IARC Latin America Collaboration Meeting Statement
Leaders of national cancer centres from 16 Latin American countries and representatives of regional and international partners (see list below) met in Lyon on 26 and 27 March 2012 under the initiative of the International Agency for Research on Cancer (IARC), to discuss the current status of research on cancer prevention and control in the region.
The aim of the meeting was for IARC to consult with the partners in Latin America to jointly identify priorities for action and develop a coordinated trategy for collaborative research.
Countries in Latin America face some of the greatest challenges in the fight against cancer. The latest figures show a projected increase in the number of new cancers in the region from 875 000 per year in 2010 to 1.5 million by 2030. Left unchecked, the combined effects of demographic change and rising incidence rates, due in part to the increasingly westernized lifestyles associated with socioeconomic changes, together with the rising costs of cancer care, would place an overwhelming strain over the next decades on the health programmes of most countries in the region.
In response, a number of Latin American countries are taking the lead globally on the prevention of cancer, through the development of health care infrastructures, the implementation of population-wide public health policies and programmes (e.g. tobacco control measures, cancer screening, HPV and HBV vaccination), and the establishment of national and regional networks for the coordination of these initiatives, such as the recently created Latin American network of national cancer institutes (“Red de Institutos Nacionales de Cáncer” – RINC/UNASUR).
The participants recognize the central role of research in providing the evidence base for effective strategies for cancer prevention and control. The development of a coordinated programme of research and training is an essential component to support government planning in the context of the political agenda that resulted from the UN General Assembly high-level meeting on the “Prevention and control of non-communicable diseases” in September 2011.
The participants welcomed the initiative of IARC in setting up this consultation meeting. The resulting closer collaboration with national and regional structures will maximize the effectiveness of the Agency’s research strategy, through its alignment and integration with the needs and priorities for cancer prevention and control in Latin America.
A number of key immediate priorities were identified:
- Cancer Registration
Support, on both a technical and advocacy level, for the development of a regional network of cancer registries, including both population- and hospital-based registries; the Agency’s Global Initiative for Cancer Registry Development in Low- and Middle-Income Countries (GICR – http://gicr.iarc.fr/) is already coordinating activities with the working group on cancer registries of RINC. Obtaining resources to launch a regional hub to support the operation of cancer registries and related training should be a top priority for the immediate future. The meeting expressed its support for IARC playing a central role in assisting the development of cancer registration activities in the region.
- Cancer Screening
Need for technical and scientific support for the design, implementation, quality assurance, and evaluation of appropriate screening programmes for breast, cervical, and other relevant cancers. The IARC Handbooks on Cancer Prevention evaluate the existing evidence for cancer prevention strategies and develop internationally agreed guidelines and evidence-based recommendations for best practices; an IARC Handbook evaluating the evidence on screening methodologies and setting out guidelines for quality assurance in the implementation and evaluation of cancer screening programmes should be a priority in support of the cancer prevention activities in the region.
- Cancer Etiology
Expansion of the multicentre study of premenopausal breast cancer in Latin American women – the PRECAMA study – currently in its pilot phase involving centres in Brazil, Chile, Colombia, Costa Rica, and Mexico; the objective is to compare specific molecular cancer subtypes in relation to risk factors (diet, physical activity, obesity, and metabolic disorders) and prognosis. There was strong support for the expansion of this study to include centres in other countries.
Expansion of the multicentre study of the molecular epidemiology of head and neck cancer onset and outcome in Latin America – the InterCHANGE study – launched in 2011 and currently involving several centres in Brazil and one in Argentina. Again, there was strong support for the possibility of expanding this platform to other countries.
- Cancer Prevention
Evaluation of current and novel prevention strategies for infection-related cancers of importance in the region, such as cervical and stomach cancer; a specific priority in this area was the investigation of the safety and immunogenicity of alternative schedules for human papilloma virus (HPV) vaccination, including testing the effectiveness of two doses and of vaccinating children instead of adolescent girls to allow the inclusion of HPV vaccine in childhood vaccination programmes.
The growing burden of prostate cancer and the absence of primary and secondary prevention strategies for this highly prevalent cancer in many Latin American countries were noted. Another priority was the prevention of cancers related to occupational exposures.
- Education and Training
Development of joint training initiatives to build a solid base of cancer researchers in the region, particularly in the areas of cancer registration, epidemiology, and prevention was supported. The need for a flexible programme which recognized the frequent need to combine clinical and research duties was noted. The importance of developing distance-learning was emphasized.
Finally, there was strong support for the establishment of a close partnership between the Agency and RINC in order to support the cooperation between the various organizations and promote the integration of IARC’s activities in Latin America with national and regional initiatives.
The Director of IARC, Dr Christopher Wild, speaking at the end of the meeting, said: “This has been an excellent opportunity for our Agency to listen to the priorities of colleagues in Latin America and to plan how to work side by side in future to reduce the burden of cancer falling on people across the region. The UN political declaration in 2011 on non-communicable diseases represents an historic moment, opening wide a window of opportunity to cancer leaders. We need to be bold in applying our professional expertise and opinion to support the political agenda. In this respect, I have been greatly impressed by the commitment expressed and the determination to bring about change through leadership from within Latin America.”
Dr Wild announced the allocation of $100 000 by IARC over the next two years to support the strengthening of collaborative activities in the key priority areas jointly identified at the meeting. An evaluation of the progress in the above-mentioned priority areas would be valuable in two to three years.
List of countries and partners participating:
Argentina, Bolivia, Brazil, Costa Rica, Chile, Colombia, Cuba, Ecuador, Guatemala, Honduras, Mexico, Panama, Paraguay, Peru, Uruguay, and Venezuela. Representatives from the Union for International Cancer Control (UICC), the World Health Organization, the Pan American Health Organization (PAHO), and the Center for Global Health of the US National Cancer Institute (CGH) attended as observers.