By Charlene Porter
IIP Staff Writer
12 September 2011
Washington — Cancer takes 8 million lives a year, and it’s gaining, expected to reach a global death toll closer to 12 million by 2030. But medical researchers in the United States and Latin America are combining their efforts to solve some of cancer’s mysteries and save lives.
In 2008 the Office of Latin American Cancer Program Development (OLACPD) at the National Institutes of Health (NIH) began working with Latin American governments to jointly pursue cancer research programs. One of the first projects getting under way is focusing on breast cancer, a leading killer of women in the United States and Latin America.
Breast cancer presents itself in four different subtypes, scientists discovered a few years ago in research focused on U.S. women alone. They found further that the likelihood of the appearance of one subtype versus another is different in white women versus African-American women.
The subtypes also “respond differently to hormonal treatment or chemotherapy,” said Dr. Jorge Gomez, director of OLACPD, in an interview. “So survival, depending on the subtype, is also different.” If doctors match the right treatment to the right subtype, they cure more cancers and save more lives.
A systematic and standardized assessment of the occurrence of the cancer subtypes among Latin America’s ethnic and national female groups has never been done, and OLACPD is beginning that study now.
“We are recruiting patients from three countries: Mexico, Argentina and Uruguay,” said Gomez. The researchers will also soon begin searching for cancer patients in Chile and Brazil to participate. The research will involve a pool of up to 3,000 women who will be monitored for five years. Patients who participate in the study will be diagnosed using a standardized method to ensure consistency of findings across their various nationalities. Once an accurate diagnosis is made, and the subtype of each woman’s cancer is identified, treatment will begin. The patients’ doctors will still take the leading role to identify the best course of treatment for each woman. Physicians will also make treatment decisions with the benefit of U.S. findings about how the diagnosed subtype for each woman’s cancer might respond to surgery, chemotherapy or hormonal treatment.
Gomez emphasizes the importance of the Latin American physicians’ role in the treatment of the women and through all stages of the research. Cultural differences in how treatments may be received or how patients might respond can be significant, he says, and local sensitivities on those matters must be factored in to all decisionmaking. That way, all the partners in international research collaborations can maintain a sense of ownership of results of the work, he says.
The results of this work should allow significant progress in fighting and curing cancer in both the United States and Latin America. Hispanic women from many different nations are members of the largest minority group in the United States, and understanding how cancer develops in their countries of origin should improve cancer treatment rates throughout the hemisphere.
An earlier research collaboration involving U.S. and Costa Rican scientists demonstrates how productive international partnerships can be. The study tested a vaccine developed by GlaxoSmithKline for its effectiveness in preventing cervical cancer, both its incidence and its mortality rate. Ongoing evaluation of the patients who used the vaccine proved it was effective, helping not just the subjects in the study, but all women at risk for this form of cancer.
The vaccine “is now part of the system of health in the United States and has been incorporated into basic health plans and benefits,” said Gomez.
U.N. FOCUSES ON NCD’S
The OLACPD collaboration with Latin American researchers comes at a time of growing international concern about cancer and other noncommunicable diseases (NCDs) such as diabetes and cardiovascular and respiratory diseases. While international health partnerships in the past have focused largely on contagious diseases such as HIV/AIDS, malaria and polio, NCDs are really the world’s greatest killers, accounting for 63 percent of all deaths worldwide, according to the World Health Organization (WHO).
The U.N. General Assembly convenes a special session on NCDs September 19–20, and one of its principal objectives will be to promote more collaborations like that of OLACPD.
Dr. Roger Glass will attend the upcoming UNGA session in his role as director of the Fogarty International Center at NIH. The center has a 40-year history of arranging international research partnerships, and with the OLACPD example, he explained how collaboration can improve results.
“They’ll [adhere to] the same ethical and laboratory standards,” Glass said, “so we can actually use global health research to address common problems faster, better and less expensively through these collaborations than we can if we only work on them ourselves.”
The U.N. General Assembly Special Session on Noncommunicable Diseases is only the second session to be devoted to a health issue. The first was a 2001 special session on HIV/AIDS that acted as a catalyst in stirring international recognition of the disease threat.
Gomez is hopeful the upcoming session will produce a similar result and convince governments to become more aggressive in dealing with cancer in their populations.
“It’s very important to have these programs coordinated worldwide to help us control, prevent and treat the disease at the earliest stage possible,” said Gomez. “That would save a lot of lives.”
The global cost of NCDs from 2005 to 2030 is estimated at $35 trillion, according to a World Bank study, but governments have a chance to save lives and reduce costs by creating greater awareness about the lifestyle choices that are risk factors for NCDs: tobacco use, unhealthy diets, physical inactivity and alcohol abuse. If these major risk factors were eliminated, calculates WHO, about 75 percent of cardiovascular disease and Type 2 diabetes would be prevented, and 40 percent of all cancers would be prevented.