Cancer was responsible for one in six deaths in 2020. The fight against it has taken steps back during the pandemic, and even the most developed healthcare systems are struggling to diagnose and treat patients quickly, disastrous for a condition in which time is of the essence. The Middle East needs to take this threat particularly seriously, because very little is known about its specific regional burden. Last week saw an early but important step in the right direction, when 30 specialists, led by Dr Humaid Al Shamsi, director of oncology at Burjeel Medical City and president of the Emirates Oncology Society, published <i>Cancer In The Arab World</i>, which is thought to be the first book dedicated to cancer data in the region. It took five years to complete and has chapters for each of the 22 Arab countries. The specificity of this approach is needed. While cancer's devastation is a global problem, it manifests differently by region, with genetics, culture and politics only a few of the epidemiological factors that need to be taken into account when treating patients. Dr Al Shamsi stresses that the Middle East differs particularly in terms of "age of onset, stage at presentation, awareness and acceptance of disease and treatment, and most importantly, eagerness to seek treatment abroad rather than from within the country". From a purely scientific standpoint, cancer's effects on a western patient are better understood than on a non-westerner. Studies have been concentrated on populations in Europe and North America, a problem not just when it comes to cancer, but health in general. Fortunately, genetic research in the Middle East is in a better place than it was. Launched in 2020, the Emirati Genome Programme, which aims to build a repository of local genomic data, is going from strength to strength. But more work and, crucially, data is still needed to turn any findings from it into real-world treatments. Health is holistic, and beyond cancer Arabs fare poorly in a number of areas that relate to it. The World Health Organisation lists tobacco use, high body mass index, low fruit and vegetable intake and lack of physical activity as key risk factors for the disease. Lebanon, for example, has the sixth highest percentage of tobacco users worldwide; Nine out of the 20 most obese countries worldwide are in the region. As a result, the outlook is bleak. A key part of the book focuses on the challenge of curing and caring for Arab cancer patients. A particularly important difficulty is the delay in which many seek medical help. The authors suggest this might be down to a lack of understanding, even embarrassment. For some, conflict and instability is the most obvious barrier to prompt care; More than 400 medics left impoverished Lebanon in 2020, and the World Bank estimates that only half of Yemen's health facilities are fully functioning. In a sign of scale of the task ahead, <i>Cancer In The Arab World </i>does not offer concrete solutions to overcome the challenge. This does not diminish its huge, perhaps historic, importance. Understanding a problem is key to solving it, and it is to be hoped that the book's data can become an important starting point in what will be a long road ahead.
