Intended for healthcare professionals


Cancer prevention and control in Eastern Mediterranean region

BMJ 2006; 333 doi: (Published 19 October 2006) Cite this as: BMJ 2006;333:860
  1. Salman Rawaf, director of public health (salman.rawaf{at},
  2. Elizabeth Dubois, public health economist,
  3. Oussama M N Khatib, regional adviser for non-communicable diseases,
  4. Sherif Omar, professor of surgical oncology
  1. Wandsworth Primary Care Trust, London SW17 7DG
  2. Wandsworth Primary Care Trust, London SW17 7DG
  3. World Health Organization, Eastern Mediterranean Region, Cairo, Egypt
  4. National Cancer Institute, University of Cairo, Cairo

    EDITOR—In the Eastern Mediterranean region (population 492 million) cancer is the fourth most common killer with about half a million new cases a year.1 2 Lung, liver, and bladder cancer are commonest among men and breast cancer among women, the highest rates among Jewish women.3

    World Health Organization modelling shows that over the next 15 years the increase in cancer incidence in the region will outstrip that in any other region (figure).4


    Predicted increase in deaths from cancer over the next 15 years (WHO)4

    Reliable data on cancer incidence through national, population based registries are available in only seven of the 22 countries, and few governments have implemented prevention and control strategies. This failure is less to do with scant resources than a lack of political will and support for the development of appropriate services. Only minimal regulation is in place to protect workers from carcinogens, promote tobacco control, and expand hepatitis B programmes.5 Public pressure for these services is low, and patients still tend to present late, with advanced disease. Well off and well educated people seek treatment abroad.

    Awareness and concern are, however, growing in all sectors of society and among health professionals about the link between environmental damage from prolonged military conflicts and rising cancer rates. Oil pollution in Kuwait and Lebanon, chemical contamination in Iraq and Sudan, and depleted uranium in Iraq, Afghanistan, and Somalia have fuelled this concern.

    Governments must take public concerns about cancer seriously. The collection and recording of sound data are essential, and cancer registries must align with international standards. Funding for national plans for cancer prevention and control must be made available. WHO's STEPwise programme should act as a guiding principle for developing these plans (

    Patient and public input is important in shaping new services. Supraregional services may be needed to ensure access to some forms of specialist care—for example, bone marrow transplants, liver units. Some collaborative work is already under way in the Gulf Cooperation Council countries. Reorientation of services away from their current heavy emphasis on private sector provision of secondary care services to one that provides equitable primary care and preventive medicine services is crucial.5 Without such reorientation, cancer statistics will continue to rise, and the burden of what in a third of cases is a preventable disease will steadily increase.


    • Competing interests None declared.


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