Essential drugs for cancer therapy: a World Health Organization consultation.

The WHO has previously produced recommendations on the essential drugs required for cancer therapy. Over the last five years several new anti cancer drugs have been aggressively marketed. Most of these are costly and produce only limited benefits. We have divided currently available anti-cancer drugs into three priority groups. Curable cancers and those cancers where the cost-benefit ratio clearly favours drug treatment can be managed appropriately with regimens based on only 17 drugs. All of these are available, at relatively low cost, as generic preparations. The wide availability of these drugs should be the first priority. The second group of drugs may have some advantages in certain clinical situations. Based on current evidence, drugs in the third group are judged as currently not essential for the effective delivery of cancer care. Adequate supportive care programmes with the widespread availability of effective drugs for pain control are of considerably greater importance. The adoption of these priorities will help to optimise the effectiveness and efficiency of chemotherapy and ensure equitable access to essential drugs especially in low resource environments. Clearly this paper represents the views of its contributors. The WHO welcomes feedback from all oncologists so that the advice it gives to governments in prioritising the procurement of anti cancer drugs can be as comprehensive as possible.

El tamoxifeno para el control del cáncer de la mama en el mundo / Tamoxifen therapy in breast cancer control worldwide

En la mayor parte de los países desarrollados y en muchos países en desarrollo, el cáncer de la mama es la neoplasia más frecuente y la principal causa de muerte por cáncer entre las mujeres. No obstante, por lo menos el 50 por ciento de todas las pacientes que hay en el mundo con cáncer de la mama sobrevivirán más tiempo si la población tuviera una mayor conciencia del problema, si se incrementara la detección temprana del trastorno y si se emplearan más tratamientos eficientes de comprobada utilidad. En la etapa temprana en que el cáncer de la máma esta localizado, el tratamiento local combinado con un tratamiento hormonal coadyuvante con tamoxifeno, que es un estrógeno sintético, podría salvar la vida de seis de cada 100 mujeres, en comparación con el tratamiento local exclusivo. El tamoxifeno tiene efectos antiestrogénicos no solo en las células mamarias cancerosas, sino también en el metabolismo hepático y el tejido óseo, con la consiguiente disminución de los factores de riesgo de enfermedades óseas y trastornos vasculares crónicos. El tratamiento prolongado con tamoxifeno tiene efectos clínicos adversos de importancia en menos de 5 por ciento de las mujeres; se producen síntomas menop—sicos y vasomotores en la mayoría de las pacientes tratadas, pero su gravedad disminuye con el tiempo. El tamoxifeno se está considerando como tratamiento estándar y se ha incluido en la lista de medicamentos esenciales de la OMS para el tratamiento del cancer de la mama en países desarrollados y en desarrollo. Para que el control del cáncer mamario tenga más éxito en todas partes, uno de los desafíos es lograr que el tamoxifeno esté al alcance de un mayor número de mujeres

El tamoxifeno para el control del cáncer de la mama en el mundo / Tamoxifen therapy in breast cancer control worldwide

En la mayor parte de los países desarrollados y en muchos países en desarrollo, el cáncer de la mama es la neoplasia más frecuente y la principal causa de muerte por cáncer entre las mujeres. No obstante, por lo menos el 50 por ciento de todas las pacientes que hay en el mundo con cáncer de la mama sobrevivirán más tiempo si la población tuviera una mayor conciencia del problema, si se incrementara la detección temprana del trastorno y si se emplearan más tratamientos eficientes de comprobada utilidad. En la etapa temprana en que el cáncer de la máma esta localizado, el tratamiento local combinado con un tratamiento hormonal coadyuvante con tamoxifeno, que es un estrógeno sintético, podría salvar la vida de seis de cada 100 mujeres, en comparación con el tratamiento local exclusivo. El tamoxifeno tiene efectos antiestrogénicos no solo en las células mamarias cancerosas, sino también en el metabolismo hepático y el tejido óseo, con la consiguiente disminución de los factores de riesgo de enfermedades óseas y trastornos vasculares crónicos. El tratamiento prolongado con tamoxifeno tiene efectos clínicos adversos de importancia en menos de 5 por ciento de las mujeres; se producen síntomas menopáusicos y vasomotores en la mayoría de las pacientes tratadas, pero su gravedad disminuye con el tiempo. El tamoxifeno se está considerando como tratamiento estándar y se ha incluido en la lista de medicamentos esenciales de la OMS para el tratamiento del cancer de la mama en países desarrollados y en desarrollo. Para que el control del cáncer mamario tenga más éxito en todas partes, uno de los desafíos es lograr que el tamoxifeno esté al alcance de un mayor número de mujeres

Publicado en inglés en el Bull. WHO Vol. 71(6), 1993

Tamoxifen therapy in breast cancer control worldwide.

