dramatic discrepancy in the ability of cancer patients to access lifesaving radiotherapy across countries and regions of the world (see Chapter 5) (Fig. 1.2). With the incidence of cancer on the rise in LMICs, there is an increased demand for IAEA assistance to introduce or expand radiotherapy capacity. The resources available to the IAEA are, however, inadequate to address the global need. Although the existing cancer infrastructure in these countries is far from being able to respond fully to all needs, it is the best available option and a useful starting point to extend the IAEA’s assistance by encouraging investments and advancements in other cancer system components, especially prevention, screening, early detection, advocacy and palliative care. 22 FIG. 1.2. Distribution of megavoltage units per region of the world. 1.5. CANCER CONTROL AND NATIONAL CANCER CONTROL PROGRAMMES The concept of national cancer control programmes (NCCPs) was introduced and developed by WHO in the mid-1980s. The first version of an NCCP guide appeared following a WHO meeting in November 1991: “A national cancer control programme is a public health programme designed to reduce the number of cancer cases and deaths and improve quality of life of cancer patients, through the systematic and equitable implementation of evidence-based strategies for prevention, early detection, diagnosis, treatment, and palliation, making the best use of available resources.” [1.12] NCCPs represent an attempt to apply current evidence based knowledge and medical achievements to populations in order to decrease morbidity and mortality from cancer. The rationale is that cancer should be prevented. Since not all cancers can be prevented, mechanisms should be put in place to detect, very early on, those cancers that do develop in order to treat them successfully. There must be adequate and effective diagnostic procedures available, and for those patients diagnosed with cancer there should be effective and cost effective therapy options. Finally, for patients with recurrent, metastatic and terminal disease, appropriate palliative strategies and treatments should also be available. In countries without an operational NCCP, the usual approach is to ‘treat the cancers when they appear’. Naturally, the first steps usually involve the establishment of one or more cancer treatment centres that will provide diagnostic services, imaging, surgery, radiotherapy and systemic therapy. With this approach, patients who have been diagnosed with cancer have a place to 23 go where diagnostic, staging and treatment interventions will be carried out. Unfortunately, in this scenario, most patients will present with advanced disease and the majority of treatments offered will be palliative in nature. Undue reliance on this approach, which may involve the use of sophisticated and often expensive technologies, can result in inequitable selection of patients, rapid depletion of scarce resources, and a shift in emphasis away from more affordable prevention activities [1.12]. Usually it is only when cancer treatment centres are already established and operational that a hospital based cancer registration system is initiated and the importance of community based cancer control interventions such as prevention and screening programmes becomes clear. 1.6. THE WORLD HEALTH ORGANIZATION AND CANCER CONTROL The World Health Organization is the international agency within the United Nations system responsible for health. Established in 1948, its objective is the attainment by all peoples of the highest possible level of health, based on the “Health for All” concept. The mission of WHO, through the Noncommunicable Diseases and Mental Health Cluster, is to provide leadership and the evidence base for international action on surveillance, prevention and control of NCDs, including cancer. The strategic directions are based on the mandates given by the resolutions of its governing bodies, the general directions and priorities of the Medium-Term Strategic Plan for 2008–2013, and the lessons learned from international experience and WHO’s work with its Member States. Given cancer’s human and economic cost, WHO