SARA STULAC is a paediatrician, but doctors in Rwanda must be adaptable. One of her first patients after arriving from America in 2005 was a young girl with a tumour the size of a cauliflower on her face. The girl’s father, a subsistence farmer, had tried traditional healers and local doctors, but the tumour had grown, along with his expenses. An oncologist was needed. If only the country had one. Eventually Dr Stulac called one in America who talked her through the treatment that would save the girl’s life.

What makes this story unusual is its happy ending. According to the International Agency for Research on Cancer (IARC), part of the World Health Organisation (WHO), low- and middle-income countries accounted for 57% of the 14m people diagnosed with cancer worldwide in 2012—but 65% of the deaths. Cancer kills more people in poor countries than AIDS, malaria and tuberculosis combined.

Residents of poor countries have long suffered from cancers, such as those of the liver and cervix, that are associated with infections. But as they have grown richer, drinking, smoking and fatty foods have led to more breast, colorectal and lung cancer. Women who used to die in childbirth now live long enough to develop breast cancer. HIV patients on antiretroviral drugs are dying of other causes.

Glass-half-full types view this as a success. But resources have not shifted with the burden of disease. Many developing countries have no trained oncologists, let alone a treatment centre. Even where care is available, the sick often delay because they are poor or do not know that treatment is urgent. Some languages have no word for cancer.

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