In most developed and many developing countries, breast cancer is the most frequent cancer and the leading cause of cancer death among women. At least 50% of all breast cancer patients worldwide would survive longer, however, if public awareness about and early detection of the condition were increased and greater use were made of efficient treatment of proven value. With early-stage, localized breast cancer, local treatment combined with adjuvant hormonal therapy with tamoxifen, a synthetic estrogen, could save the lives of 6 women out of 100 compared with local treatment alone. Tamoxifen has anti-estrogenic effects not only on breast cancer cells but also on liver metabolism and bone, with concomitant decreases in risk factors for chronic skeletal and vascular system diseases. Long-term tamoxifen treatment causes major adverse clinical effects in < 5% of women; menopausal and vasomotor symptoms occur in the majority of treated women, but their severity lessens over time. Tamoxifen is being considered as a standard therapy and is included in the WHO list of essential drugs for the treatment of breast cancer patients in both developing and developed countries. For the control of breast cancer more successfully worldwide, one challenge is to make tamoxifen therapy available to greater numbers of women.

The control of breast cancer. A World Health Organization perspective.

The greatest decrease in breast cancer mortality is likely to derive from applying globally existing therapies at an earlier stage. A high priority of the World Health Organization (WHO) cancer control program is the outreach approach that promotes worldwide access to cancer therapies of proven values. Therefore, the first priority in national health programs for breast cancer is to encourage patients to present for diagnosis and treatment at an earlier stage of the disease. In the development of guidelines for the early detection of breast cancer, the WHO emphasizes the importance of appropriate widespread coverage of high-risk groups as opposed to repetitive screening of low-risk groups, so that early detection will be effective. A WHO/USSR controlled trial of breast self-examination and community-based adjuvant therapy is helping to develop the WHO global recommendations for the control of breast cancer. Depending on the extent of the breast cancer problem, the local resources, and the cultural situation, national health strategies should include all three main elements--public education, early detection, locally available treatment, or a combination of these to a national comprehensive program for the control of breast cancer.

Cancers of the stomach, lung and breast: mortality trends and control strategies.

Mortality trends for the three most common tumours--stomach, lung and breast cancer--were evaluated for nine countries. Stomach cancer is decreasing sharply and consistently in the countries studied. However, virtually all of this decline can be attributed to improvements in food preservation techniques and the resulting change in diet, rather than any action of the medical community. Lung cancer is rapidly increasing in most countries, especially in women, and is likely to become the dominant cancer worldwide by the end of this century. So far, only comprehensive tobacco-control programmes in the United Kingdom and Finland have succeeded in reversing the upward trend in lung-cancer mortality. Breast-cancer death rates are generally rising, although some recent, but probably short-term, declines have been seen. Effectiveness of the currently available approaches for each of the common cancers is summarized in Table 1. Because about half of worldwide mortality from cancer occurs in developing countries and resources in these countries are severely limited, care needs to be taken in the selection of proper priorities (18). The most effective tool we have at this time to deal with these tumours is the control of tobacco for the prevention of lung cancer. Comprehensive national programmes, consisting of legislative and education measures, are needed. The greatest decrease in breast-cancer mortality is likely to be the result of early detection and prompt treatment of the disease; public awareness of the value of early detection is an important factor here. Fortunately, mortality from stomach cancer is decreasing on its own, as little can be done to control this disease otherwise.(ABSTRACT TRUNCATED AT 250 WORDS)

Women and cancer.

PIP: The primary cause of death in women in the world is cancer. In most developing countries cancer of the cervix is the most prevalent cancer. Breast cancer has this distinction in Latin America and the developed countries of North America, Europe, Australia, and New Zealand. It is also the most prevalent cancer worldwide. The most common cancer in Japan and the Soviet Union is stomach cancer. Effective early detection programs can reduce both breast and cervical cancer mortality and also the degree and duration of treatment required. In Iceland, cervical cancer mortality declined 60% between the periods of 1959-1970 and 1975-1978. Programs consist of mammography, physician breast and self examination, and Pap smear. The sophisticated early detection equipment and techniques are expensive and largely located in urban areas, however, and not accessible to urban poor women and rural women, especially in developing countries. Tobacco smoking attributes to 80-90% of all lung cancer deaths worldwide and 30% of all cancer deaths. Passive smoking increases the risk of lung cancer to 25-35% in nonsmokers who breathe in tobacco smoke. Since smoking rates of women are skyrocketing, health specialists fear that lung cancer will replace cervical and breast cancers as the most common cancer in women worldwide in 20-30 years. Tobacco use also contributes to the high incidence of oral cancer in Southern and South Eastern Asia. For example, in India, incidence of oral cancer in women is 3-7 times higher than in developed countries with the smoking and chewing of tobacco in betel quid contributing. Techniques already exist to prevent 1/3 of all cancers. If cases can be discovered early enough and adequate treatment applied, another 1/3 of the cases can be cured. In those cases where the cancer cannot be cured, drugs can relieve 80-90% of the pain.^ieng

Bladder cancer: approaches to prevention and control.

Bladder cancer is the twelfth most common cancer globally, with approximately 170 000 new cases each year; a third of these cases are in the developing countries. There are two major etiological types. The first is more common in the industrialized countries and is associated with exposure to certain occupational and environmental carcinogens, but most importantly with tobacco smoking. The second type is associated with Schistosoma haematobium infection of the urinary tract and is one of the most frequent tumours in eastern Mediterranean and African countries. Both types of bladder cancer are largely preventable. Comprehensive education and legislative approaches are recommended to reduce tobacco consumption and exposure to industrial carcinogens. Safe and effective drugs are available to treat schistosomiasis within integrated control programmes in endemic areas.