The global incidence of cancer is soaring due to the rapid increase in the number of elderly people in most countries By the year 2020, there will be 20 million new cancer patient each year, and 70 per cent of them will live in countries tha collectively will have less than 5 per cent of the world resources for cancer control . We have seen J explosion in our understanding of the disease at a molecu lar level and are now poised to see some very significant advances in prevention, screening and treatment.

Dramatic technological change is likely in surgery, radiotherapy and chemotherapy, leading to incrased cure rates, but at a price. The compltion of the Human Genome Project will almost certainly bring sophisticated genetic risk assessement methods reauiring careful intagration into existing screening programmes. Preventive strategies could considerably reduce the global disease burden at low cost, and palliative care to relieve pain and suffering should be a basic right of all cancer patients. The next 25 years will be a time of unprecedented change in the way in which we will control cancer. However, the optimal organization of prevention and detection programmes as well as of treatment services is a universal problem in all economic environments.

The world is in a health transition. Infection as a major cause of suffering and death is giving way to new epidemics of non-communicable disorders such as cardiovascular disease, diabetes and cancer. Different countries are in dif­ferent stages of this transition depending on their age structure and economy. Some countries are faced with a double burden, with increasing infection problems com­pounded by surging cancer rates. This is fuelled in part by the globalization of unhealthy lifestyles.

Cancer is often thought to be the problem of rich coun­tries. The 1998 World Health Organisation World Health Report life expectancy data for 1997 and the World Bank data on per capita gross national product expressed in US dollars (pcGNPS) is available for 155 countries. Cancer in Five Continents’* and the Electronic Database for Cancer provide incidence figures for 1990 and those predicted for 2020/ The incidences for men and women were analysed separately. The ratio of cancer incidence per 100000 popu­lation in 2020 to 1990 can be compared and correlated to the wealth of the population. Many relatively poor coun­tries with already inadequate treatment facilities will see an explosion in cancer incidence.

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