Although coverage of health crises in the developing world focuses on 'high profile' diseases such as HIV/AIDS, malaria and tuberculosis (TB), cancer claims more lives than those three diseases combined. The World Health Organization (WHO) estimates that by 2020 the developing world will account for 60% of new cancer deaths. This is largely because 80–90% of cancer patients have advanced, incurable forms of the disease by the time they are diagnosed. Women, particularly, are reluctant to discuss any symptoms that may occur until it is far too late; they often believe that the illness is the work of evil spirits and seek the help of traditional healers rather than conventional medicine. There is also a stigma attached to breast cancer; women can find themselves deserted by their husbands after undergoing a mastectomy.

Combating cancer, then, in continents such as Africa, is not just about treating the illness itself, but about educating people — healthcare workers and patients — about the reality of the disease. AstraZeneca (AZ) began such a programme in Ethiopia in 2005. Now into its third year, AZ's Ethiopia Breast Cancer Programme has led to significant improvements in how breast cancer is understood in a country where the incidence of disease is increasing yet there is only one resident oncologist.

Of course, AZ could have supplied the drugs, Nolvadex and Arimidex, free, but if it was to establish an initiative with any real, long-term significance for Ethiopia it needed to find a partner with expertise in developing the country's infrastructure. So when Bernie Tyrrell, AZ's vice president, Breast Cancer and Infection, was first looking into ideas for a philanthropic project, he turned to Axios International for assistance.

Figure 1

Axios, a health management company based in Paris under the leadership of Dr Joseph Saba, already had significant experience implementing and validating field and access programmes in the developing world. It has helped pharmaceutical companies such as Abbott Laboratories, Pfizer, Novartis and Gilead establish access and assistance programmes across Africa, and has been instrumental in improving the treatment and care of people with HIV/AIDS in Tanzania (with Abbott) and strengthening HIV/AIDS drug delivery and supply management in Nigeria.

Why Ethiopia?

Before the start of AZ's breast cancer programme, no other major pharma initiatives were taking place in Ethiopia, one of Africa's poorest states. According to WHO, close to 80% of Ethiopia's 70 million population lives on less than $2 a day. Three quarters of the population do not have access to clean water or proper sanitation, and the last two decades have seen the country subjected to drought, disease and war. Male life expectancy at birth is 49 years; female life expectancy is 51. Breast cancer is the second most common cancer among young women in Ethiopia.

Figure 2

Despite its volatile past, Ethiopia has achieved relative political stability of late, which makes it more conducive to the establishment of a programme such as this. As Axis CEO Joseph Saba explains: "The need for treatment is everywhere, but we have criteria to assess. We have to find the best fit. It is important that the government of the country is strong; the project suffers a lot if you have a government that doesn't care."