among the countries, there will be a different emphasis in
the general approach of improving cancer registration in the
region. RINC was invited to join the Advisory Committee,
whose duties are to review the work of the Hub, advise on
future developments and provide inputs regarding cancer
control initiatives that are relevant to the region (12).
The Biobank Working Group
Since the late 1990s, biobanks have become an important
resource in medical contemporary research. In this context,
the Latin American and Caribbean Network of Tumour
Banks was set up in 2007 by the former Latin American and
Caribbean Alliance for Cancer Control and joined RINC later
on as Biobanking Working Group. It aims to organize a
network for the collection of tumour samples and blood of
patients with the most prevalent tumours in the region. Such
specimens are essential research focused on identifying
tumour markers and developing new therapeutic targets.
The initial goal was to establish a cooperative milestone to
allow design strategies to consolidate tumour banks in
member countries. In the meantime RINC has achieved the
following targets:
‰ Technical support for the standardization of nine existing
tumour banks.
‰ Implementation of six new tumour banks.
‰ Training delivered to 21 experts.
‰ The implementation of regional training and technical
capacity-building centres at national cancer institutes in
Rio de Janeiro, Bogotá and Mexico City (13).
Breast cancer - a major challenge
Breast cancer is the most common cause of cancer and the
leading cause of mortality from cancer among women in
Latin America. Mortality has increased over the past two
decades and breast-cancer survival is, on average, 20%
lower than in the United States and Western Europe. High
rates of breast cancer mortality can be attributed to
advanced stage at diagnosis: only 5% to 10% of new
diagnoses are made at a stage I of the disease. Health system
structures have been identified as major barriers to
successful breast cancer screening. In some regions of Latin
America, mammography equipment is scarce, with up to 20%
of equipment needing repair.
In this context, seeking to align public cancer prevention
and control recommendations and policies and share
programme experiences that have been successful and
might be adapted and implemented by other network
members, the RINC Breast Cancer Control Working Group
started focusing on the quality of mammography as a
regional strategy, a programme that Brazil has been
implementing throughout the country with success. This
turned out to be an option which was unable to attract the
interest and the participation of more than four countries in
the region. Since 2014 a new approach is being prepared
under the leadership of the government of Paraguay (14).
Collaboration with international organizations
The planning of health policies and its decision-making
process in Latin America historically has always had the
strategic participation of international organizations, in
particular of the Pan American Health Organization (PAHO).
The current scenario is characterized by the presence of an
increasing number of actors with a powerful agenda and
great capacity for articulation. In the past years, cancer
control in the region has been supported by leading
multilateral organizations and strong potential partners
such as IARC, WHO, UICC, the United Nation's International
Agency for Atomic Energy (with its PACT programme),
PATH, the World Bank, and other institutions such as the
National Cancer Institute, the American Cancer Society
(ACS) and the Center of Disease Control (CDC) in the
United States, and ultimately the Ítalo-Latin American
Institute (IILA).
However, the overall balance of the agencies' investments
in the region in terms of human resources and funds to
support prevention, detection, treatment, research and
epidemiological information, unfortunately show more
unsatisfying outcomes than successful initiatives. The main
reasons for that are - to a great extent - the lack of
coordination among the agencies, duplication of agendas,
discontinuity of actions and the waste of resources.
Furthermore, agencies have been traditionally engaged in
collaborative partnerships with governments by proposing
their own values, concepts and guidelines related to the
subject without analyzing profoundly other options or being
open to the health agenda or epidemiological priorities of
the countries concerned. On the other hand, governments
have an unclear vision of their own real demands, which
leads to a low programme implementation capacity. Also, it
is not uncommon that rotations in the governments impact
on the development and continuity of agreements and
projects (15).
In contrast, RINC has been working collaboratively with
international agencies seeking to increase the
implementation capacity of its member countries. The fact
that RINC represents the demands and common interests of
various governments, facilitates interaction and
understanding with the agencies. Collaboration with
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