The Bomb

Cancer kills more people globally than HIV, tuberculosis and malaria put together.

Last year, it killed nearly eight million people, and by 2020 there are expected to be 16 million new cases of cancer every year.
There is only one conclusion that can be drawn from these tough facts, the conclusion being that cancer is a major public health challenge in Africa and other developing countries. And something needs to be done fast before this ticking time bomb explodes.
Unfortunately, cancer has remained at the background of public health discourse in many African countries. The theme of World Cancer Day 2013 was “Cancer – Did you know?”
It was a perfect theme, because there is much that we do not know about cancer.
African countries, due to their economic situation, are precariously placed when confronting the disease. Treatment is expensive, public knowledge is limited and people are generally not aware of how big a problem we are facing.
Dr Kingsley Ikenna Ndoh, in an article titled “Cancer – Africa’s ticking time bomb” writes that: “For many years cancer has been thought to be mainly a Caucasian problem in most parts of Africa. And the concept of the disease has remained abstruse, even among health professionals.
“However, in the last decade many African countries have seen the influx of better diagnostic equipment such as magnetic resonance imaging (MRI) and computerised tomography (CT) scans. With the advent of improved diagnostics, it has become evident that cancer has extended its ugly tentacles to Africa.
“Furthermore, Africa has seen a lot of her prominent citizens die of cancer. For example, the immediate past president of Nigeria, Alhaji Musa Yar’adua was rumored in the local Nigerian media to have died of lung cancer in a Saudi hospital, the immediate past president of Ghana, Professor Attah Mills died of throat cancer in a Accra hospital in 2012.
“There are countless other examples of prominent Africans dying in foreign hospitals as a result of cancer. These deaths from cancer in different parts of Africa have heralded a greater awareness of cancer on the continent.”
Unfortunately, there is a paucity of cancer specialists and resources to prevent and manage the disease.
According to the Indian Ministry of Foreign affairs, India made an estimated US$2 billion from health tourism in 2012, and it is estimated that 26 percent of this sum came from Nigerians seeking healthcare – a significant number for cancer-related treatment – in that country.
What this means is that for many people with cancer in Africa, if you don’t have money to fly to India you will die early.
“There have been some efficient campaigns organised around AIDS, tuberculosis and malaria, but recently there have been more deaths in the world caused by cancer than these three diseases combined.
According to WHO estimates, in the whole of Africa there were more than 80 000 new cases of cervical cancer detected in 2008 resulting in 53 000 deaths.
“Moreover, a majority of cancers in Africa are diagnosed at an advanced stage because of the lack of screening and early detection services as well as limited awareness of early signs and symptoms of cancer among the public and healthcare providers,” adds Dr Tawanda Mushawarima from Zimbabwe.
Despite this growing burden, cancer continues to receive low public health priority in Africa, largely because of limited resources and other pressing public health problems, including communicable diseases such as HIV and AIDS, malaria, and tuberculosis.
It may also be in part due to a lack of awareness about the magnitude of the current and future cancer burden among policy makers, the general public and international private or public health agencies.
As the World Health Organisation's Director-General, Margaret Chan, put it, “non-communicable diseases are no longer diseases of affluence”.
In the face of scarce resources and so many competing priorities, African countries have moved slowly to deal with cancer.
“If you are the Kenyan Minister of Health and you have US$10 per head to spend, you can imagine how hard it must be to prioritise,” says Prof David Kerr, a cancer therapeutics specialist and co-founder of the cancer care charity, AfrOx.
Kerr helped set up AfrOx to raise awareness and improve cancer care in the continent. Out of all the developing regions of the world, countries in Africa are the most resource-challenged: radiotherapy, for example, is available in just 21 out of 54 nations, and there are very few oncologists.
Many African languages still do not have a word for cancer. Yet cancer is only going to become a bigger burden.
“More people (in Africa) are now reaching middle age, a time when cancer becomes more prevalent,” explains Dr David Forman, a cancer epidemiologist at the International Agency for Research on Cancer , a WHO agency.
Dr Corey Casper, an epidemiologist at the Seattle-based Fred Hutchinson Cancer Research Centre, runs the Uganda Programme on Cancer and Infectious Diseases, which provides research, training and clinical care on infection-related cancers.
He says the problem is cost: an HPV vaccine treatment costs a whopping US$350 for three doses over six months, whereas the benchmark for standard childhood vaccines is about US$1.
Dr Casper says cancer is still perceived as too expensive to treat.
“Some childhood cancers, such as Burkitt's lymphoma, cost as little US$500 to cure, with success rates of 95 percent. It costs US$300 per month for life to keep someone on ARVs, so a one-off US$500 to treat a child seems like money well-spent.”
The international community also dictates the agenda to a certain extent: Uganda receives US$200m annually from the US for HIV treatment, but less than US$1m for cancer.
It is time to disentangle citizens from the complex web of an epidemic of preventable cancers and infectious diseases.
We must turn our lenses to the fight against cancer. Now is the time!

May 2013
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