Cancer: Africa's silent killer
HANY BESADA AND VADIM ERMAKOV - Sep 10 2008 14:25
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
Source: Mail & Guardian Online
Web Address: http://www.mg.co.za/article/2008-09-10-cancer-africas-silent-killer
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