Maternal and infant mortality, early pregnancies, fragile health systems, HIV, malaria, tuberculosis... And now, among the challenges that sub-Saharan Africa faces in terms of health, there is one that also needs visibility: cancer.
The threat is not new, since the continent has suffered its ravages for a long time, but its expansion, far from stopping, is skyrocketing.
This is the conclusion reached by a group of experts in the field and that can be read in a report published this Tuesday in the scientific journal
The Lancet .
.
Their conclusions are harsh: they calculate that when we reach the year 2030, one million people will die annually from this disease in its many variants.
This represents double the mortality currently registered, with 520,348 deaths in 2020, according to the World Health Organization (WHO).
Cases will also skyrocket: up to 1.4 million annually.
These are figures that they take for granted "if we do not intervene quickly," experts warn.
The report has been prepared by an international team made up of 53 specialists led by doctors Wilfred Ngwa, from Johns Hopkins University (United States), and Beatrice W. Addai, oncologist and CEO of the Peace & Love hospital in Accra (Ghana) and founder of Breast Cancer International, and which focuses on the sub-Saharan region, that is, it does not include countries in North Africa.
Throughout its 82 pages, it breaks down the trajectory that 21 types of malignant tumors will present and places special emphasis on the causes behind such high figures.
This commission of experts, made up of professionals from the academic and health worlds, calls for improved access to cancer care, prevention and diagnosis, and proposes a national control plan for each country.
Africa has made enormous progress in recent decades to combat the main causes of mortality and morbidity, such as communicable diseases (mainly HIV, tuberculosis and malaria), maternal, nutritional and perinatal diseases.
Thanks to these efforts, funding and improvements in living standards in general, the data has improved.
But the cancer has made an appearance.
In previous years it was already warned that the incidence of what is usually called the "silent epidemic" was increasing.
Specifically, in 2018 the International Agency for Research on Cancer (IARC) reported that 693,487 Africans would die from this cause that year, with a projected increase of 1,429,812 deaths by 2040 across the continent.
In the case of sub-Saharan Africa, in particular, in the last 30 years the incidence has also doubled.
Yet Africa only receives 5% of the global funding needed to prevent and treat these diseases, according to other research.
In fact, right now malaria causes 60% less mortality and tuberculosis also claims fewer lives.
In 2020, sub-Saharan Africa registered 4.2% of the cases worldwide and goes in the opposite direction to the rich states, where the chances of dying from this cause have decreased by 20% between 2000 and 2015. Also the other way around in Europe and the United States, women are more affected than men, with 139 affected compared to 119.4 per 100,000 inhabitants.
The most common among men
is prostate, and liver and colorectal are listed below.
However, the researchers express their concern about two groups that are especially threatened: women and children.
As for the former, they calculate that one in seven (14% of all African women) is at risk of developing cancer before the age of 75 and that cervical and breast cancers are the ones that cause the most deaths. .
“More than a third of all deaths from cervical cancer in the world occur in sub-Saharan Africa, despite the fact that this population only represents 14% of the global female population.
Meanwhile, only 16 of the 46 countries in the region had launched vaccination programs against the human papillomavirus in 2019, with an average vaccination coverage rate of 49.4%,” reads the publication.
about the children,
researchers estimate that by 2050 half of child patients will also occur on the continent.
The current prevalence is 56.3 per million inhabitants.
A multifactorial problem
The escalation of cancer can be attributed to a combination of factors.
One of the main ones has to do with the fragility of the health systems in most sub-Saharan countries.
Facilities and programs for prevention, diagnosis and treatment are insufficient, as well as qualified personnel.
In fact, in most of the nations evaluated, participation rates in prevention programs are less than 50% and in some they barely reach 10%.
It is in line with health spending:
the average is 4.95% of the Gross Domestic Product, according to the World Bank, compared to 9.9% in the European Union.
A woman holds a plaque during a march to raise awareness of the importance of screening to prevent breast cancer in Nairobi, Kenya. SOPA Images (Getty Images)
In sub-Saharan Africa, more patients die than in the rest of the world before and during interventions due to the aforementioned deficiencies in public health.
A 2020 survey of 34 health centers in the region that offered treatment services revealed that, although practically all of them had equipment to perform CT, X-ray and ultrasound scans, only 23 offered MRIs and only four performed CT scans.
It must be added that these establishments are usually located in urban areas, which complicates access for the rural population;
in fact, another study quantified that 70% of the population of the continent does not have access to radiotherapy services.
Another reason cancer can occur is because it is associated with an infection.
