The global burden of cancer is large and projected to grow larger. Each year there are approximately 10 million new cancer cases and more than 6 million deaths worldwide. In many developed countries, including the United States, cancer accounts for more than 20 percent of all deaths. In less developed countries, all-site cancer rates are generally lower and cancer accounts for a lower percentage of deaths. However, it is within developing countries that cancer is projected to increase most rapidly over the next few decades. Unless current trends change, cancer in developing countries is expected to represent 70 percent of the global cancer burden by the year 2030, a statistic driven by demographic shifts toward more elderly populations and the movement toward more Western lifestyles, most notably increased per capita tobacco consumption and higher fat/lower fiber diets.

In developing countries, up to 25 percent of cancers are currently linked to infectious agents, including hepatitis viruses and human papillomavirus (HPV), the leading cause of cervical cancer. Approximately 80 percent of the women who die from cervical cancer live in developing countries. Cancer prevention activities in these countries are scant, and screening and early detection programs are rare. Compounding this problem are limited financial resources available for cancer treatment and fewer highly trained and skilled providers of cancer care.

As an institution with an international mandate, NCI's challenge is not just to eliminate suffering and death due to cancer in the United States, but to do so worldwide. And although advanced communications technology and air travel have made the world much "smaller," from the perspective of addressing the worldwide cancer burden, it is still a very big world and a very big task. The challenge is indeed daunting, but it is one from which we cannot shrink. More has been learned about cancer over the last two decades than in all of previous human history combined. Over the next two decades, we must begin to broadly apply what we have learned and continue to learn.

As this special issue of the NCI Cancer Bulletin demonstrates, NCI's international activities are both broad and deep. These activities recognize the diversity of the environments and genes that characterize the earth's population, offering invaluable opportunities to investigate these interactions. They also take advantage of molecular epidemiology to substantially increase what we know about and can do about cancer. The mission to train both Americans and foreign nationals to battle cancer is one that we take very seriously. Each year more than 1,000 international researchers work in NCI laboratories. These researchers make significant contributions to NCI's research program while acquiring the knowledge, skills, and abilities to enhance the research environment of their home countries.

NCI's Office of International Affairs (OIA) is charged with monitoring the institute's international activities, many of which are managed within NCI's intramural and extramural divisions. In addition, OIA manages a range of activities that are intended to catalyze research advances through individual and group training, and through facilitation of interactions between cancer researchers in the United States and the international research community.

The articles in this issue of the Bulletin cover just a small sampling of the kinds of activities in which NCI is engaged. More importantly, they also offer some context for the global burden that cancer represents - a burden that NCI is committed to eliminating with the help of members of the cancer community from the United States and around the world.

Dr. Joe Harford
Director, NCI Office of International Affairs