Building Radiopharmaceutical Sustainability for Cancer Care in Africa

Cancer is a leading cause of death globally, but it is one that hits lower income countries particularly hard. Without the use of radiopharmaceuticals — medical drugs containing radioisotopes — the abilities of doctors in such countries to detect and treat cancer are limited.

This problem is especially acute in Africa. In order to address it, the IAEA is helping African countries to build expertise through educational and training programmes, and to develop their own facilities to locally produce radiopharmaceuticals, which in many cases have a short shelf life and need to be used quickly after production.

Local and independent radiopharmaceutical production will lessen African countries’ reliance on imported shipments and expertise and help to reduce costs. Trained and qualified radiopharmacists are key to this strategy.

“Without qualified radiopharmacists, the sustainable use of radiopharmaceuticals for cancer care is nearly impossible,” said Aruna Korde, a radiopharmaceutical scientist at the IAEA. She has been working with health and education authorities in Africa to develop training for local radiopharmacists. “Countries require their own radiopharmacists to contribute to the diagnosis of cancer patients as soon as possible, and we are helping make that happen by expanding radiopharmacist training into different languages,” Korde said.

Through an IAEA technical cooperation project, in collaboration with the Government of Morocco, a French-language master’s programme on radiopharmacy was introduced to address Africa’s shortage of qualified radiopharmacists. In 2021, the first cohort from the programme graduated, giving Burkina Faso, C?te d’Ivoire, the Democratic Republic of the Congo and Mauritius their own certified radiopharmacists for the first time. A similar collaboration with South Africa led to radiopharmacists from Ethiopia, Kenya, Uganda and Zambia completing their master’s programmes. Furthermore, radiopharmacists continue to be trained in Africa through hands-on training courses.

To enhance the knowledge of radiopharmaceuticals in the region, the IAEA is helping to establish the African Association of Radiopharmacy, to be launched in February 2022. The Association will bring together a network of radiopharmacy professionals to collaborate and share experiences. As part of this initiative, the IAEA is supporting both the development of a regional education centre to train radiopharmacists and the upgrading of facilities to strengthen the self-sufficient production of radiopharmaceuticals.

As the field of radiopharmaceuticals rapidly evolves and more advanced diagnostic techniques, such as positron emission tomography (PET) and radiotherapeutics, become increasingly common, countries new to radiopharmaceuticals need to catch up quickly, explained Korde.

Several African countries are working on expanding and upgrading their radiopharmaceutical facilities for the production of radiopharmaceuticals, with the help of the IAEA’s technical cooperation programme and through IAEA coordinated research projects.

Through support from the IAEA, Tunisia has been able to start using PET, while Algeria recently installed and started a medical cyclotron — a machine that enables the country to produce its own radiopharmaceuticals and allows for routine PET imaging for many types of cancers, such as lymphomas and lung and colon cancers. This has also enabled the implementation of labelling with the radioisotope gallium-68, which is used for the diagnosis and staging of prostate cancer and neuroendocrine tumours. PET imaging will also allow for the introduction of effective and targeted cancer treatment therapy.

Nuclear medicine and PET imaging techniques are essential for cancer management but are increasingly expensive and inaccessible in many countries. With the new cyclotron facility in Algeria, it is now possible to easily produce large quantities of radiopharmaceuticals to help diagnose and treat more patients each day.

“The development and use of radiopharmaceuticals and their applications in recent years has allowed us to increase our knowledge in detecting, assessing and better treating various types of cancers we previously could not,” said Salah Bouyoucef, Professor of Nuclear Medicine at the Bab El Oued Teaching Hospital in Algeria.

Through IAEA initiatives, African countries that previously had no capacity to produce and use radiopharmaceuticals now do, or soon will. Ethiopia, for example, is in the midst of building its first medical cyclotron at St. Paul’s Hospital Millennium Medical College in Addis Ababa.

The quality, safety and sustainability of radiation technologies, including radiopharmaceuticals, will be discussed at the IAEA's Scientific Forum on Rays of Hope: Cancer Care for All from 27 to 28 September, during the 66th Annual IAEA General Conference. The Scientific Forum will be livestreamed.

How radiopharmaceuticals work and fight cancer

Radiopharmacy involves the preparation and handling of radiopharmaceuticals for diagnosis, treatment and palliation, and is increasingly used for the management of cancer. It enables the screening of tumours, the selection of appropriate therapies, and the monitoring and evaluation of a tumour’s behaviour. Radiopharmaceuticals are produced in hospitals or at industrial radiopharmacies by radiopharmacists, who are responsible for ensuring product quality and radiation safety.

Radiopharmaceuticals contain small amounts of radioactive substances called radioisotopes — atoms that emit radiation. The radioisotopes used can be produced by irradiating a specific target inside a nuclear research reactor or in particle accelerators, such as cyclotrons. Once produced, the radioisotopes are tagged on to certain molecules based on biological characteristics, which result in radiopharmaceuticals.

Once inside a patient’s body, the different physical characteristics and biological properties of radiopharmaceuticals cause them to interact with or bind to different proteins or receptors. The drugs tend to concentrate more in specific body parts depending on the physiological processes and biological characteristics of the radiopharmaceutical. Using special cameras, doctors are able to precisely examine cancerous cells by selecting specific types of radiopharmaceuticals that bind with tumours and make them distinctive. If the radioisotope emits particulate radiation, the radiopharmaceutical may also be used in therapeutical applications.