Questions & Answers with Dr Eva Steliarova-Foucher
Scientists from the International Agency for Research on Cancer (IARC) participated in the Lancet Oncology Commission on Sustainable Care for Children with Cancer, which brings together many global partners and calls on governments to take action to radically improve outcomes for children with cancer on a global scale. Dr Eva Steliarova-Foucher, a scientist in the IARC Section of Cancer Surveillance, leads the childhood cancer team, a project of IARC and the International Association of Cancer Registries (IACR).
What was IARC’s contribution to the report of the Lancet Oncology Commission?
We were invited to join the Commission to contribute our expertise with registration of cancers. We also contributed the background data and were involved in the development of the strategy for estimating the childhood cancer burden on a global scale.
Why has childhood cancer been neglected in the fight against cancer?
Several factors may have caused this. First, children represent a minor proportion of all cancer patients. This is probably why childhood cancer is mentioned in less than half of national cancer control plans.
Second, cancer in a child was, and in many areas still is, a deadly disease. In some cultures, this may have been perceived as a punishment and imposed a stigma on the child’s family. This fear, coupled with the unaffordable costs of care, may have led to a reluctance to seek cancer diagnosis or treatment, and childhood cancer therefore remained an unknown public health problem.
The third reason for the neglect may be related to the fact that public health measures in paediatric populations were focused on containing infections, malnutrition, and other diseases of childhood, thus relegating cancer in children to the bottom of the priority list.
Why should childhood cancer be a priority now in terms of public health?
The improved survival of children with cancer achieved in high-income countries has demonstrated that these patients can be cured and many of them can lead meaningful lives despite their diagnosis. This improvement was considerable: in the 1960s, about 20% of children with cancer survived, whereas nowadays about 80% are treated successfully. This success was driven by the dedication of professionals, international collaborations, and investments.
The report of the Lancet Oncology Commission shows how similar progress could be achieved in low- and middle-income countries. The World Health Organization (WHO) Global Initiative for Childhood Cancer is leading the call for action to improve survival in low- and middle-income countries, so that globally by 2030 at least 60% of children with cancer are cured.
How can IARC help to reduce gaps in childhood cancer care?
If we want to report progress, the improvement in childhood cancer survival needs to be measured. It needs to be measured in the whole population of children, not only among those who are correctly diagnosed, reach a hospital, and can afford treatment. This is why the Commission calls for an investment in registration of cancers in children.
Information on the number of cases in a population and on their survival is collected and reported by population-based cancer registries, but they cover less than 15% of the world’s population. There are no cancer data on the other 85% of children in the world.
The Global Initiative for Cancer Registry Development, an IARC-led programme, works with local policy-makers and professionals to help them establish a reliable and sustainable reporting system, which will show the benefits of investments in childhood cancer care.