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Cancer is currently responsible for more than 7 million deaths
per year worldwide, more than malaria, tuberculosis and
HIV/AIDS combined. There are more than 600 000 deaths
annually in Africa from cancer. In the developing world, the
number of new cancer cases will increase significantly over the
next 10 years. By 2020 there are expected to be 15 million new
cases of cancer every year, 70% of which will be in developing
countries, where governments are least prepared to address the
growing cancer burden and where survival rates are often less
than half those in more developed countries. African countries
will account for over a million new cancer cases a year and
they are the least able of all developing countries to cope,
having fewest cancer care services.
Currently the world is focused on controlling the spread
of HIV, TB and malaria, which are all acknowledged to be
major killers in the developing world. Huge sums of money
are currently available to help combat these diseases. Cancer
is set to become the newest epidemic in the developing world,
claiming a vast number of lives, and there is currently limited
funding available to tackle this disease. Raising awareness
of this looming epidemic in Africa is the first step. If we take
concerted action now, we can prevent another tragedy.
A meeting on Cancer Control in Africa was held on 10 - 11
May 2007 in London to raise awareness of the growing cancer
epidemic in Africa and to determine how best to deliver
comprehensive cancer care to Africa. A new organisation
(AfrOx) set up by Professor D Kerr, Oxford University,
organised the meeting.
Over 130 delegates attended the meeting, which was held
in London’s Reform Club. Twenty African countries (Benin,
Botswana, Burkina Faso, Cameroon, Cape Verde, Egypt, Gabon,
The Gambia, Ghana, Lesotho, Libya, Malawi, Mauritius,
Morocco, Mozambique, Nigeria, Rwanda, Sierra Leone, South
Africa and Zambia) and the Yemen were represented at the
meeting by their Ministers of Health, their representatives, or
their leading oncologists. In addition, representatives from
major national and international health care and cancer-related
charities and organisations including representatives of the
pharmaceutical industry, the World Health Organization, the
World Bank, the International Agency for Research on Cancer
(IARC) and the African Development Bank, members of the
UK parliament, African doctors and health care workers
attended the meeting, together with leading oncologists from
the RSA, UK, USA, France, Netherlands, Ireland, Sweden,
Norway and India.
The aims of the meeting were to: (i) determine the degree of
priority cancer is afforded in national programmes in Africa;
(ii) determine the most affordable and effective components of
cancer control; (iii) decide on a clear implementation strategy
for bringing these programmes to African countries; (iv) design
mentorship and training programmes for African health care
workers and scientists, and engage the support of Oxford
University and the international cancer care community to
run these programmes; and (v) identify a strategy to raise the
necessary funds to enable implementation of the cancer control
programmes.
The African health ministers and their representatives
who presented at the meeting stated unanimously that
they recognise the explosion in cancer incidence and would
welcome the support of the international oncology community
in tackling the growing cancer epidemic, but that in order to
deliver comprehensive cancer control to Africa effectively we
must integrate with existing programmes that are tackling
AIDS, malaria and TB.
This is the first collective and definitive statement by a
representative cross-section of African health ministries of the
urgent need to initiate cancer control programmes. It lays to
rest the myth that the only health priorities in Africa are those
related to infectious diseases and that care of chronic diseases
is best integrated with existing programmes.
In Africa, it is thought that up to a third of cancer deaths
are potentially preventable. In 2002 in sub-Saharan Africa,
there were more than half a million cancer deaths, of which
almost 40% can be explained by chronic infection and tobacco
usage. Chronic infection with the hepatitis virus increases the
risk of liver cancer, infection with HIV increases the risk of
Kaposi’s sarcoma, and chronic infection with certain types of
human papillomavirus increases the risk of cervical cancer.
Today we have vaccines to protect against hepatitis B and
human papillomavirus infection, but they are not available
in the countries that need them most. Tobacco use is the most
preventable cause of death. Unless we see concerted action to
establish cancer prevention programmes (vaccination, anti-
smoking measures, etc.) to reduce the number of cancer cases,
the limited treatment facilities that exist in the majority of
African countries will be completely overwhelmed by an ever-
expanding cancer burden.
Lack of resources and basic infrastructure mean that
most Africans have no access to cancer screening, early
diagnosis, treatment or palliative care. While there have been
some improvements in recent years (in 1991 there were 63
radiotherapy machines and currently there are over 200),
radiotherapy is available in only 21 of Africa’s 53 countries,
reaching less than 5% of the population, and consequently
patients are denied a treatment that can be life-saving and
significantly improve cancer pain.
Some of the startling findings at the London meeting
included: (i) cancer sufferers, when diagnosed, face
The cancer burden in Africa
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stigmatisation in many African countries; (ii) a diagnosis of
cancer is equated with an inescapable and painful death; and
(iii) the majority of attending nations have no elements of a
cancer plan.
The main output from the meeting was the London
Declaration on Cancer Control in Africa (see www.afrox.org),
a document that aims to raise awareness of the magnitude of
the cancer burden in Africa and to call for immediate action to
bring comprehensive cancer care to African countries.
It builds on the World Health Assembly Resolution on
Cancer Prevention and Control (2005) and on previous
declarations from the International Atomic Energy Agency
(Cape Town Declaration on Cancer Control in Africa,
December 2006) and the International Union Against Cancer
(World Cancer Declaration, July 2006).
There was complete agreement among delegates that
the only way effectively to prevent, detect and treat the
rising numbers of cancers in Africa is to develop broad
partnerships between local health care delivery systems,
research institutions, international organisations, national
governments in developed and developing countries, and
the pharmaceutical industry. Strong local and international
leadership is essential. The relevant organisations and
individuals, with funds from government and private
donors, must be brought together to develop achievable and
sustainable national cancer plans that are evidence based,
priority driven and resource appropriate for African countries.
Delegates also agreed that the introduction of cancer care
into African countries requires integration of clinical and
public health systems so that they become truly comprehensive
and bring together prevention, early diagnosis, treatment,
palliative care and the investment needed to deliver these
services in terms of trained staff, equipment, relevant drugs
and information systems. However, any cancer control strategy
must be guided by the needs of the country and must be
resource appropriate for that country.
We believe that we have a timely opportunity to develop
a sustainable model for developing comprehensive cancer
care to African countries, authored by the member states and
with technical, policy and financial support provided by inter-
agency alliances and governments in the developed world.
Daniel A Vorobiof
Sandton Oncology Centre
Johannesburg
Raymond Abratt
Groote Schuur Hospital and University of Cape Town
Cape Town
Corresponding author: D A Vorobiof (voro@tiscali.co.za, voro@global.co.za)
Key reading
Editorial. Cancer treatment: not just a question of costs. Lancet 2007; 369: 1665.
Global Action Against Cancer. Geneva: World Health Organization and International Union against
Cancer, 2005: 1-24.
Kmietowicz Z. Tackle cancer in Africa now to prevent catastrophe, say health activists. BMJ 2007;
334: 1022-1023.
National Institute for Health and Clinical Excellence. Referral Guidelines for Suspect Cancer. London:
NICE, 2005. www.nice.org.uk/pdf/cg027niceguideline.pdf (last accessed 4 September 2007).
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