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“In 30 countries of the world there is no equipment at all for treatment“

“In 30 countries of the world there is no equipment at all for treatment“

Photo: Franco Cavalli

Professor Franco Cavalli is the President of the Union for International Cancer Control (UICC) and Scientific Director of the Oncology Institute of Southern Switzerland (IOSI). He talked to about the lack of radiation equipment in developing countries and the importance of prevention. Too many cigarettes, too much alcohol and not enough exercise – the 2008 World Cancer Report clearly revealed that the chief cause for the severely increasing cancer incidence rates in developing nations is their increased adoption of Western lifestyle. What is your take on this Professor Cavalli?

Franco Cavalli: The Western lifestyle is definitely a significant cause, because especially the very quick change in diet plays an important role. But we cannot tell just yet whether this changed lifestyle in the developing countries is really the chief cause. We still simply don’t know enough to be able to say that. After all, the available data on the whole is very meager. However, you can say that especially in developing countries there are still many tumors that are driven by poverty, like cervical cancer for instance. So this means infection-associated cancers. Are there also other factors conceivable as a cause?

Cavalli: Definitely. For instance the environmental aspect is still relatively uncharted. Yet in developing countries, tumors affecting the lymphatic system increase drastically. This fact suggests the conclusion that environmental influences also play an important role in the occurrence of new cancer incidences. Are there international standards for the treatment of different types of cancer?

Cavalli: So far there are no government guidelines. However, professional organizations have published recommendations. But even the World Health Organization is fairly at a loss in view of the international situation. In 30 countries of the world, there is no equipment at all for treatment. And generally speaking, treatments are very expensive. The cost of a cancer treatment at around 2,000 to 6,000 Euros is virtually inconceivable for patients in less developed countries.


Photo: Chinese man who smokes How does the health care policy in the individual countries respond to this?

Cavalli: Cancer is a complex disease. To handle it appropriately, above all you need a well-functioning health care system that should work in a multidisciplinary fashion. In many countries of the world this is very difficult to implement. Politicians for the most part are only interested in short-term solutions. What’s more, the global financial crisis has had a corresponding impact on government spending. Good physicians and nurses often leave their country and move to industrial nations. Public health care systems are thus more and more weakened or in parts are already shut down. Basically, all countries know that something needs to happen, but to some extent they don’t know what they should do or where they should start. There are studies that indicate that the survival rate for breast cancer in the U.S.A. is 81 percent, but in women in Africa (south of the Sahara Desert) is a mere 32 percent. What are the reasons for this?

Cavalli: In developing nations, the disease is still oftentimes discovered too late. Getting an early diagnosis is therefore a big problem. But treatment options after a diagnosis also are largely nonexistent. This makes it very difficult to get this disease under control. What could help?

Cavalli: Prevention is very essential, because prevention is always the cheapest way. Unfortunately, ignorance about the causes of cancer is very large in developing countries. Cultural differences also play an important role in disease awareness. What’s well received in the U.S.A. by no means has to work in Africa.

Photo: Woman cuts through a cigarette she has in her mouth 
To stop smoking is the best
prevention against cancer;
Piotr Marcinski In your opinion, which countries appropriately deal with this disease?

Cavalli: Depending on your point of view there are one or two positive examples. Japan for instance has a big problem with gastric cancer. But the Japanese pursue a lot of great prevention and they also do a lot more in terms of early diagnosis. France on the other hand has a relatively well-developed health care system, which of course is also very important. They even have a national cancer program. How are things in the U.S.A.?

Cavalli: There are two areas where the U.S. is certainly something like a showcase and that is in the fight against tobacco abuse and in funding research. But on the other hand, if we take a look at the high rate of obesity in the United States this picture gets murky. And if we then also figure in the importance of a well-functioning health care system, it becomes clear that the U.S.A. no longer represent a thoroughly good example. After all, just in the individual U.S states alone there are serious differences in part. You only need to take a look at the slums for example. So what is the most important thing to successfully fight against cancer?

Cavalli: In terms of prevention, smoking and tobacco use must be the absolute number one priority. Germany for instance is still completely in its infancy in this regard. The impact of smoking is seen in Africa: In the old days nobody smoked there, but now there are more and more smokers and thus also incidences of cancer. And if the Chinese continue to smoke like they do now, over the next 15 years three million people per year will die from cancer just in that country alone.

The interview was conducted by Nadine Lormis and translated by Elena O'Meara.


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