Uganda can avert cancer crisis

Contrary to popular belief, cancer is neither new in Uganda nor is it a Western disease; it existed right from the start of Western medicine in the country. The documentation by missionary doctor Sir Albert Cook, the father of modern medicine in Uganda, described cases between 1897-1904 considered to be cancers. Cancer registration started in the late 1940s and Uganda is the only country in Africa with cancer data dating over half a century. Cancer diagnosis was developed in the department of pathology at Makerere Medical School.

“With the ability to count cancers, clinicians could easily describe them.” Such was the description at Mulago Hospital of a peculiar cancer affecting the jaws of children, Burkitt Lymphoma, after the discovery. This discovery greatly impacted cancer medicine, with the first cancer shown to be caused by a virus and curable by using drugs alone.

That Uganda’s cancer was curable received the attention of researchers worldwide. The National Cancer Institute of the United States saw an opportunity to collaborate with Makerere University resulting in the establishment in 1967, of the Uganda Cancer Institute. From this collaboration came training programmes in cancer medicine for Ugandans, consultative services and follow-up programmes for patients.

Uganda was ahead in Africa with a world-class research institute, a respected cancer registry and high calibre cancer experts. It was the envy of many countries in the region including South Africa which didn’t, by then, have a dedicated cancer centre. This good start was not sustained hence the current extremely high cancer morbidity and mortality.

Not surprising, the World Health Organisation (WHO) estimated that there will be six million cancer cases all over the world by 2020, most of these will be in the developing countries in Africa. In the next five years, it is estimated that there will be 60,000 cancer cases in the country at any time. This is alarming given that there is no new investment in cancer treatment facilities. Eighty five per cent of cancer patients are from the rural areas without access to specialised care. Only four per cent cases of cancers diagnosed currently are attended to at the Uganda Cancer Institute, meaning 96 per cent die without care.

The factors that have led to the current increase in cancer include lifestyle changes such as tobacco smoking that causes lung cancer and consumption of alcohol causing liver cancer. Viral infections have also contributed greatly to cancers. Together with environmental changes, these factors are responsible for cancers such as Hodgkin’s lymphoma, Burkitt’s lymphoma and Leukemia, especially in children.

The high cancer death rate in Uganda can be attributed to late diagnosis and care which is a reflection of poor access to services. Further compounded by lack of knowledge, patients first consult traditional healers before seeing qualified medical personnel.

Also, our medical training is skewed towards infections hence cancer comes as an afterthought, a contributory factor to late referral. This is worsened by the fact that cancer treatment in the country is expensive. Although 60 per cent of the current increase of cancer can be directly attributed to HIV infection, cancer is not reflected in the funding of HIV such as Global Fund and PEPFAR. Cancer, therefore, is an example of inequity in health care adversely affecting vulnerable groups such as women, children and HIV population. However, sizable elite members of the population are treated abroad.

Uganda and the rest of Africa are unprepared for cancer explosion mainly due to lack of policies and funding. There is currently growing interest in cancer issues in the country but there is no clear guidance and strategy. A framework for participation of various stakeholders is needed using a workable approach embodied in a comprehensive national cancer control programme. This is recommended by WHO since it is puts emphasis on prevention and the whole community.

Additionally, the government should provide an enabling environment for participation of civil society, medical fraternity, international community, academic institutions and research organisations in cancer control. There must be a strong regulatory system to avoid exploitation of cancer patients and situations for selfish motives.

It is vital that vaccination against Hepatitis B and cervical cancer is included in routine programmes. Screening for cervical and breast cancer must be available and easily accessible at the lowest level of health care system. Accessibility of treatment countrywide should be facilitated through a network of centres coordinated by a national centre of excellence with referral conduits for patient follow-up and surveillance.

In conclusion, Uganda is capable of averting the looming cancer crisis by building on the existing foundation. There are indicators that we can again become a model in cancer control given the steps the government has taken such as: increased funding for the Uganda Cancer Institute and the increased visibility of Non Communicable Diseases in the new Health Policy II and Health Sector Strategic Plan III.

Uganda being signatory to the World Health Assembly declarations on cancer and framework convention on tobacco, we must implement these agreements. Finally, Uganda should support the upcoming UN General Assembly resolution slated for September 2011 on Non Communicable Diseases such as cancer, becoming a Millennium Development Goal.

Dr Orem is the director Uganda Cancer Institute