The generic who deserves your trust

Dublin played host last week to the world’s first cancer summit. By next year...

Dublin played host last week to the world’s first cancer summit. By next year cancer is set to become the biggest killer in the world, killing more people than HIV/AIDS, TB and malaria combined. Dr John Seffrin, CEO of the American Cancer Society (ACS) spoke about the challenges facing Africa and the energy Lance Armstrong has brought to the battle.

Q: We know that in Africa people are dying of cancers that are curable in the developed world. Will the ACS be working in Africa?

A: We have a major commitment to Africa, for two reasons. Cancer is a growing problem in Africa and it is not given the attention it deserves. The continent is overwhelmed by so many other problems and we need to raise awareness that cancer needs to be addressed. If we don’t deal with it, we will see a terrible burden that the continent can hardly afford.

Secondly, there are relatively low prevalence rates in Africa, but high growth of the cancer burden. Africa offers us our first chance to get ahead of cancer, but we need to help to build civil society and get the activists going. By doing this we can prevent what would be huge suffering.

Q: Now that we have identified cancer as a growing problem in Africa, what can be done?

A: There are important things that need to be done. We need to work on health promotion for people who don’t have cancer. Then we also need to work out how we deal with people who have late stage disease. In Africa there is poor to absent palliation and that needs to be addressed. Unlike the new drugs for cancer therapy which are expensive, analgesics that offer pain relief are relatively inexpensive. There is so much we can do very quickly and these are things that wouldn’t take years to change. In Africa many patients are presenting with late stage disease so we need to ensure that these patients are treated with dignity and compassion. Dying from cancer does not have to be traumatic in every sense of the word – it’s much harder to die with dignity if you have dementia for example than it is if you have terminal cancer. We know what to do, we need to do it. There are so many things we can do now. Earlier we didn’t have the knowledge and technology to make major inroads. Now we are able to help in the worldwide fight against cancer, build capacity and provide assistance.

Africa doesn’t have to be the “lost continent” – it can show the way on how to deal with non-communicable diseases, especially cancer, even though it is a tall order to fill.

Q: Cancer has been identified as the biggest killer disease by 2010, why is it not part of the Millennium Development Goals?

A: We are in discussion with World Health Organisation officials and they are absolutely committed to having non-communicable diseases and cancer in particular as part of the MDGs. We need to sound the alarm to the rest of the world that this is a problem that every nation will face. The magnitude of the problem is unknown in the world – cancer will kill more people than HIV/AIDS, TB and malaria combined.

If we address it the reduction in human suffering and the saving of lives will be massive. The economic spin-off of people staying alive will be huge. Most people can live a normal lifespan and not get cancer. Cancer has always been associated with age, but it has already become the leading cause of death among people in their mid-life. The cost of care and loss of productivity is huge, so there are tremendous economic incentives to address cancer.

Q: Does it sometimes frustrate you that so much energy and so many resources have to be found to fight the tobacco industry which is selling a product that is clearly so damaging?

A: I wonder what we would do if the world started selling a lethal cocktail that infected people with HIV? We need to make people aware that the promotion of tobacco is an act of violence. 250-million children will eventually be killed by tobacco. We need to rethink what we are willing to tolerate. Just as we say we won’t for example tolerate landmines, we need to similarly not tolerate an industry that is addicting children. It’s hard to understand that we sometimes have this laissez-faire attitude to tobacco while we are intolerant of hard narcotics.

Q: Do we need similar activism in cancer that we have in HIV/AIDS?

A: I believe that we need activism, but there are some differences and the tactics and methods may need to be adapted. We will not and we cannot solve the problem without more aggressive advocacy. Our research has shown that there are major things that need to happen for us to make an impact and each one of them require significant advocacy. Of course we also need to increase the amount and the variety of research we do, we need to elevate prevention into public policy and we need to provide access to quality healthcare everywhere. We need to push cancer higher up on the agenda.

Q: You have worked in cancer for many years, how has the landscape changed?

A: When ACS started cancer was a death sentence. We have many problems in the world today – global terrorism, HIV/AIDS, poverty, global increases in obesity – to mention a few. I do not know anyone who can assure us on how to solve these problems. However, we know of things we can do to address cancer. We also know what will happen if we don’t intervene. We know if we do act we can bring the death rates down and in large populations we can bring it down rather dramatically. However, in our world we see huge differences in terms of the length and quality of people’s lives. For example in Russia the life expectancy today is much less than it was 15 years ago, so we need to raise the sense of urgency. The global population is ageing everywhere, we are all getting older which means there is a much higher risk of non-communicable diseases, in particular cancer.

So, those making the decisions can ask what the returns are on their investments and I can assure you that an investment in cancer delivers a high yield and low risk. It has been shown that there will be a return on the investment. This is a very different picture from when my career started. We had no cures then, now we do.

Q: Why is a cancer summit such as this one in Dublin so important?

A: People are given the opportunity to come and learn and share about best practice. We are bringing together a diversity of delegates – survivors, public health specialists, non-governmental organizations and so on. We have a global presence of 64 countries. We come from this meeting with a better understanding of how we can work together and collaborate. This summit could go down in history as being the moment where everyone came together and created a true global movement around cancer.

Q: What has someone like Lance Armstrong brought to cancer?

A: He has brought many good things to the movement. He is the personification of the hopeful side of cancer. Here is a man who had a very advance stage of disease. When I was in college, 90% of cases similar to his would have been fatal. Now 90% are curable, even at an advanced stage. Lance Armstrong is more than a cancer survivor, he is a cancer thriver. To be that ill and go through a near death experience and then go on to become a world champion – that makes a huge statement. Because of his story we are seeing a growing number of people who come through the cancer experience and achieve things they would not have achieved otherwise.

Having cancer is a life changing event. I think it has something to do with people knowing that this is the real deal. It’s about knowing that every cancer has the potential to kill you.

* ACS is the world’s largest voluntary health organisation fighting cancer.