WHO's activities in the Eastern Mediterranean Region

Newsdesk WHO’s activities in the Eastern Mediterranean Region Under Gro Harlem Brundtland, the Khanum Memorial Cancer Hospital, WHO, although generally available main emphasis of WHO's cancer- Lahore, Pakistan's leading charity in most countries, are not affordable control programme in the Eastern hospital. “Except for Karachi, no in more than 50% of the EMR. Mediterranean Region (EMR) has region in the country has got any Moreover, the lack of good quality focused on nurturing national cancer tumour registry; we are in the process cancer data hinders evidence-based programmes, according to Oussama of developing one at Lahore”, he policy formation and accurate Khatib, WHO's regional advisor for adds. assessment of cancer prevalence. non-communicable diseases. According to the 2001 global Almost 75% of countries have During the past several years, survey, there are major gaps in established cancer registries, but the WHO has provided “special technical national capacity to prevent, detect, completeness, coverage, and quality support” to Bahrain, Iraq, Jordan, and manage cancer in the EMR. of data available from these registries Lebanon, Libya, Morocco, Oman, and National cancer reference centres are vary. Several EMR countries Saudi Arabia, in order to help them fairly common throughout the including Bahrain, Cyprus, Iraq, set up their own cancer registries. region, but the services provided by Jordan, Kuwait, Oman, and Qatar This work is essential, explains have managed to establish Cancer incidence/100 000: 190·7 Ala'din Alwan, WHO Reprepopulation-based cancer registCancer mortality/100 000: 123·3 sentative in Jordan, because ries mainly because they are Cyprus Life expectancy (Years): 70·9 Afganistan "despite the paucity of accurate fairly rich and have smaller Lebanon Iran Iraq morbidity and mortality data populations than other countJordan Bahrain on cancer in the [Eastern ries in the region. However, Pakistan Mediterranean] region there is cancer data in a large Kuwait Qator enough evidence to indicate proportion of EMR countries Saudia that cancer is becoming a major are derived from hospital-based Arabia Oman public health concern in all registries. “Good progress has member countries”. been made in some countries Djibouti The EMR includes all Arab over the past decade in nations, Afghanistan, Cyprus, upgrading cancer information Djibouti, Pakistan, and Iran. Cancer registries are a priority in the EMR. systems although this remains a And in some of these countries, challenge not yet addressed in eg, Bahrain where cancer accounts for these centres vary considerably in many other member States”, Alwan about 12·2% of all deaths, cancer is terms of accessibility and quality. notes. the second or third most common Furthermore, national guidelines for Philip Salem (St Luke's Episcopal cause of death. According to Alwan, the clinical management of common Hospital, TX, USA) believes that one there are three main reasons for the cancers are available in only one third of the “major challenges for the new recent increase in cancer-related of countries. director of WHO will be [to combat] mortality: increasing tobacco use; Human resources for health tobacco epidemics”. In the EMR, higher life expectancy; and changes in are not adequately developed in the tobacco manufacturers target young lifestyle—particularly diet. Further- area of cancer control. There is an people with cigarettes that have far more, hepatitis B virus-related urgent need to fill the gap in primary- more nicotine and tar than those hepatocellular carcinoma has become care training to educate professionals available in the western countries. He a serious public-health problem in the about diagnostic techniques and suggests that “education in schools EMR because of the high rates of treatment modalities for common should be changed to incorporate “unnecessary injections” given by cancers, and to address the general health education as an integral local health workers. shortage of specialist oncologists. One component”. But despite increasing concerns, of the ways in which these problems The other challenges are “to many EMR countries still do not have could be addressed is to “use local establish effective cancer surveillance effective national control pro- resources including cancer care systems, comprehensive and feasible grammes. According to a global workers more efficiently", points out primary prevention programmes in survey done in 2001, only 50% of Andreas Ullrich, WHO Cancer most EMR countries, (addressing the EMR countries have cancer control Programme in Geneva. Such a model, major risk factors, diet and physical plans. In Pakistan, for example, one he says, was developed this year by activity), and promoting the availof the most highly populated of the WHO in Iraq and could be replicated ability of optimal standards for the EMR countries, there have been in resource poor countries in the management and palliation of several attempts to formulate national EMR. common cancers particularly in low plans in the past, but still “there is no Another important problem is the income countries”, according to concrete national cancer pro- lack of access to cost-effective Alwan. gramme”, says Zia Faruqui of Shaukat anticancer drugs, which, according to Khabir Ahmad

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THE LANCET Oncology Vol 4 January 2003

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