Eduardo Cazap, MD :: Profile
President, Latin American and Caribbean Society of Medical Oncology (SLACOM), Buenos Aires, Argentina
President-elect, International Union Against Cancer (UICC), Geneva, Switzerland
Q: You've been an oncologist in Argentina for over 30 years. What brought you to breast cancer research?
A: Cancer is a global problem. This may seem like a simple statement, but it's not. If you consider the world, there is a troubling gap between the advancement of scientific knowledge and applicable knowledge to populations. No longer can we talk about this problem in terms of rich and poor countries; that's not a useful distinction to make because even so-called rich countries, like the United States, have big challenges in delivering medical resources for all the population. Patients do not have equal access to quality care.
With breast cancer, an example of this inconsistency is the use of mastectomy as a treatment. Despite scientific advances, mastectomy remains the most common treatment for breast disease throughout the world. This is not always a good medical practice, and it is a result of very practical problems. In many places there are simply no pathologists, or there are so few that the reports are delayed to the point of being unhelpful-in some cases, many months. Doctors in these situations have little choice beyond treating their patients with mastectomy, even if they know that many would be better treated with less radical surgeries.
With BCRF support, I am pursuing the question of how to analyze the conditions of care in a given country or region - in my case 12 countries in Latin America and the Caribbean: Mexico, Brazil, Argentina, Peru, Chile, Colombia, Venezuela, Paraguay, Uruguay, Panama, Honduras and Bolivia. Once we analyze the situation, we can begin to improve the continuous delivery of good medical care in this region. It comes down to identifying the best strategies for improving delivery of breast cancer treatment.
The lack of information was the basis of our research.
Q: How does this process work in the project that you initiated?
A: The first phase of our research was a survey, which was published with analyses in a special issue of Cancer in October 2008. We initially lacked basic data about the conditions of care throughout the region. For the survey, an advisory board of the Latin American and Caribbean Society of Medical Oncology (SLACOM) generated 65 questions about breast cancer related to epidemiology, screening, diagnosis, treatment, research, palliative care, and medical education. Phone interviews with 100 experts in the 12 countries - this ranged from directors of cancer centers, to heads of scientific societies, to established surgeons and oncologists-gave us a detailed description of breast cancer in the region. Our panel reviewed the survey and came up with results that we can use as a basis to focus our attention on improvement.
The second phase is a comparison between the experts' assessment of the state of breast cancer and what governments say they are doing in the area of breast cancer. National cancer plans and better epidemiologic data are needed for all countries. The World Health Organization and the International Union Against Cancer has deemed them an urgent priority. A complete review of countries' capacities is necessary before determining the best approaches to bringing governments and the private sector into stronger collaborations to improve breast cancer care.
Q: What has the initial survey revealed?
A: Many things, some of them alarming. It is known that Latin America has a lower incidence of breast cancer than that of more developed countries, but the mortality rate is higher. Our survey provided a window on why that may be the case. We learned that an overwhelming majority of breast cancer suspicion in these countries (79%) is identified by the patient herself. Hand in hand with this finding is the fact that there are almost no laws or guidelines in the countries surveyed for mandatory mammographic screening. Mammography exists in most locales, but its use is limited. We believe that women are detecting breast cancers themselves when the disease is more advanced because they are not routinely screened for the disease. This reality contributes to poorer outcomes. This situation is closely related to poor medical and general population education.
We also learned that while there are research activities and data collection going on in the region, projects are limited and only 1% of these activities are conducted in the formal academic setting of a university. To date, there is very poor support from governments for cancer research in Latin American and Caribbean countries.
On the positive side, three quarters of the experts surveyed indicated that some type of population-based cancer registry with incidence data from the last five years was available. Without the survey we never would have known that this data exists. We are now devoting resources to bringing this data together in a standardized, accessible format.
Q: What is your outlook on whether breast cancer can be prevented and cured on a global level?
A: Things will improve when there are established national cancer plans throughout the region. I believe we can prevent and cure cancer as good access to care for as many people as possible increases.
Q: How has BCRF helped you?
A: To my knowledge, BCRF was the first organization to fund independent research in breast cancer in Latin America and the Caribbean at the regional level in the time that I have practiced oncology.
Q: What do you see as the biggest challenge in cancer research?
A: Governments worldwide increasingly lack the political will to improve health care systems to the extent that is needed. This is primarily due to lack of adequate budgets. There should be more regional and national medical collaborations, with funding from governments.
Q: What advice would you give to young physician-researchers?
A: To be open-minded and to look for new strategies suited to our populations and local resources.
Read more about Dr. Cazap's current research projects funded by BCRF.