By Tendai Makaripe
Cancer kills more people globally than HIV, tuberculosis and malaria put together. Last year, it killed nearly 8 million people and by 2020 there are expected to be 16 million new cases of cancer every year.
There is only one conclusion that can be drawn from these tough facts, the conclusion being that cancer is now a major and growing public health challenge in Africa.
Unfortunately, despite the glaring problem cancer poses, cancer has remained at the background of public health discourse in many African countries. The theme “World Cancer Day 2013” was “Cancer – Did you know?” in my opinion this was a perfect tagline for people in Africa.
African countries are the least able to cope with this illness, and the number of deaths and people dying in pain is higher than in the rest of the world simply because its treatment is too expensive and people are not aware of the size of the problem.
Something should be urgently done to effectively deal with the cancer problem in Africa.
Dr. Kingsley Ikenna Ndoh in his article “Cancer –Africa’s ticking time bomb” writes that
“For many years cancer has been thought to be mainly a Caucasian problem in most parts of Africa. And the concept of the disease has remained abstruse, even among health professionals.
“However, in the last decade many African countries have seen the influx of better diagnostic equipment such as Magnetic Resonance Imaging (MRI) and Computerised tomography (CT) scans. With the advent of improved diagnostics, it has become evident that cancer has extended its ugly tentacles to Africa.
“Furthermore, Africa has seen a lot of her prominent citizens die of cancer. For example, the immediate past president of Nigeria, Alhaji Musa Yar’adua was rumored in the local Nigerian media to have died of lung cancer in a Saudi hospital, the immediate past president of Ghana, Professor Attah Mills died of throat cancer in a Accra hospital in 2012.
“There are countless other examples of prominent Africans dying in foreign hospitals as a result of cancer. These deaths from cancer in different parts of Africa have heralded a greater awareness of cancer on the continent.”
Unfortunately, there is a paucity of cancer specialists and resources to prevent and manage the disease. According to the Indian Ministry of Foreign affairs, India made an estimated $2 billion from health tourism in 2012, and it is estimated that 26% of this sum came from Nigerians seeking medical care in India.
A significant percentage of these patients seeking care in India from Nigeria suffered from cancer. It is evident therefore, that a diagnosis of cancer without the means to go “abroad” for treatment is tantamount to a death sentence.
“There have been some efficient campaigns organised around AIDS, tuberculosis and malaria, but recently there have been more deaths in the world caused by cancer than these three diseases combined.
“Africa remains the continent which is least prepared to cope with the devastating effects of this new pandemic, having only a few cancer care services available”, said Filip Kaczmarek, Vice-Chairman of the Development Committee of the European Parliament.
According to WHO GLOBOCAN estimations, in the whole of Africa, there were more than 80 thousand new cases of cervical cancer detected in 2008 and 53 thousand deaths the same year by the same cancer.
“Moreover, a majority of cancers in Africa are diagnosed at an advanced stage because of the lack of screening and early detection services as well as limited awareness of early signs and symptoms of cancer among the public and healthcare providers, said Dr Tawanda Mushawarima, a medical doctor in Harare.
Despite this growing burden, cancer continues to receive low public health priority in Africa, largely because of limited resources and other pressing public health problems, including communicable diseases such as acquired immune deficiency syndrome (AIDS)/human immunodeficiency virus (HIV) infection, malaria, and tuberculosis.
It may also be in part due to a lack of awareness about the magnitude of the current and future cancer burden among policy makers, the general public, and international private or public health agencies.
As the World Health Organisation‘s director general, Margaret Chan, put it, “non-communicable diseases are no longer diseases of affluence”.
In the face of scarce resources, and so many competing priorities, many African countries have been powerless to do much.
”If you are the Kenyan minister of health and you have $10 per head to spend, you can imagine how hard it must be to prioritise,” says Prof David Kerr, a cancer therapeutics specialist and co-founder of the cancer care charity for Africa, AfrOx.
Kerr helped set up AfrOx to raise awareness and improve cancer care in the continent. Out of all the developing regions of the world, countries in Africa are the most resource-challenged: radiotherapy, for example, is available in just 21 out of 53 nations, and there are very few oncologists. Many African languages still do not have a word for cancer.
Yet cancer is only going to become a growing burden.
”More people are now reaching middle age, a time when cancer becomes more prevalent,” explains Dr David Forman, a cancer epidemiologist at the International Agency for Research on Cancer (IARC), a WHO agency, adding that Africa’s population is growing, and getting older.
Emilie Filou, in her article “In Africa, cancer is a burden that can no longer be ignored” states that, “The difference is that a disproportionate number of cancers in Africa are caused by infections, such as the hepatitis viruses (B and C), which cause liver cancer, or the human papillomavirus (HPV), which causes 98% of cervical cancers. The worldwide average for infection-related cancers is about 22%; in Africa, the figures are much higher: 40% of cases in women and 30% in men.”
The silver lining in these grim numbers is that there is a great opportunity to intervene before the onset of cancer, thanks to vaccines, says Dr Corey Casper, an epidemiologist at the Seattle-based Fred Hutchinson Cancer Research Center.
Casper, who runs the Uganda Program on Cancer and Infectious Diseases, which provides research, training and clinical care on infection-related cancers, says the problem is cost: an HPV vaccine treatment costs a whooping $350 (£220), for three doses over six months, whereas the benchmark for standard childhood vaccines is about $1.
To an average family in Africa the cost is too much and once one has been attacked by the disease it is as good as a death sentence.
Said Filou, “…but even at $350 a pop, a vaccination campaign could still be worth running. Cervical cancer is the most prevalent cancer among women in sub-Saharan Africa and the most deadly. However, the cost of national screening programmes also remains substantial, despite efforts to develop lower-cost systems.
While there has not been a detailed cost-benefit analysis of screening versus vaccination for cervical cancer yet, organisations such as the Global Alliance on Vaccination and Immunisation (GAVI) are already working to bring down the cost of the HPV vaccine.”
The problem, Casper says, is that cancer is still perceived as too expensive to treat.
“Some childhood cancers, such as Burkitt’s lymphoma, cost as little $500 to cure, with success rates of 95%. It costs $300 per month for life to keep someone on ARVs [the drugs used for HIV], so a one-off $500 to treat a child seems like money well-spent.”
The international community also dictates the agenda to a certain extent: Uganda receives $200m annually from the US for HIV treatment, but less than a $1m for cancer.
Africa has lost too many precious lives from HIV, malaria and tuberculosis; the last thing Africa need is another public health explosion of many deaths from a raging cancer epidemic.
It is time to disentangle its citizens from the complex web of an epidemic of preventable cancers and infectious diseases. We must turn our lenses to the fight against cancer. Now is the time!
Comments
About Author
