Cancer is threatening to overwhelm poor countries and governments are under pressure to organise the kind of joined-up global response enlisted to tackle the HIV/AIDS epidemic.

Just as with the human immunodeficiency virus (HIV) that causes AIDS, effective drugs, highly-trained doctors, and policies to step up awareness, prevention and screening have been able to turn cancer into an often manageable condition in rich nations.

But in poorer countries, where cancer drugs and specialist knowledge of the disease are scarce, it is still almost always a killer.

“People think that cancer is a disease of the elderly, the rich, the north and the west, but by 2020, 70 percent of all new cancer cases will be in the developing world,” said David Kerr, an oncology specialist from Britain’s Oxford University.

Meanwhile only about five percent of global resources for cancer are spent in developing countries, where knowledge about preventing the disease and how to get drugs to cure it or keep it in check is extremely low.

“If you take a country like Ghana - it has 25 million people, and four oncologists,” Kerr said. “In Sierra Leone, there are none.”

Despite the focus on infectious diseases like HIV and malaria, cancer actually kills more people a year in poor countries than AIDS, tuberculosis and malaria combined, and is predicted to become an even bigger killer.

BIG KILLER

According to the International Agency for Research on Cancer (IARC), cancer will kill more than 13.2 million people a year by 2030, almost double the number it killed in 2008 - and the vast majority of deaths will be in low and middle-income countries.

Experts estimate that 75 percent of all those who get cancer in poor regions will die of it, compared with fewer than half of cancer patients in high-income countries.

In the Lancet medical journal last week, the Union for International Cancer Control (UICC), the International Network for Cancer Treatment and Research (INCTR), the American Cancer Society (ACS) and the LiveSTRONG group headed by the cyclist and cancer survivor Lance Armstrong said now was the time to act.

“If we don’t intervene now, it’s not just the cost of the intervention that we’ll have to add on, it’s the cost of doing nothing. If we want to wait until 2030 and cope with that chaos, I’m sure society will not thank us,” Julie Torode, deputy chief executive of the UICC, said in a telephone interview.

That echoed a similar call in August from an international team of cancer specialists who said the disparity of cancer care between rich and poor was “no longer acceptable”.

“What we have now is a global situation ... not unlike when treatment first appeared for HIV/AIDS,” Julio Frenk, of Harvard School of Public Health, told reporters in a conference call.

“Cancer affects people in rich and poor countries. The problem is that access to prevention and treatment is so unequally distributed that dying from a number of cancers is something that only happens to poor people in poor countries.”

“WHOLE-SYSTEMS APPROACH”

As with HIV/AIDS, experts say the solution to what Torode described as a “tsunami” of cancer threatening the developing world is a multi-pronged effort backed by international donors.

“If you think about the AIDS fight, a lot of that was about awareness-raising, social reprogramming around the use of condoms and so on,” said Kerr. “Cancer needs the same whole-systems approach.”

“A lot of it needs to be about investing in raising awareness and trying to catch the cancer as early as possible. After all, it’s far easier to cure a cancer the size of a grape than one the size of a grapefruit.”

Experts say one of the main obstacles to taking on the burden of cancer in the developing world is the fear that the drugs needed will be prohibitively expensive.

GlaxoSmithKline and Merck & Co make vaccines against the human papillomavirus that causes almost all cervical cancer - the biggest cause of cancer death among women in poor countries - but these are often seen as too pricey to be included in developing nations’ health programmes.

High-profile rows in Europe about whether health systems and insurers should pay for a new generation of expensive targeted cancer medicines like Roche’s Herceptin also perpetuate a myth that cancer is simply too costly a disease for poor countries to tackle, experts say.

But they argue that there are many cheap generic drugs for diseases such as breast cancer and some childhood cancers that could have a dramatic impact on death rates in poor countries - if only systems were built to get them to those who need them.

Kerr points to the breast cancer drug tamoxifen as a good example, while Torode highlights a cost per patient of just $50 in several African countries for generic chemotherapy drugs with a 50 percent cure rate for a type of cancer called Burkitt’s lymphoma - which kills many children in poor countries.

“That’s not an expensive drug, and it’s not difficult to do, but you just have to focus,” she said.

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By Kate Kelland, Health and Science Correspondent

LONDON (Reuters)