International Affairs: My Annual Meeting

International Affairs: My Annual Meeting

George W. Sledge, MD, FASCO

Jun 08, 2011
Well. I have completed my year as ASCO President, as of Monday, and now get to return to obscurity. Or, as one of my colleagues told me, surveying my palatial digs in the Conrad Hilton Suite, "Next year, Motel 6 in Skokie, George." No doubt. But this year I had the opportunity to lead the world's greatest society of cancer professionals through its Annual Meeting, and it is on this that I would like to share some thoughts with you.

I would like to start, in this post, with international affairs. Though we are the American Society of Clinical Oncology, some 30% of our membership comes from outside the U.S., and more than half of those joining us in Chicago travel here from other countries. This year I participated in two joint sessions with sister societies that dealt with the international cancer problem. The first was the joint ASCO/ESMO symposium, which I chaired with Professor David Kerr, the current ESMO president. David had hosted me in Milan for a joint session at their meeting, so it was a very real pleasure to return the favor.

Our joint symposium focused on the problem of cancer in low- and middle-income countries. The speakers included Peter Boyle, a distinguished cancer epidemiologist; Jan Agosti of the Gates Foundation, who has a special interest in HPV-induced cervical cancer; and Henry L. Chan of Hong Kong, an expert in Hepatitis B vaccination and hepatoma. First, the bad news: we will see a huge increase in cancers in low- and middle-income countries over the next few decades. These countries simply have not devoted the resources needed to save the lives of cancer patients. In some cases, this is because they are desperately poor; and in some cases, it is because they are mismanaged by petty tyrants busy filling their Swiss bank accounts. But in either event, the end result is a rising tide of cancer deaths. In my presidential address I quoted a number of 12 million cancer deaths worldwide by 2030, but Peter Boyle suggested in his talk that the real number could easily be 50% higher.

One fascinating aspect to cancer in the developing world is the high percentage of cases with a viral etiology, in particular HPV-induced cervical cancer and hepatitis B-induced hepatoma. The good news is that these both have solutions particularly in the form of population-based vaccinations. What impressed me about the presentations of Dr.'s Agosti and Chan is the necessity of taking a long view when one is considering the effect of these vaccinations. For instance, hepatitis B vaccinations administered in the past decade or so to newborns in Asia will have their greatest effect on hepatoma incidence somewhere around 2040. You have to be in this for the long haul, which means you need either government infrastructure or the laser-like focus and deep pockets of the Gates Foundation.

The second international affairs symposium I participated in was the joint UICC/ASCO symposium, with current UICC chair (and ASCO board member) Eduardo Cazap. The UICC differs from ASCO and ESMO in that it is an organization of organizations rather than an organization made up of individual members. ASCO, for instance, is a proud UICC member. Our joint symposium focused on the delivery of breast cancer care in low-income countries. Our speakers, a true all-star lineup, included Larry Norton, Gabe Hortobagyi, Ben Anderson, and Mary Gospodarowicz. We heard all about the usual problems in delivering appropriate care in lands lacking not only modern biologics, but even such basics as radiation therapy machines, surgeons, and adequate pathology support.

But we also discussed solutions. Breast cancer mortality worldwide could be hugely reduced at relatively low cost. We do not need a high-tech, expensive, 100% approach, but rather the setting and achievement of some basic standards. ASCO, you will recall, has endorsed a tiered approach to the breast cancer problem, under the tutelage of Dr. Ben Anderson and the Breast Health Global Initiative (BHGI). I would love it if every HER2-positive breast cancer patient in the planet got adjuvant trastuzumab, but I find it shocking that there are 20 countries in Africa where it is illegal to import morphine for dying patients, and large stretches of the continent where there are no radiation therapy facilities whatsoever. It seems pointless to argue over the difference between 90% and 100% in countries that have not yet managed more than 10%.

The World Health Organization, a worthy organization if ever there was one, has spent the great majority of its history focusing on the eradication or control of infectious disease. The time has come for the world's health agencies to take on non-communicable diseases, including but not limited to cancer. The UICC, with the strong support of ASCO, is a driver of the upcoming international summit on non-communicable diseases, which we hope will be a first step to a greater focus on cancer problems in low- and middle-income countries.

Before I leave the subject of international affairs, some final comments. I sometimes heard complaints from members of our Society that we devote too much energy to international affairs, presumably to the detriment of our U.S. members. Nothing could be further from the truth, from either a financial or a focus standpoint. We gain immeasurably by our international presence. We live in a time that demands an international presence. We deal, both as an organization and as a profession, with pharmaceutical companies headquartered outside the U.S., who run clinical trials on a worldwide basis. Our international presence means that important clinical trials (important to American physicians and patients) are regularly presented first at ASCO, even when conducted largely outside the U.S. And, as my good friend Larry Norton pointed out at the UICC/ASCO symposium, we are a remarkably homogenous species genetically: two pigeons perched on a park bench in Central Park are more genetically distinct than any two humans on the planet. We learn enormously from each other. And I will add my personal belief that cancer patients in Kenya deserve to live just as much as my patients in Indianapolis. My own institution is proud to have a long-lasting relationship with a hospital in Eldoret, Kenya. Both our interests and our responsibilities draw us into the international arena.


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