Low income countries can beat cancer

The cancer burden is rising globally, exerting significant strain on populations and health systems at all income levels. The International Agency for Research on Cancer (IARC) estimated 18.1 million new cases and 9.6 million deaths across the globe in 2018. This translates to one out of six deaths globally and far exceeding the number of deaths from HIV and Aids, malaria and tuberculosis combined. Cancers of the breast, colorectum, lung, cervix uteri and thyroid are most prevalent among females while those of the lung, prostate, colorectum, stomach and liver are top among males.

The disease burden is greatest in low-income and middle-income countries (LMICs), where 70 per cent of cancer deaths occur with the sub-Saharan Africa projected to have more than an 85 per cent increase in cancer incidence by 2030. This rise is attributed to demographic changes such as ageing and population growth, changing prevalence of cancer risk factors and increased exposure to risk factors such as environmental carcinogens, urbanisation, unsafe food and water, infectious agents, lifestyle changes such as obesity, alcohol and tobacco use.

Many cancers can be prevented. Others can be diagnosed early in their development, treated and cured. However, there is a limited public awareness on cancer symptoms. This coupled with geographical inaccessibility of services, cost of treatment, social cultural factors, poor referral and post referral follow ups and other social determinants of health delay timely diagnosis. The consequence is physical, financial and emotional strain on cancer patients and their families. Ultimately, prolonged disability and premature mortality have social and economic impact on LMICs.

In May 2017, world governments made a commitment to further invest in cancer control as a public health priority, passing the World Health Assembly Resolution 70.12 on cancer prevention and control. However, historically, cancer has received little attention from global policymakers and donors with only 5 per cent of global spending on cancer directed to LMICs while 1 per cent of global health financing is directed to Non-Communicable Dis eases. Thus, LMICs are finding it difficult to respond to the cancer challenge on national health systems.

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Behavioural interventions

At an individual level; avoid tobacco use; eat a healthy diet; if you choose to take alcohol, do so only in moderation; limit processed foods; maintain a healthy weight and be physically active; avoid tanning beds and sunlamps while at the same time protecting yourself from intense midday sun; get vaccinated against Hepatitis B and Human Papilloma Virus; avoid risky behaviors such as unsafe sex and sharing of injectable drug needles; lastly, get regular medical checkups -- regular self-exams and screenings for various types of cancers can increase your chances of “catching it early”-ask your doctor about the best cancer-screening schedule.

Biomedical interventions

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The first step in the event of a diagnosis with cancer would be to find the right doctor for the specific disease followed by designing of a treatment plan and creation of a social support system. Treatment aims to cure disease, prolong life, and improve the quality of life. The most effective and efficient treatment is linked to early detection programmes and follows evidence-based standards of care.

Structural interventions

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In view of the complex nature of the disease and the fragmented and uncoordinated interventions in LMICs, taking a systems approach in cancer control plans tailored to regional and national priorities would address the challenge more holistically. Future research priorities in oncology. Research on oncology in LMICs needs to focus on: (1) risk reduction and early detection aimed at determining specific genetic, biological, and behavioral risk factors for cancer and evaluating innovative models to improve screening and increase early diagnosis and (2) survivorship and symptom science aimed at reducing treatment-related symptoms and enhancing survivorship.

- The writer is an Implementation Scientist based in Nairobi

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