Radiotherapy and oncology in Papua New Guinea--how it differs from Western practice

This article describes differences in professional oncology practice between Papua New Guinea and developed countries. The rugged terrain and tribalism have created the late persistence of a stone age culture with a low level of education and this in turn has caused the late presentation of tumours. Paradoxically the commonest cancers are those which are frequently cured in Western countries, yet the cure rates are low in PNG due to late presentation. Despite this very few metastasize--in contrast to cancers in developed countries. Difficulties in diagnosis are discussed. Differences in management arise due to lack of facilities such as electrons or iridium wires, but policy differences arise also due to the poor follow-up. Many patients cannot afford to return for follow-up and the government cannot assist. Many patients abscond and good pre-treatment counselling is essential. Chemotherapy is available but doses of the more marrow-toxic or expensive drugs are reduced in view of the poor support facilities. Problems of training staff and of Cancer Registration are discussed. Most of the above problems are non-medical and should gradually diminish with government determination to provide a Health Service to benefit the whole population.