|
Chairman,
Distinguished
Members of the Governing Council,
Ladies and
Gentlemen,
It gives me great pleasure to join you for this
part of the 42nd session of the Governing Council and to be able to
address you after another year of achievement by IARC. It has been a
year characterized by excellent collaboration between the various
units in the Agency and the cancer control programme at WHO
Headquarters.
Noncommunicable diseases, including cancer, are
increasing worldwide. To respond to this growing challenge, WHO has
given cancer control a higher priority in its programme of work and in
technical collaboration with countries.
Last year, I spoke of the development of the global
strategy for noncommunicable diseases prevention and control.
Immediately after the last session of your Council in May 2000, the 53rd
World Health Assembly endorsed the strategy and passed a resolution
supporting WHO in intensifying its work in this area. It also urged
Member States to develop effective national programmes, and
highlighted the need to strengthen global partnerships to implement
the strategy.
The strategy puts emphasis on the rising impact of
cancer in low- and middle-income countries and the disproportionate
suffering it causes in poor and disadvantaged populations. We know the
incidence and survival of cancer are influenced by socio-economic
status in both industrialized and less-developed countries. People in
the lower income bracket tend to have higher cancer incidence and
poorer cancer survival than those in the higher income bracket.
Some of the differences in cancer incidence can be
explained by known risk factors, such as tobacco smoking, occupational
exposures, reproductive behaviour, diet and chronic infections. The
social class differences in cancer patient survival may be explained
by the fact that cancers in higher social classes are more frequently
diagnosed at an early stage and have access to better treatment.
This should be a major concern for all of us as we
influence research and decision-making. We should promote a clear
understanding of these social inequalities. We should push the
development of effective measures to deal with this inequality in our
work with Member States.
WHO is committed to promoting national cancer
control programmes as the most effective national-level strategy for
reducing morbidity and mortality from cancer and improving quality of
life of cancer patients and their families. We know enough to prevent
at least one-third of all cancers. We can cure a further one-third of
cancers by early diagnosis and effective therapy, and we can control
pain and other symptoms with good palliative care.
Advances in prevention, early detection, and
treatment are outcomes of research and development.
However, to translate existing knowledge into
effective cancer control programmes, health services and behavioural
research must also be important elements of our research. We need to
determine the best way to organize clinical services and to improve
the participation, compliance and responsiveness of the public and
health professionals to different control measures.
Providing technical support to Member States in
cancer control is an increasingly important function of WHO. Our
experience in cancer control is building up. In December 2000, WHO
reviewed the progress of the national cancer control programmes
strategy launched by WHO some 8 or 9 years ago. Based on experience
gained from Member States and our collaboration with other partners,
the meeting discussed the strengths and constraints of the strategy
and began the process of updating the WHO publication on National
Cancer Control Programmes. The participation and contribution of IARC,
IAEA and UICC was vital to the success of this initiative. We plan to
launch the new edition of this publication, jointly with the
International Union Against Cancer, during the 18th
International Cancer Congress, which will be held in Oslo in July
2002.
The Noncommunicable Diseases and Mental Health
Cluster in WHO has more recently held two important consultations on
screening. One was on screening for noncommunicable diseases. Its
focus was on the general principles of screening for cardiovascular
diseases, cancer and diabetes. The second consultation was done on
Cervical Cancer Screening. In both consultations staff from IARC were
prominently represented. The evidence presented during these
consultations clearly showed that some screening approaches can be
recommended for policy development now while others need further
research because their effectiveness is not yet proven.
A number of significant conclusions were
highlighted by the consultations. It was emphasized that screening
tests are not accurate enough to guarantee the expected reduction in
mortality. Programmatic issues should be carefully taken into account
to ensure a high level of compliance to screening. There should be
good quality control and prompt referral for diagnosis and treatment
of patients with abnormal tests. Concerning cervical cancer, the main
conclusions were that middle income countries which are screening
using cytology, should be re-organizing their programmes, because
current methods are considered ineffective. There were also areas
where more work has to be done. New approaches, such as visual
inspection with acetic acid (VIA) as an alternative to cytology
screening in low resource settings and HPV testing as primary
screening, cannot be recommended for policy development as their
effectiveness has not yet been proven.
