As part of its mission to fight cancer around the world, ASCO collaborates in many activities with regional and international cancer societies. ASCO's International Affairs Committee takes the lead in recommending educational partnerships to benefit the global oncology community at large and patients with cancer worldwide.

The brief reports that follow provide examples of the challenges and activities of oncology societies in four countries, and ways in which ASCO interacts with these societies to advance their missions.

Nigerian Society Addresses Need for Knowledge among Professionals, Public

In Nigeria, lack of awareness and understanding of cancer-among both the public and professionals-is one of the biggest barriers to effective cancer care, according to Clement A. Adebamowo, MD, ScD, an oncologic surgeon who is President of the Society of Oncology and Cancer Research of Nigeria (SOCRON).

Dr. Adebamowo explains that patients with cancer don't present with signs and symptoms like the classic cases in medical textbooks, in part because the Nigerian population is comparatively young. "A cancer diagnosis is often last on the list of differential diagnoses. The high prevalence of infectious diseases also lulls clinicians into a reduced index of suspicion." In addition, following diagnosis, patients with cancer are often treated inappropriately, he says.

The lack of early diagnosis and appropriate treatment then leads people to doubt the efficacy of "Western" treatment. "The entire situation reinforces notions about alternative explanations for the etiology of cancer and shifts the preference toward 'traditional' or 'spiritual' treatments," Dr. Adebamowo says.

Nigeria's lack of organized and adequate health-care financing is also a major barrier to cancer care. Not able to afford care, patients do not present when the disease is at an early stage, hoping it will go away. "They try to raise funds from friends and family, causing further delay. The advanced stage of disease leads to poor outcomes, making people unwilling to support treatment of future patients because of a perceived futility of such efforts in the past."

In 2003, Dr. Adebamowo, who is currently the Chair of ASCO's International Affairs Committee, received an International Development and Education Award (IDEA) from The ASCO Cancer Foundation®. The IDEA program identifies early-career oncologists in developing countries and offers experiences and mentoring in leadership development. As an IDEA recipient, Dr. Adebamowo recognized the power a professional organization could have in advocacy, education, and research, and he worked with colleagues in Nigeria to create SOCRON in 2005.

"Without ASCO, there would be no SOCRON-period," he comments. "The ASCO leaders we interacted with were tremendously supportive and have remained engaged-traveling to Nigeria to give presentations, mentoring Nigerian oncologists, and opening doors for SOCRON to take advantage of opportunities."

Now with 400 members, SOCRON provides education and information for both professionals and patients on its website, and in 2008 held its first International Conference on Modern Cancer Management, which was standing room only at all of its sessions. SOCRON will hold a second conference in February 2011. "You guessed it-ASCO is already supporting the meeting by providing international faculty," Dr. Adebamowo comments.

Oncology training is still "fairly rudimentary" in Nigeria, with only a few centers offering training of reasonable quality, Dr. Adebamowo says. Some physicians have received medical oncology training out of the country, but very few return to Nigeria to practice. Chemotherapy is given by hematologists as well as radiation, surgical, gynecologic, and pediatric oncologists, complemented and supported by the patient's primary care physician.

Chinese Society Focuses on Medical Education, Research

Shukui Qin, MD, the President of the Chinese Society of Clinical Oncology (CSCO), says that CSCO's goals encompass the development of continuing medical education, enhancement of multidisciplinary collaboration and academic exchange, encouragement of multicenter research, and promotion of standardized tumor diagnosis and treatment so as to benefit patients with cancer in all of China.

Founded in 1997, the 10,000-member society has several robust educational programs in addition to its annual meeting, which last year attracted 15,000 people. In one such program, expert oncologists travel to western China and outlying communities to give presentations on the latest developments in tumor diagnoses, radiotherapy, molecular target therapy, and other fields. "So far, tens of thousands of physicians have benefited from lectures, and their clinical and research ability has been boosted as well," Dr. Qin reports.

Another educational activity is CSCO's thematic academic forums, which include presentations by international experts on specific topics. Thematic forums have been presented on lymphoma; gastrointestinal, lung, and breast cancers: molecular targeted therapy; and biologic therapy.

CSCO has also created a charitable foundation. In 2002 it founded the Science Foundation of China Clinical Oncology, which supports clinical research, continuing medical education, professional training, and international academic communication.

Currently, lung and stomach cancer are the two most frequent types of cancer in China for both sexes combined, although among women breast cancer has the highest incidence. An increase in cancer rates looms in China because of the high use of tobacco in the country. With 20% of the world's population, China consumes 30% of the world's cigarettes, according to the American Cancer Society website.

The interaction between ASCO and CSCO becomes stronger every year. For example, attendance at the Best of ASCO conference grew from 600 in 2009, the first year it was held in China, to nearly 900 participants a year later-one of the largest Best of ASCO meetings in the world.

ASCO's IDEA program is another strong tie between the two organizations. The IDEA grant covers expenses for an individual to attend the ASCO Annual Meeting and visit a cancer center, and it establishes a scientific mentoring relationship between leading oncologists in ASCO and the award recipients. China has consistently had the highest or second-highest number of IDEA applications, and 14 awards have been given to Chinese oncologists.

