The international review of cancer control that Uruguay requested

What it is

The imPACT mission is the comprehensive cancer-control assessment instrument that the International Atomic Energy Agency (IAEA) runs together with the Pan American Health Organization, the World Health Organization and the International Agency for Research on Cancer (IARC). It evaluates national capacities in planning, registration, prevention, early detection, diagnosis, treatment and palliative care, as well as the regulatory infrastructure for radiation safety. On 11 August 2021 the Ministry of Industry, Energy and Mining reported that, through a note verbale from IAEA director general Rafael Mariano Grossi, the mission was confirmed at the request of the Minister of Public Health; the designated focal point was Dr Marisa Fazzino, director of the National Cancer Control Programme, and the report would be addressed to then Minister Daniel Salinas.

What is questioned

According to the report itself, after a virtual analysis the in-country technical mission took place in Montevideo from 6 to 10 December 2021, with visits to INCA, the Pereira Rossell Hospital, the Paediatric Hospital, the FNR and private providers. The document was presented to the Ministry of Public Health in September 2022 and updated in February 2023 with adjustments by the Ministry itself. Its priority recommendations include drawing up and coordinating a national cancer prevention and control plan "in order to optimise efforts and promote transparency and accountability"; strengthening the Ministry's regulatory functions to independently monitor service quality, "for example, in relation to waiting times, delays in pathology and timely treatment"; "reviewing the allocation of resources for high-cost cancer medicines so that it is consistent with the most prescribed medicines"; and "allocating the resources needed to guarantee the operation of linear accelerator (LINAC) and brachytherapy equipment in the health system's public providers by buying spare parts and guaranteeing maintenance and technical assistance so that services are delivered without interruption". On registration, the report highlights that the National Cancer Registry is population-based, covers the whole country and has permanent, qualified staff, but that the transition to an electronic format "poses the most important challenge" and will require more financial resources.

Why it matters to you

Without a registry there is no policy: the decision to buy an accelerator, hire oncologists or cover a drug is made on that data. An international assessment has already been carried out, with concrete recommendations on accelerator maintenance, waiting times and resource allocation for high-cost medicines; that its follow-up is not public deprives taxpayers of any way to know whether what was found was corrected.

Where it stands