How Refurbished Linacs Prevent Cancer Deaths in the Developing World

When lay people think about preventable deaths in the developing world, conditions like malaria and tuberculosis may be the first to come to mind. These are diseases for which an effective vaccine or cure exists, but treatments are not being delivered effectively, resulting in unnecessary deaths and suffering among the most underprivileged patients. Cancer, a set of conditions for which effective cures and preventive treatments do not always exist, may seem to fall in a different category. But while many cancers are fatal in their advanced stages, early screening and curative treatment can prevent many of them from reaching this point.

Unfortunately, access to the equipment needed for these early measures is not equitable. In many parts of the world, shortages in imaging and nuclear medicine equipment are barring patients from access to lifesaving treatment. One study of low- and middle-income countries found that scaling up imaging to address these shortages could prevent as many as 2.46 million deaths from the 11 cancers included in the research. There is also a deep unmet need for radiotherapy (RT) equipment: According to Varian, only 10% of patients in low-income countries have access to RT equipment.

This problem is especially pronounced in Africa, where fewer than 300 linear accelerators (LINACs) are in use on the entire continent — and approximately 1,000 more are needed to fully accommodate patients’ needs. The IAEA has found that patients in several countries, including Niger, Sierra Leone, and Chad, have no access to RT equipment at all. In others, such as Sudan, Angola, and Madagascar, a single RT center may serve 10 to 20 million people.

Shortfalls in imaging equipment are part of the problem, but equally important is the lack of professionals trained in their use. In low-income African communities, many qualified radiation oncology and diagnostic imaging personnel relocate to Western Europe, North America, Australia, and other regions where the market for their skills is more established.

Numerous agencies have taken notice of the crisis and are attempting to expand RT access in Africa, both by delivering affordable equipment and addressing the need for trained personnel. Through its Programme of Action for Cancer Therapy, the IAEA is mobilizing resources and delivering technical cooperation programs, as well as sponsoring the development of documents for long-term planning and fundraising. As the organization has explained, the goal is not to simply donate equipment and personnel’s time, but to support these countries in creating self-sustaining cancer control programs. That requires not only radiotherapy centers, but also robust prevention, screening, and palliative support infrastructure.

In all of this, there is a role for private enterprise: The Global Diagnostic Imaging, Healthcare IT, and Radiation Therapy Trade Association, which includes 600 companies from around the world, has laid out a number of steps these providers can take to help promote universal access to RT. One of the most important ones is providing access to affordable technologies–and used and refurbished products are simply the most effective way to infuse these countries with high-quality imaging equipment with many years left in its life cycle. While there is a place for donated equipment, the need is so great that a self-sustaining system will require long-term