The liver can come from hepatitis B or C;
and that of the cervix, by the human papilloma virus.
Sub-Saharan Africa has the highest percentage in the world of malignant tumors resulting from a previous infection: 27% of all those registered in 2018. Specifically, the high rates of HIV (which are also the highest in the world) have led to the incidence of malignant tumors such as Kaposi's sarcoma, cervical cancer and non-Hodgkin's lymphoma.
"Despite the reduction in HIV-related deaths due to the expansion of antiretroviral therapy, HIV-associated malignancies have not shown a decrease in their incidence," the study authors warn.
The lack of information also makes it difficult to reduce rates: in a continent where awareness-raising efforts focus on issues such as gender equality or the importance of hygiene to prevent disease or family planning methods to avoid unwanted pregnancies, information about cancer is relegated to the background.
It is increasingly common to find awareness days in African public health centers, but the information collected confirms that they are clearly insufficient.
This lack results in patients presenting at medical centers with tumors in very advanced stages, already incurable.
In addition, there is another group of factors that have more to do with the westernization of the African way of life: smoking, alcoholism, a sedentary lifestyle and increasingly worse eating habits are a quartet that swells the annual number of cases and deaths.
Obesity caused by the consumption of ultra-processed foods is associated with types of cancer such as breast, cervical and colorectal.
As for tobacco, the study condemns the "aggressive" marketing campaigns of tobacco companies, which have caused an increase in consumption "in clear contrast to high-income regions."
Cigarette consumption is projected to have increased by 41% by 2025, up from 12.8% in 2010, and countries such as Lesotho are already registering 26.7% consumption.
A considerable percentage of deaths from cancer of the lung, trachea, bronchi and mouth are attributed to this habit.
Alcohol intake, however, is more variable, because there are States – Muslims, fundamentally – that report total abstinence, while others give high figures of consumption.
With regard to environmental factors, it is well known that sub-Saharan African economies depend, to a greater or lesser extent, on agricultural and mineral extractive industries, all of which are associated with increased exposure to known carcinogens such as pesticides, mercury, hazardous chemicals and polluted air.
Exposure to these agents also influences.
Finally, and as the only positive reason, there is the aging of the population, which is also greater than before because the development of recent decades has brought with it an increase in life expectancy.
Beth Kabasabiti, a member of an association that supports women with cancer, coordinates a session among several affected women at the Mulago hospital in Uganda.
Lynsey Addario (Getty Images)
treatment abandonment
Another consequence of the increase in mortality is that the treatment abandonment rate is very high due to their high costs and the poverty of the population.
In the case of women with breast cancer, 38% do not finish it, exemplifies the report.
In the case of children, in Kenya, 54% do not finish it, and in Zambia, 46%.
And with regard to the smallest, one more complication arises: the lack of pediatric oncologists means that children obtain a diagnosis when the disease is already very advanced.
In fact, only four countries have this type of specialist in their public health system: South Africa, Uganda, Tanzania and Ghana.
The other 31 nations studied report that they do not have this profile, so children are treated by nurses and general practitioners.
Poverty is noticeable when it comes to paying for treatment.
The researchers affirm that treating cancer is not cheap in Africa, and that, on top of that, African countries pay higher prices for medicines for these pathologies than Latin American countries with a similar income level or disease rate.
"Consequently, this leaves the door open for low-quality generic drugs to flood the market," the authors write.
urgent actions
Reversing or, at least, slowing down the impact of this range of diseases in sub-Saharan Africa is a matter of doing, but also of not doing.
The most urgent recommendation is that each country develop or update its national plan for the control of these pathologies, and that this include the necessary specifications for childhood cases, comorbidities such as HIV or malnutrition, the supply of adequate medications and the provision of psychosocial, supportive and palliative care.
It is important not to turn our backs on traditional medicine practices, since they are used by 80% of citizens, the study notes.
Developing comprehensive case registries and investing in diagnosis, treatment, research, digital technologies and staff training is just as important.
With regard to financing mechanisms that involve the mobilization of funds, the recommendation is that these be pooled and then allocated to health associations such as the Global Fund against tuberculosis, malaria and HIV or GAVI, the Global Alliance of vaccination, to ensure that patients have faster and more equitable access to medicines.
As for the practices that must stop, the authors draw attention to the brain drain.
“Large investments in training and recruitment will be wasted if high-income nations continue to attract local staff with more lucrative NHS job offers.
Government cooperation between African states and high-income countries is essential to end the brain drain and improve retention rates.
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