International classification, cancer and care: accounting for the diagnostic potential of low- and middle-income countries

Year of award: 2022


  • Dr Henry Llewellyn

    King's College London, United Kingdom

Project summary

International cancer classifications are fundamental to oncology. They structure diagnostic routines, research programmes, treatment pathways, and grounds for correspondence and comparison across settings. They are vital to cancer epidemiology, which influences national and global health investment and policy. Importantly, the process of classification is not simply a matter of discerning biological difference; it also demands ethical and political choices, which have major social consequences around the world. They are made largely by classification experts in elite settings in the Global North and overseen by the WHO's International Agency for Research on Cancer. Decision-making is therefore rooted in particular moral frameworks and assumptions about technical capabilities for diagnosis, which might not be appropriate to the situations of practitioners (and patients) in low-and middle-income countries, who often face the challenges of severely limited resources and healthcare infrastructure.

I will address these urgent concerns in my fellowship through a 5-year multi-sited ethnographic research project with a regional focus on sub-Saharan Africa, a region with generally extremely limited cancer diagnostics and treatments, and what has been described as an emerging cancer epidemic. It will focus on brain cancer, an aggressive and highly complex disease, understandings of which are currently undergoing major change.