 years later that this has happened.
UHNews: How far away are we from conquering cancer? Will we really see this happen in our lifetime?MG: Well, our motto for PMH is conquering cancer in our lifetime…and with the progress in science, we at present time we can cure 50-60% of all cancers with new advances in cancer prevention, especially vaccines for infection-related cancer. I think we can eliminate a number of cancers and with all the efforts for tobacco control in Canada there has already been a reduction in mortality from lung cancer and many other tobacco-related cancers. So I think we are already making progress. I am not sure we will eradicate all the cancer – certainly not in my lifetime – but we certainly can make cancer much more treatable manageable and much less of a health issue. In Canada, we have an opportunity to apply all the knowledge that we have and deliver all the care, and relatively speaking, have few barriers to what I would call achieving the achievable. It is not perfect, but at least we can do it. There are huge parts of the world where this is just a dream because there are no resources.