Winning the cancer war in sub-Saharan Africa

Non-communicable diseases (NCDs), such as cardiovascular disease, cancer, diabetes, and obesity, kill 41 million people per year, with 77 percent of these deaths occurring in low- and middle-income countries (LMICs).

In sub-Saharan Africa, NCDs are now responsible for roughly 37 percent of deaths – up from 24 percent in 2000. Cancer is one of the top three diseases driving this increase, accounting for more than a half-million deaths in 2020. And this number is expected to double by 2030 if the current status quo is maintained.

As with other NCDs, many cases of cancer could be prevented by addressing behavioural risk factors, such as tobacco and alcohol use and obesity, which contribute to more than 40 percent of all cancer deaths worldwide.

Many common cancers, such as colorectal, breast, prostate, and cervical cancer, can now be treated successfully if detected early. But they remain among the deadliest in Africa, because patients there are typically diagnosed too late with advanced disease and frequently do not complete their care.

There are multiple reasons for this, including a combination of financial (out-of-pocket), health-system, and sociocultural barriers, as well as chronic underfunding that impedes the ability of African public-health agencies to provide timely, value-based quality care. Many African countries also lack the resources, infrastructure, and workforce needed to implement effective vaccination and population screening programmes. And, despite improvements over the last few years, many countries do not have access to safe, timely diagnostic and treatment services.  Consequently, cancer survival rates in LMICs are abysmally low compared to high-income countries (HICs).

A recent Lancet Oncology Commission report on cancer in sub-Saharan Africa that I co-authored emphasises the need for African governments to invest in local data collection and research to support and develop resource-efficient cancer detection and treatment programmes tailored to their countries’ specific needs and funding requirements. We also recommend that governments start to think of innovative ways to expand universal health-care coverage to include cancer services such as early diagnosis, targeted treatments, and supportive care.

Kenya, Nigeria, and other countries are already moving ahead with initiatives to expand access. By mobilising international support and engaging local stakeholders, these countries could invest in prevention and early detection strategies, including mobile screening units, community outreach programmes, self-examination kits, in vitro diagnostics, and telehealth, thus improving prevention and early detection.

But diagnosis is not enough. “System preparedness” is essential, and the infrastructure and skilled workforce to provide treatment for detected cancers must be expanded in tandem with any early diagnosis.

Moreover, to ensure equal access to health services, African countries should train primary-care physicians to identify early signs of cancer and facilitate timely referrals. A patient in sub-Saharan Africa sees 4-6 health-care providers, on average, before a cancer diagnosis is made.

Governments should also integrate resources meant for Covid-19, HIV/Aids, and other infectious diseases toward comprehensive strategies. While integrated clinics capable of treating both infectious diseases and NCDs would be ideal, policymakers must be pragmatic and consider the shortage of health-care personnel, particularly in densely populated areas, and develop models and innovations that can help bridge some of these access barriers.

-- Project Syndicate

Dr Mutebi is a breast surgical oncologist and assistant professor of Surgery at the Aga Khan University Hospital, Nairobi.