Can High Cancer Rates in Sub-Saharan Africa be Contained?

A commission recommends expanded universal health care and early cancer screening to fight against cancer in sub-Saharan Africa, one of the worst-hit regions in the world.

A new Lancet Oncology Commission finds that annual cancer deaths in sub-Saharan Africa (SSA) could reach 1 million by 2030, almost double the 520,000 deaths from cancer that happened in 2020.

Without rapid interventions, the commission notes, cancer incidence is also projected to double by 2040 to more than 1.4 million cases per year.

In comparison to the rest of the world, about 4.2 percent of all new global cancer cases are estimated to have occurred in SSA.

Women are more affected by cancer than men in SSA (139.0 vs 119.4 per 100,000), in contrast to the US and Europe, with breast and cervical cancer among the most common types of cancer in the region. Breast cancer fatalities can be reduced by screenings, while cervical cancer occurrences can be reduced by HPV vaccines.

What’s more, childhood cancer prevalence in SSA now stands at 56.3 cases per million and based on current projections, half of the global childhood cancers in 2050 will take place in Africa.

The growing cancer crisis in SSA could be the result of a combination of factors, including infections, environmental exposures, ageing populations, increasing adoption of Westernised lifestyles, and infrastructure challenges, a news release explains.

To make matters worse, many of these factors were further exacerbated during the coronavirus pandemic.

The Commission, made up of national and international experts from healthcare and academia, offers a framework that can be utilised by governments and NGOs (non-governmental organisations) to boost access to cancer care, speed up cancer prevention and increase survival in SSA.

“Projected trends underscore the devastating costs of inaction on cancer incidence rates and cancer mortality in sub-Saharan Africa,” says Commission Chair Wilfred Ngwa, Johns Hopkins Medicine, USA/ICT University, Cameroon.

“While the list of barriers hindering effective cancer control in the region is long, the pursuit of robust cancer registries, effective cancer control plans, early cancer screening and detection, and the integration of palliative care into the cancer care pathway is especially critical.

“In parallel, there needs to be a greater focus on the implementation of telemedicine and new technologies, building and training the oncology workforce, and boosting cancer research. Despite these enormous challenges, our findings and recommendations highlight that solutions exist to radically improve cancer care across the region.”

Sub-Saharan Africa beset by cancer

In a separate study by the International Agency for Research on Cancer (IARC) that was published alongside the Commission, breast and cervical cancers were the most common forms of the disease, ranking first in 28 and 19 SSA countries respectively in 2020.

The study also noted that cervical cancer was responsible for most cancer deaths (1 in 100 deaths) and was the leading cause of cancer deaths among women in 27 countries (breast cancer, on the other hand, was the leading cause of cancer deaths in 21 countries).

Even though there are geographic variations to be taken into consideration, women in SSA have a risk of almost 14 percent of developing cancer by the age of 75. In males, prostate cancer was the leading cause of cancer (77,300 cases) in 40 SSA countries, followed by liver (24,700 cases) and colorectal cancer (23,400 cases).

The disease cannot be challenged properly because there is a scarcity of cancer prevention programmes, and even if there were, most SSA countries have prevention programme participation rates lower than 50 percent, with some cases as low as 10 percent or less.

As for cervical cancer, more than a third of all global deaths from the disease occur in SSA, even though the SSA female population represents only 14 percent of the global female population. HPV vaccination coverage rate is low, at 49.4 percent on average – and only 16 out of SSA’s 46 countries had rolled out HPV vaccination programmes.

The news release also lists the reasons for a substantial portion of the cancer burden in SSA, including infectious diseases (most commonly viral diseases, including HPV), tobacco use, alcohol consumption in men, and daily high-calorie intake.

For example, obesity rates have increased significantly due to the shift to a more Western diet alongside more sedentary lifestyles, jumping by 1400 percent in Burkina Faso and by more than 500 percent in Ghana, Benin, Ethiopia, and Togo in the past three decades.

Thanks to forceful marketing campaigns by tobacco companies, tobacco use has skyrocketed, as opposed to high-income regions. Across Africa as a whole, smoking is predicted to increase by 41 percent from 12.8 percent in 2010 to 18.1 percent in 2025, while in some countries the rate is already much higher, such as Lesotho, where tobacco use is at 26.7 percent.

Alcohol use is more varied with some countries drinking more than others, and others completely abstaining from it.

The Commission does note that there has been some silver lining: as the first low-income country to have implemented a national HPV vaccination programme, Rwanda was so successful that the country became one of the countries with the highest HPV vaccination coverage worldwide.

“Population knowledge and attitudes about cancer risk factors are critical to reducing the burden of cancer in sub-Saharan Africa,” said Commission co-chair Beatrice Wiafe Addai, at Peace and Love Hospitals Ghana and Breast Care International.

“Public health campaigns need to form an instrumental part of any effective cancer control programme to raise population awareness about harmful risk factors, and healthy habits and dispel misinformation.

“At the same time, transformative policies must be in place to foster cancer prevention uptake. Previous case studies have shown that civil societies could work with governments to design cancer awareness education programmes, scalable across SSA in parallel with other initiatives.”

Recommendations

The Commission offers a list of eight actions to make decisive progress toward reducing the burden of cancer in Sub-Saharan Africa:

1. Develop or update national cancer control plans and provide sustained financing, to ensure their implementation

2. Invest in cancer registration to provide data upon which rational cancer planning will be undertaken

3. Expand universal health coverage, incorporating cancer care into essential benefits packages and national health insurance systems to reduce out-of-pocket expenditures for essential therapies for citizens with cancer

4. Pilot early cancer screening and detection programmes that make use of point-of-care technology delivered by allied health professionals

5. Include palliative care as an integral and key part of cancer care

6. Establish relevant training programmes for healthcare and allied professions to build and maintain the cancer workforce

7. Establish national cancer research institutes and committees with agreed funding streams; develop international collaborations and external partnerships

8. Invest in telehealth and other digital health solutions.

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