Transcript of the Interview with Franco Cavalli on the World Cancer Report 2014

Franco Cavalli

Franco Cavalli

Basically there is nothing new in what has been presented this year in the 2014 World Cancer Report because it corresponds to the forecasts which were made years ago. What we can say is that those forecasts, alas, were correct and we are witnessing on a global scale an increase in the number of cancer cases and cancer deaths. Most probably, this year or next year, cancer is going to become the number one killer worldwide.

The message is repeated in the report I think for many reasons: the first one is, I think, that many people and professionals and most of the media do not realise that cancer is becoming mainly a problem in the developing world. In fact, in the developed world the incidence is no longer increasing or is just increasing in proportion to the increase in life expectancy, while the incidence of cancer is rapidly increasing in the developing world. This is worsening the statistical outcome because in the developing countries there is a lack of early detection possibility and a tremendous lack of therapeutic resources so that the outcome of most tumours is much worse.

Take breast cancer as an example: While we are curing here at least 70% of the cases, in the developing world the cure rate for breast cancer is somewhere between 10 and 20%. So it is important to repeat this message because, although the WHO and the UN have declared that we must decrease the mortality from noncommunicable disease by 25% by 2025 not a lot has been accomplished. So I think it is important to repeat this message that cancer rates are on the rise globally.

I think that cancer in the developing world is not yet considered a priority because, on the one side, there is still not enough pressure from the public opinion, unlike AIDS where it has been the pressure of public opinion that has convinced the governments and the G-8 and G-20 to tackle the problem of AIDS. Here in cancer, it is important to repeat the message because we do not yet have sufficient pressure coming from public opinion.

Another reason is that governments are largely unwilling to tackle the problem because cancer is a very complex problem, much more complex than AIDS, and tackling the cancer problem necessitates first of all that governments must tackle the problem of having a functioning healthcare system. Without a healthcare system you cannot tackle the cancer problem and governments are scared to get involved in improving the healthcare structure on a world wide scale because politically this is a very hot issue. And, it will take many years to reach some goals and people who are elected in governments do not think in the long term generally but just to the next election. I think it is important that we demonstrate that a lot can be done in prevention and early detection and also in treatment of cancer. Let’s think in terms of paediatric oncology where it has been demonstrated by many examples that with very few resources you can dramatically improve the situation in the developing countries; this can help to fight against this nihilistic attitude of the governments towards the cancer problem.

My opinion is that we can fight cancer on a global way with the creation of some kind of global fund for fighting cancer by different organisations like the World Bank and G-8 and so on. We need a global fund for cancer like the one that we have for AIDS. On the other side, we have enough funds to concentrate mainly on intervention and early detection to start with; we need better tools for early detection but they are becoming available. We have to fight to oblige governments to implement the anti-tobacco legislation. They should do this anyway because of the international treaty but tobacco companies do whatever they can to prevent governments from implementing what they have to do based on this international treaty. The global fund should provide to developing countries a basic package for treatment that includes some radiotherapy machines and some essential drugs for the treatment of cancer. Let’s just think of the example of Burkitt’s lymphoma in children; it costs just a few dollars of cytoxin to cure those patients. So this can be done.

I think it is important that oncologists realise, and many are realising, that we have the dramatic problem of the exploding costs of the new anti-cancer drugs which are completely out of control. This has been advocated by many important economists, for instance by Professor Stiglitz who is the Nobel Prize Laureate in economics. He has said repeatedly over the last year that the current business model for evaluating and launching new drugs, mainly in cancer but also in other areas of medicine, is no longer sustainable. It has to be considered broken; we need new models in order to have efficacious treatment but not treatment that cost a fortune a year per patient, which is becoming impossible to finance even for the richest countries in the world.

My message to fellow oncologists is, I think, quite simple: We should not think only about the patients we will see today in our clinic but we have to think of the millions of patients worldwide who desperately need better treatment, who need an affordable treatment. Mainly we should think of the hundreds of millions of persons worldwide who can be prevented from developing cancer, since we know that about 40% of cancer can be prevented if we can avoid all of the risk factors that are known today. It is our duty to not just limit our engagement to offer treatment to our patients, we must think globally.