/ 28 September 2012

Beating cancer at its own game

The South African government is considering introducing an HPV vaccine for 10-year-old girls.
The South African government is considering introducing an HPV vaccine for 10-year-old girls.

Vaccinate all girls against HPV
If all 10-year-old South African girls are vaccinated against human papilloma virus (HPV), the country's cervical cancer rate could be dramatically reduced.

Cervical cancer – caused by HPV – is the second most common cancer among women in this country. It is particularly prevalent among black women. There are more than 100 types of HPV, but not all cause cancer. The forms that lead to the condition are usually sexually transmitted.

In 2006, a vaccine that protects against the four main types of cancer-causing HPV was licensed in the United States. Two forms of HPV – types 16 and 18 – are responsible for 70% of cervical cancers, and are protected against by Gardasil, manufactured by the drug company Merck, as well as by another vaccine, Cervarix from GlaxoSmithKline.

The vaccines are close to 100% effective in preventing infection with most forms of cancer-causing HPV, but work much better in people who have not yet contracted HPV. It is therefore recommended that young teenage girls who have not yet had sex are vaccinated against HPV to reduce their chances of developing cervical cancer.

The South African government has indicated that it is considering introducing an HPV vaccine to be administered to every 10-year-old girl in the country. However, both vaccines, which require three shots, are extremely expensive. In the US, for instance, each shot of Gardasil costs about R1 000. The South African health department is negotiating lower prices with manufacturers, but making a vaccine available will still cost hundreds of millions of rands.

Get the cancer registry working
It is crucial that South Africa gathers accurate information on cancer prevalence (how many people have cancer), incidence (the rate at which the condition is increasing) and tendencies. Without such figures, it is impossible to develop appropriate cancer policies or to determine how to spend available resources adequately.  

But South Africa's cancer information system is in a critical state as its cancer registry has not been updated for the past decade. This means that we have no up-to-date information on how many people have cancer, whether cancer is on the increase or what types of cancer are more common than others.

We also don't have any recent data on the prevalence of HIV-associated cancers such as Kaposi's sarcoma. All our statistics are based on information gathered more than a decade ago, or on estimates from other countries with similar health profiles.

The cancer registry collapsed in the early 2000s when some doctors and pathologists feared they could be held legally liable for disclosing patients' personal details.

Last year, new regulations on the registration of cancer were promulgated. These regulations make it compulsory for every healthcare worker who has diagnosed a new cancer case to note it on a prescribed form. Those who don't could be fined up to R30 000.

But although legislation was put in place more than a year ago, so much politics is at play that officials have not managed to get it going yet.

Modernise equipment
South Africa urgently needs new and better maintained radiotherapy equipment. Radiotherapy is the cheapest form of cancer treatment, yet equipment at state hospitals is often out of order, leaving thousands of cancer patients without treatment for months at a time.   

This problem is critical, because cancer becomes increasingly difficult to treat as it spreads through the body and the later the treatment starts, the lower the positive outcomes.

Poor maintenance, including late or non-payment of service providers, also plays a huge part in equipment being out of service. According to radiologists at major teaching hospitals, equipment is often out of date and simply too old to use reliably.

Create a cancer council
Having an organisation to co-ordinate South Africa's cancer-fighting efforts will greatly improve the country's response to the condition, as the one hand is often unaware of what the other is doing.  

Australia has such a body and the US has a National Cancer Institute that co-ordinates cancer research projects conducted by universities, hospitals, research foundations and businesses.

South Africa would benefit from an association that addresses cancer responses on three levels: prevention, treatment and research.

Use tax for health promotion
The government raises R8billion in tobacco taxes every year. If that money is allocated to health, some of it could be used to create a health institute that produces messages to encourage healthy living.

One out of three cancer cases is because of smoking. Increasing the number of messages that discourage young people from smoking can go a long way towards minimising this statistic. Information about lifestyle choices, such as eating habits and a lack of exercise, that significantly contribute to cancer, will also help South Africans to be better informed about ways to prevent the disease.

Extra funding would also make a big difference in the private sector, where non-governmental organisation working to fight cancer and other non-communicable diseases  spend up to 50% of their time raising funds. In effect, it will allow money generated by an addiction that causes deadly disease to be used to stop people taking up the habit.  

Mia Malan works for the Discovery Health Journalism Centre at Rhodes University