Developing a global strategy for cancer (Reprinted from Eur J Cancer, vol 35, pg 24-31, 1999)

Over the next 25 years there will be a dramatic increase in the number of p eople developing cancer. Globally, 10 million new cancer patients are diagn osed each year and this will be 20 million by the year 2020. Cancer is now the public's most feared disease. Billions of dollars are spent annually on cancer research by the drug industry, cancer charities and governments, bu t a cure for cancer appears elusive. And yet, we are in the midst of a revo lution in our ability to image parts of the body, painlessly and in fine de tail. We also now understand the intricate workings of the human genome-ult imately responsible for controlling all biological processes in health and disease. By the year 2003 the entire DNA sequence of the human genome will be determined. Powerful computer networks will allow detailed comparisons o f genetic structure, so identifying new risk factors. Gene chips will detec t minute code changes of considerable relevance. Novel screening technologi es will allow us to detect just a few cancer cells in a patient. Roboticall y guided destructive processes will target abnormal cells in patients long before any cancer-related symptoms develop. And all this is likely by the f irst quarter of the next century. How are people, society and healthcare sy stems going to deal with these tremendous technological advances for cancer ? Detailed information will be available in every home through easily under standable computer links. Choices now made by professionals will be equally understandable to all. Public education on health will be strengthened all owing a more critical and realistic assessment of media reports on new tech nologies. But as technology becomes more complex, the gap between the globa l rich and poor could widen. The export of unhealthy lifestyles-cigarette s moking, dietary habits and sedentary occupations will disproportionately in crease cancer in many developing countries, which can least afford the trea tment costs. The WHO Cancer Programme is developing a strategy to identify priorities in cancer prevention, detection and treatment in a wide range of epidemiological and economic settings. (C) 1999 Elsevier Science Ltd. All rights reserved.