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Cancer: Africa's silent killer

Hany Besada, Vadim Ermakov

The increasing onslaught of cancer in Africa has been largely overlooked and ignored.

While the world is focused on controlling the spread of HIV/Aids, tuberculosis and malaria in Africa, the increasing onslaught of cancer has been largely overlooked and ignored.

According to the World Health Organisation (WHO), by 2020, African states will account for more than a million new cancer cases per year out of a total of 16-million cases worldwide.

Africa remains the continent least prepared to cope with the devastating effects of this new pandemic, having only a few cancer care services available.

The puzzling question for the world’s leading medical practitioners is how cancer has managed to step from its traditional central position in the West to fragile Africa.

Some answers can be found in the rising pollution that is affecting an increasing number of African cities across the continent, as well as ongoing economic development and, consequently, increased life expectancy and disposable income, which has resulted in more Africans living in urban areas and adopting Western dietary patterns.

All of this has resulted in a gradual increase in cancer cases, particularly breast cancer among women and prostate cancer among men.

African men and women are not only more likely to get prostate or breast cancer respectively at a younger age, but also more likely to be diagnosed at a more developed stage of the disease.

Underlying causes
The WHO has furthermore identified the underlying causes of the increase in cancer cases. Principally, the problem is exacerbated by steadily aging populations, high smoking rates, poor nutrition (which destabilises the immune system), and the adoption of a lifestyle rich in fatty foods and lacking exercise.

This has prompted a number of scientists to speculate that there may be a genetic component contributing to the development of cancer in Africans. However, critics contend that Caucasian women continue to record a higher incidence of breast cancer than their African counterparts.

Moreover, it has been suggested that increasing cancer rates in Africa may be a direct result of the HIV/Aids pandemic, which lowers the body’s immunity and creates abnormal cells that cannot be killed swiftly by medical treatment, but which rather multiply and cause cancer in the long run.

Breast cancer represents 22,2% of all cancers among women, with a varying geographical magnitude, of which the densely populated Kampala in Uganda and Harare in Zimbabwe account for 11,3% and 12,6% of cancer cases respectively.

According to a World Bank-funded study (2007), due to increased air pollution caused by vehicle exhaust gases and dust—carrying pollution levels nearly 10 times higher than the WHO standard—there are about 200 new cancer cases diagnosed in the Burkina Faso capital, Ouagadougou, every year. Zimbabwe’s autocratic President Robert Mugabe is also believed to have developed prostate cancer, which he can have neither diagnosed nor treated in Harare. 

In Zimbabwe’s case, the surge of cancer cases in recent years has placed an even heavier burden on the country’s deteriorating healthcare sector. It is thought that up to 80% of the pharmacists, therapists, doctors, nurses and radiologists who were trained in the country after independence have already emigrated—mainly to the United Kingdom, Australia, South Africa, Namibia and Botswana.

Grim picture
Although many of the cancers found in Africa are preventable or treatable when detected early enough, the grim picture of insufficient resources and a lack of basic infrastructure means that most Africans have no access to cancer screening, early diagnosis, treatment or palliative care. With life-saving radiotherapy being available in only 21 of Africa’s 53 countries, which are accommodating less than 20% of the population, many die in pain and misery due to a lack of treatment.

At the same time, more than one-third of cancer deaths are a result of preventable causes, such as viral infection, poor nutrition, pollution and widespread tobacco use.

Governments across the continent are not adequately prepared to address the growing cancer burden, with resulting survival rates that are often 50% lower than those of the more developed regions.

With high mortality rates, numerous political and socio-economic ills, rampant crime levels and corruption, the continent now has to face yet another major challenge—the spread of non-infectious diseases, and cancer in particular. The WHO has reportedly stated that Africa is expected to have the highest incidence of cancer by 2030, should present trends continue.

As a policy recommendation, it is necessary to establish effective, affordable and workable cancer control plans (particularly national control programmes), which would require the integration of clinical and public health systems in African countries in order to fight the onslaught of cancer. African governments must be the driving force in implementing cancer control programmes, with multilevel support from the international community, if a successful implementation of these programmes is to be effective.

International governments and organisations would need to work collectively and take note of existing awareness, educational, prevention and treatment programmes to help facilitate the delivery of comprehensive cancer care programmes to African states, and raising awareness among many Africans who are living with the disease.

After all, the state of health of people living in Africa must become a global concern, because it is more cost-effective to prevent a pandemic while it is in its infancy, rather than dealing with it at the development stage.

Hany Besada is senior researcher and programme leader, health and social governance, at the Centre for International Governance Innovation in Waterloo, Canada. Vadim Ermakov is from the Hertie School of Governance in Berlin

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