Dr. Qin notes, "While constantly improving itself, CSCO pays attention to the introduction of foreign advanced technology and scientific management experience."

Advancing Research a Goal of Latin American Society

Founded in 2004, SLACOM-the Latin American and Caribbean Society of Medical Oncology-already has 2,000 members. It includes all of South and Central America as well as the Caribbean. As might be expected in such a huge area, the prevalence of cancers varies widely. SLACOM's founder and President, Eduardo ­Cazap, MD, a medical oncologist and cancer researcher in Buenos Aires, describes some of these variations:

The cancer incidence and mortality rates in some countries, such as Uruguay and Argentina, are similar to those in the United States, with breast, lung, colon, and prostate cancers in the lead. In contrast, in countries on the Pacific side of South America, including Chile, Peru, and Ecuador, gastric and gallbladder cancers are more prevalent.

Even within the same country, cancer epidemiology can vary widely, Dr. Cazap explains. Big cities in Argentina and Brazil, for example, have different cancer rates than those found in the Argentina's northern provinces or the Brazilian jungle. Each country's health-care strategy and cancer control plans must be adapted to the local and regional realities, he points out.

The incidence and mortality for many cancers is rising in most Latin American countries, largely due to the aging of the population, urbanization, and the westernization of lifestyles. Two barriers to effective cancer care are the lack of organized strategies for primary and secondary prevention and the limitations in access to care, Dr. Cazap says. Contributing to these obstacles is the fact that research is poor at the local and regional level, so the population data available are scarce or fragmented.

ASCO is furthering research in less-developed countries through its International Clinical Trials Workshop, which features research education that is adapted to local issues of accrual, informed consent, and regulation. Research nurses and data managers participate in the workshop along with physicians. In 2009, Argentina was the site of ASCO's first International Clinical Trials Workshop. Dr. Cazap, who is an ASCO Board of Directors Member and liaison to ASCO's International Affairs Committee, says that the Argentina workshop served as a pilot that has led to improvements in later workshops, now slated for Egypt, Romania, and Uruguay in 2011.

"ASCO was instrumental in the organizational development of SLACOM," Dr. Cazap states, noting that ASCO helped support the organizational training and mentoring for SLACOM senior staff. ASCO and SLACOM continue to collaborate in a number of ways, presenting four Best of ASCO meetings in the region annually and planning additional International Clinical Trials Workshops after the one in Uruguay in 2011.

"ASCO and SLACOM are ideal partners," Dr. Cazap notes. "ASCO can provide scientific and organizational expertise, well-developed programs, and prototypes for SLACOM's own future programs. For its part, SLACOM can provide local and regional advice, collaboration in education, and promotion of ASCO in Latin America. As ASCO expands its international program, Latin American experiences and pilots serve as examples that can be duplicated in other regions of the world."

Japanese Oncology Societies Advance Oncology Training, Standards

Cancer is the primary cause of death in Japan, where incidence of the disease is growing. Two oncology societies-the Japanese Society of Medical Oncology (JSMO) and the Japan Society of Clinical Oncology (JSCO)-have worked together to educate oncologists and influence health-care regulation to improve cancer care. Most of JSMO's approximately 8,000 members are medical oncologists, whereas surgical oncologists represent over half of JSCO's more than 17,000 members.

Yoshihiko Maehara, MD, Chief Director of JSCO, notes that smoking rates are much higher and cancer screening rates are much lower in Japan than in the United States. Public education about cancer prevention is inadequate, and JSCO is intensifying its public outreach and cancer prevention activities.

Both Dr. Maehara and Kazuo Tamura, MD, JSMO President, point to a shortage of qualified oncology specialists as a barrier to cancer care in Japan. Accordingly, a number of the two organizations' activities focus on oncology training, continuing education, and promoting high standards of care.

In 2007, JSCO and JSMO joined forces with several other cancer-related organizations in Japan to form the Japanese Board of Cancer Therapy, which has certified nearly 8,000 physicians who have basic knowledge of oncology. But only 451 medical oncologists have been certified by JSMO so far, and Dr. Tamura says he would like to see up to 4,000 certified medical oncologists. He reports that only about half of Japan's medical schools have an independent department of neoplastic diseases, and JSMO is urging academic centers to establish medical oncology departments.

ASCO has strong ties with both JSCO and JSMO as well as Japanese oncologists individually, many of whom are ASCO members. In fact, ASCO has more members from Japan than from any country outside the United States. Japan is also well represented at the ASCO Annual Meeting. Among international attendees at the 2010 Annual Meeting, the number from Japan was second only to the number from Germany.

ASCO partners with both JSCO and JSMO to hold joint symposia at their annual meetings. In addition, ASCO holds the Best of ASCO meeting in Japan each year in collaboration with JSMO. Dr. Tamura and Dr. Maehara both value ASCO's collaborations with their organizations. Dr. Maehara comments, "ASCO is the world's leading organization for cancer care. We recognize that it is highly significant for us to interact with ASCO." ■

© 2011. American Society of Clinical Oncology. All rights reserved.