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Cancer in Developing Countries: The Great Challenge for Oncology in the 21st Century
Preface by the Editors
6
Acknowledgement
6
Contents
8
Contributors
10
Foreword
12
Developing Countries
12
An Unequal World
15
Challenge and Opportunity
18
Cancer in Context
20
The Coming Plague
23
I. Introduction
28
References
31
II.1 The Cancer Problem in Developing Countries
32
References
36
II.2 Some Observations on the Geography of Lymphoid Neoplasms
37
II.2.1 Global Distribution and Pathogenesis of Lymphoid Neoplasia
37
II.2.2 BurkittÌs Lymphoma
41
II.2.3 Acute Lymphoblastic Leukemia in Young People
45
II.2.4 Follicular Lymphoma
47
II.2.5 T Cell Lymphoma
48
References
50
II.3 Bridging the Childhood Cancer Mortality Gap between Economically Developed and Low- Income Countries: Lessons from the MISPHO Experience
53
II.3.1 Introduction
53
II.3.2 General Framework
54
II.3.3 What Can be Done and How? The Model Case of Nicaragua.
55
II.3.4 MonzaÌs International School for Pediatric Hemato-Oncology (MISPHO)
61
II.3.5 International Initiatives
65
II.3.6 Lesson from the Experience
68
II.3.7. Conclusions
69
References
70
II.4 Transfer of Medical Technology to Developing Countries: Nicaragua - Success and Failure
72
II.4.1 Introduction
72
II.4.2 Nicaragua: Geographical and Political Facts
72
II.4.3 Programme Background
73
II.4.4 Cervical Cancer in Nicaragua
74
II.4.5 The Swiss-Nicaraguan Project for Secondary Prevention of Cervical Cancer
76
II.4.6 How Political Upheaval Influences Health Care: Patients Pay the Price
76
III.4.7 Conclusions
77
References
77
II.5 Oncology in Serbia in the Last Ten Years: 1990-2000
78
II.5.1 General Remarks
78
II.5.2 Some Epidemiological Characteristics of Cancer in Vojvodina
84
II.5.3 Environmental Pollution
89
II.5.4 Summary
93
References
94
II.6 Oncology in Albania in the Last Ten Years: 1991-2001
97
II.6.1 General Overview
97
II.6.2 Actual Situation of General Health Care in Albania
98
II.6.3 Oncological Care in Albania
100
II.6.4 Different Points of View Regarding the Oncological Situation in Albania
104
References
107
II.7 CanSupport: Pioneering Domiciliary Palliative Care in Delhi
108
II.7.1 Introduction
108
II.7.2 The Cancer Scenario in India
109
II.7.3 The Situation in Delhi
110
II.7.4 The Burden of Cancer for Palliative Care Services in Delhi
111
II.7.5 CanSupport: The Conception
114
II.7.6 CanSupport: The Organization
116
II.7.6 CanSupport: Our Initial Experience
117
II.7.7 CanSupport: The Future
120
References
120
II.8 Developing Palliative Care in Kerala
121
II.8.1 Introduction
121
II.8.2 Methods
121
II.8.3 Results
122
II.8.4 Discussion
125
References
130
II.9 Breaking the Vicious Cycle that Hinders Cancer Control in Developing Countries
132
II.9.1 Introduction
132
II.9.2 The Vicious Cycle Encountered in Developing Countries
133
II.9.3 Addressing the Problem
135
II.9.4 Simplifying Therapy Ò Realistic or Retrogressive?
138
II.9.5 The Importance of Clinical Research in Developing Countries
142
II.9.6 The Need for Cooperation
143
II.9.7 Summary
145
References
146
III. Audit in Oncology in the Third World
148
III.1 The Growing Burden of Cancer: Incidence and Mortality
148
III.2 Risk Factors and Prevention: Do We Use the Chance?
153
III.3 Cancer Detection: Early or Too Late?
162
III.4 Treatment of Cancer: A Perspective
168
III.5 Palliative Care: The Most Urgent and Most Rapid Way to Less Suffering
173
References
176
IV. Conclusions and Strategies for Reducing Cancer Mortality in Developing Countries
182
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