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There needs to be international action on tobacco

Today, leaders from cancer organisations across the world – from Australia to Argentina, and Taiwan to Turkey – have issued a joint statement about how to address the growing burden of cancer worldwide.

It’s the first time that so many eminent cancer scientists and policy makers, from so many nations, have spoken with one voice about what needs to be done to combat cancer – in the poorest as well as the richest nations.

The statement comes off the back of a consensus meeting of 25 leaders of cancer organisations, chaired by our Chief Executive, Dr Harpal Kumar, and Professor Harold Varmus, Director of the US National Cancer Institute.

It aims both to raise the profile of global cancer issues, and to act as an urgent clarion call to action. The report is published in the journal Science Translational Medicine – but we’ve summarised its key points below.

The recommendations

The experts have made recommendations in five areas: prevention, screening, treatment, data collection and research, and you can read a complete list of their recommendations at the foot of this post. But these four areas particularly caught our attention:

  1. Strengthening global tobacco control
  2. Improving access to vaccines
  3. Developing national cancer plans
  4. Increasing access to the fruits of research

Strengthen global tobacco control – a top priority

Tobacco control received more emphasis than any other area, and the recommendations were wide-ranging and uncompromising.

Tobacco remains far and away the single biggest cause of cancer worldwide and is linked to over a dozen types of cancer. Strong recommendations in this area are clearly needed, and should be welcomed by everyone committed to reducing the burden of cancer.

The report took the opportunity to urge governments to raise taxes on tobacco, and to stop the tobacco industry expanding further into new markets such as sub-Saharan Africa.

Such strong action is necessary because, as our Chief Exec points out, the global burden of tobacco remains absolutely unacceptable. “There is still much work to do in the UK and worldwide to protect the next generations from the unnecessary suffering and death associated with tobacco-related cancers,” Harpal told us.

“While the focus of an organisation like Cancer Research UK must begin at home, we have a moral responsibility to work with others to ensure the scourge of tobacco-related cancers doesn’t engulf the poorest countries of the world while we are looking the other way.”

Improve access to vaccinations

Vaccine

Greater access to vaccines is needed

Another key priority for the cancer leaders was vaccination.

They called for the development of a low-cost vaccine against human papillomavirus (HPV) and urged governments to find ways to introduce vaccines to protect their populations.

They welcomed efforts to vaccinate against hepatitis B in parts of Asia and Africa, but called for extensions to these programmes.

And they called for more research into the development of vaccines against Epstein Barr virus (linked to Burkitt’s lymphoma and nasophayngeal cancers) and hepatitis C virus.

Let’s look at the reasons why this was so high up the priority list.

Although cancer can’t spread between individuals, each year more than 2 million people develop cancers caused by an infection. All cervical cancers, and many other genital cancers, are caused by HPV. More than eight out of ten liver cancers worldwide are caused by hepatitis B and C. And a bacterial infection of the stomach called Helicobacter pylorii accounts for nearly two thirds of stomach cancers globally.

These are shocking statistics, especially given that many of these infections are relatively easy to prevent through wider distribution of HPV and hepatitis B vaccines, particularly in the developing world (where the greatest burden of infection-related cancers falls).

These vaccines have the potential to save literally hundreds of thousands of lives each year. Cost is, of course an issue – but a promising development in 2011 saw the Global Alliance for Vaccines and Immunisation (GAVI) negotiate a 67 per cent reduction in the vaccine’s price , down to $15 per course.

Because of this, a few of the world’s poorest countries – notably Rwanda, Uganda and Peru have already begun to introduce national HPV vaccination programmes. And there are plans to introduce the vaccine in Kenya, Sierra Leone, Ghana, Madagascar, Malawi, Niger and Tanzania.

But there are still many countries where the vast majority of people remain unprotected.

Clearly, vaccination is an area where a huge number of cancer deaths could be prevented relatively easily.

Create or strengthen existing cancer plans

Despite the World Health Organisation’s recommendation, only half of the world’s nations have a ‘cancer plan’ – a political strategy to tackle the disease, a figure that drops to below one in five for African countries.

Cancer plans help a country to identify local priorities relevant to cancer, ultimately allowing resources being targeted more effectively. So the development of such a plan is a tremendous investment, particularly in developing countries where resources are even more scarce.

“Political action against cancer is essential to transform the fruits of research into patient benefit,” says Harpal, who said he hopes that the recommendation to create or strengthen existing cancer plans will spur countries into action.

