PAEDIATRIC AND ADOLESCENT CANCER
CANCER CONTROL 2014 111
L
ow-income countries, particularly French-speaking
sub-Saharan African countries, still have a very young
population with at least 40% aged less than 15 years
old with a low life expectancy, around 50, and a fertility index
still high around 5. So cancer in children younger than 15,
even if the incidence rate is nearly the same, represent a
higher proportion of the population in these countries (about
5% of all cancers) than in high-income countries (now less
than 0.5% in France). We know that the number of cancers in
adults will rapidly increase in the future1 due to ageing of the
population and changes in lifestyle. Many countries are not
prepared in any way to face this new challenge: the
complexity of caring for a growing number of patients with
cancers which require so many different skills from so many
different actors working closely together.
The situation will be complicated in low-income countries
by the fact that at the same time, other health problems such
as maternal and neonatal mortality, malnutrition and
infectious diseases will not be totally under control and that
other non-communicable diseases like diabetes and
cardiovascular diseases will also take more and more room
increasing difficulties to find funding.2
Therefore, as everything cannot be achieved at the same
time, more than ever, each country has to define its health
priorities in oncology according to:
‰ Where it is regarding oncology indicators (incidence,
mortality, types of tumours observed, existing
infrastructure, number of oncology specialists for
treatment and diagnosis, number of trained people
providing supportive care of cancer patients, etc).
‰ What are the best cost-benefit ratios in terms of a
reduction in mortality and morbidity for different
interventions (prevention, early diagnosis, pathology,
diagnostic imaging, surgery, radiation therapy, medical
treatments, supportive care) to fight the different types
of cancer.
RETINOBLASTOMA: AN EXEMPLARY
TUMOUR IN YOUNG CHILDREN
THAT CAN BE CURED IN LOWINCOME COUNTRIES
PIERRE BEY, EMERITUS PROFESSOR OF RADIATION ONCOLOGY, UNIVERSITY OF LORRAINE, MEDICAL
DIRECTOR OF ALLIANCE MONDIALE CONTRE LE CANCER (AMCC), ADVISER TO THE PRESIDENT OF THE
INSTITUT CURIE, PARIS, FRANCE, FOUSSEYNI TRAORE, CHU GABRIEL TOURÉ, BAMAKO, MALI, FATOUMATA
SYLLA, IOTA, BAMAKO, MALI, GABRIELLE CHENGE, CLINIQUES UNIVERSITAIRES DE LUBUMBASHI,
LUBUMBASHI, RD CONGO, JULIEN ILUNGA, CLINIQUES UNIVERSITAIRES DE LUBUMBASHI, LUBUMBASHI, RD
CONGO, ROBERT LUKAMBA , CLINIQUES UNIVERSITAIRES DE LUBUMBASHI, LUBUMBASHI, RD CONGO,
LAURENCE DESJARDINS, INSTITUT CURIE, PARIS, FRANCE, ISABELLE AERTS, INSTITUT CURIE, PARIS, FRANCE,
PASCAL SIRIGNANO, CABINET PROTHELEM, PARIS, FRANCE
Cancer will be one of the major health challenges worldwide in the next few decades. Among all
the different types of this ubiquitous disease, cancer in children must be among the priorities in
action plans to combat cancer in low- and middle-income countries. Among childhood tumours,
retinoblastoma appears to be a good example as it is now curable in over 95% of cases in highincome countries due to early diagnosis and quick access to a competent multidisciplinary team.
Relying on the experience of Institut Curie in Paris (the reference centre for all retinoblastoma cases
in France), we have developed a programme to help local teams in some sub-Saharan French
speaking countries (these currently include Mali, Democratic Republic of Congo, Senegal and the
Ivory Cost, and soon in Madagascar) to become national or regional reference centres promoting
early diagnosis campaigns, offering all treatment facilities including conservative treatments and
rehabilitation after enucleation.