Chairperson,
Ladies and Gentlemen,
The present and potential burden of tobacco-induced
cancer is such that every country should give high priority to tobacco
control in its fight against cancer. Tobacco use in all forms is
responsible for about 30% of all cancer deaths in developed countries
and a rapidly rising proportion in developing countries and in
underprivileged communities.
In addition to the obvious health impact on tobacco
users themselves, second-hand smoke or environmental tobacco smoke or
ETS is a very serious form of indoor air pollution. Non-smokers
breathe in the same toxic chemicals as the smokers do, with similar,
although smaller effects. In the US, second-hand smoke causes about
3,000 lung cancer deaths a year, compared to less than 100 lung cancer
deaths per year from traditional forms of outdoor air pollution.
Second-hand smoke also causes and aggravates asthma and other
breathing problems, particularly in children. It is also an important
cause of sudden infant death syndrome. While most discussion about
second-hand smoke have concentrated on lung cancer and breathing, the
effects on heart disease are even larger.
Supported by two decades of evidence, the
scientific community now agrees that there is no safe level of
exposure to second-hand smoke. WHO is strengthening its efforts to
raise awareness of environmental tobacco smoke and protect non-smokers
from its damaging effects. The World No Tobacco Day this year is
sending a strong message on "Second-hand smoke" to warn the
world about this real and significant threat to our health. Major
events are planned around 31 May in Geneva, New York, Osaka and
Tokyo.
While the tobacco industry continues to claim that
the evidence that second-hand smoke causes disease - particularly lung
cancer- is controversial, independent authoritative scientific bodies
have concluded that second-hand smoke causes many diseases. When the
tobacco company officials became aware that IARC was conducting, in
the early 1990s, a large-scale European epidemiological study on the
relationship between ETS and lung cancer, company officials feared
that the study results could accelerate restrictions on consumption.
From 1993 until the release of the IARC report in 1998, the tobacco
companies commissioned studies and held conferences designed to cast
doubt on the toxicity of environmental tobacco smoke and on the
methods used in the study. Media campaigns that were developed then to
undermine the message that passive smoking kills, continue today.
I commend IARC on the decision to undertake a
review of the 1987 environmental tobacco smoke monograph and can
assure you of our strongest support.
Modifying diet is another important approach to
cancer control. In recent years, substantial evidence has shown a high
consumption of fruits and vegetables has a protective effect against
many cancers, and conversely, excess consumption of animal products,
including red meat and dietary fat can cause certain cancers.
Moreover, eating habits that may inhibit the development of
diet-associated cancers will also lower the risk of cardiovascular
disease. The European Prospective Investigation into Nutrition and
Cancer conducted by IARC is an important initiative in this field. We
will follow-up closely the results of the investigations that will
help us clarify the role of dietary components in the occurrence of
cancer among the European populations.
Since other common noncommunicable diseases share
the same lifestyle-related risk factors, action to prevent cancer
should focus on controlling these risk factors in an integrated
manner. This is one of the strategic directions of the global strategy
for the prevention and control of noncommunicable diseases. It
requires joint work and close coordination with programmes for the
prevention of other related noncommunicable diseases, mainly
cardiovascular diseases, chronic obstructive pulmonary diseases and
diabetes. The structure and mechanisms necessary to make this work
will vary from one country to another according to the epidemiological
situation, disease control priorities, available resources and
existing initiatives.
We need to intensify partnerships for cancer
prevention and control if we are to reverse the rising trends of this
disease. By working together we can bring our collective knowledge and
experience to bear.
Finally, let me again express my appreciation for
the Agency’s achievements during the last year – the support of
cancer registries, the important contributions in the fields of cancer
epidemiology, environmental causes of cancer, promoting knowledge on
carcinogenesis, and prevention and early detection of cancer. Let me
also thank Dr Kleihues for his excellent work here in IARC, as well as
his very helpful participation in the global management team of WHO.
I look forward to the outcome of the 42nd session
of the Council. You have a full agenda ahead of you and I wish you a
productive meeting and an enjoyable stay in Lyon.
Thank you. |