Cancer plans have certainly been effective here in the UK. Beginning with the Calman-Hine report in 1995, successive governments have redrafted and refocused policy priorities. As a result we’ve seen substantial improvements in UK cancer outcomes although, as recent reports have shown, there’s still a way for us to go.

Expanding the reach of cancer research

Reseacher looking at DNA fingerprint

Research data needs to be more open

Collaboration is everything in research, and – in keeping with wider trends in greater openness and transparency – the consensus statement is very clear on three particular points.

Firstly, they want researchers to move towards more open models of publishing and sharing their results. This is particularly crucial to reduce unnecessary duplication and speed up research, but also to make sure scientists can base their research on the latest, most up-to-date, relevant data.

Second, they want databases that store large volumes of research data to be constructed so that they’re interoperable, and available to researchers around the globe – again to speed up research and increase innovation.

And finally, they make a clear statement of opposition to the patenting of genetic data – something that frequently makes headlines around the world. This will remove “obstacles to cancer research, and to the design and reasonable pricing of improved means to classify and treat cancers based on genetic information,” they say.

These aren’t changes that can happen overnight. Existing business models and interests are old and well-entrenched, and we need to make sure that we don’t throw the baby out with the bath-water – after all, the status quo has taken us a long way towards our goal.

Nevertheless, the statement is clear: openness and transparency are the way forward, and failure to embrace them will hinder further progress.

‘Profound significance’

For many, these recommendations may not come as a great surprise.

But the primary aim of this consensus statement is not necessarily to break new ground. Instead it’s an opportunity to take stock, to reflect on the progress that’s been made in combating cancer, and to identify the top priorities for the future.

In doing so, this statement should be of considerable value to governments, international policy makers and research funders.

Also, its publication in a high-profile scientific journal is likely to have brought the issues to the attention of a new audience – the scientific community – whose crucial role in the fight against cancer will benefit from consideration of the global political picture.

But, arguably, this statement has even more profound significance. It sends out a clear message that leaders of some of the largest cancer organisations in the world are committed to combating cancer beyond their own borders.

According to Harpal, this is the first time leading research organisations across the world have come together to consider how best to address the global burden of cancer.

“The number of people diagnosed with cancer across the world is increasing. But there are clear actions that all countries can take, which will go a long way to reducing both the numbers diagnosed from cancer, and deaths from the disease,” he says.

This consensus statement has the potential to mark an important turning point in the global fight against cancer. Only by working harder to ensure the scientific and political developments made in the richest nations of the world – and their benefits – are equally shared around, will we have any chance of addressing the global burden of cancer.

It’s up to us to decide.

Hazel Nunn

The recommendations in full

Prevention

  • Exempt tobacco products from free trade agreements
  • Raise taxes on tobacco
  • Stop the tobacco industry expanding into new markets such as sub-Saharan Africa
  • Reduce smoking among health professionals
  • Deglamorise smoking and make it less socially acceptable
  • Continue extending coverage of hepatitis B vaccination to reduce liver cancer in Africa and Asia
  • Increase production and distribution of low-cost HPV vaccinations
  • Develop vaccines against hepatitis C and Epstein Barr viruses
  • Assess benefits and harms of aspirin and other drugs to prevent cancer including best dose, duration and identify those who will be most likely to benefit and be harmed

Screening

  • Provide more balanced information to the public on benefits and risks of cancer screening
  • Do more research into which cancers (and pre-cancerous problems) identified through screening need treating – and which do not

Treatment

  • Create or strengthen national cancer plans so that resources are used more efficiently
  • Make sure new cancer therapies reach all countries as quickly as possible
  • Increase participation in clinical trials
  • Improve sharing of clinical trial data across countries by making it compulsory for researchers to register their clinical trials online, ensuring results are shared with the scientific community whether they are positive or negative, and standardising practices across the world
  • Greater financial support for trials that involve expensive procedures, address rare cancers, and involve repurposing of existing treatments
  • Pharmaceutical companies should collaborate with each other and with other organisations on trials that involve drugs produced by different companies

Data collection

  • Increase funding for cancer registries – organisations that record the number of cancer cases and deaths
  • Improve pathology – training of more pathologists who can classify different types of cancer by looking at them under a microscope

Research

  • Promote international collaboration, sharing of data, international standards for research
  • Share data on the internet
  • Promote open exchange of information including public electronic libraries
  • Oppose patenting of genes or gene mutations (which act as obstacles to cancer research)

Images via Flickr and Wikimedia Commons

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