Many specialist doctors and nurses in Africa are migrating to greener pastures, leaving cancer patients with few options. Credit: Jeffrey Moyo/IPS

By Jeffrey Moyo
HARARE, Feb 13 2015 (IPS)

Hidden by the struggles to defeat Ebola, malaria and drug-resistant tuberculosis, a silent killer has been moving across the African continent, superseding infections of HIV and AIDS.

World Cancer Day commemorated on Feb. 4 may have come and gone, but the spread of cancer in Africa has been worrying global health organisations and experts year round. The continent, they fear, is ill-prepared for another health crisis of enormous proportions.

By 2020, according to the World Health Organisation (WHO), approximately 16 million new cases of cancer are anticipated worldwide, with 70 percent of them in developing countries. Africa and Asia are not spared.“Africa is at a crossroads in the face of rising cancer cases, with the disease proving to be more deadly than HIV/AIDS and it is worsening at a time when the continent faces a serious shortage of cancer specialists,” Menzisi Thabane, private oncologist in South Africa’s Eastern Cape Province

“Africa is at a crossroads in the face of rising cancer cases, with the disease proving to be more deadly than HIV/AIDS and it is worsening at a time when the continent faces a serious shortage of cancer specialists,” Menzisi Thabane, a private oncologist in South Africa’s Eastern Cape Province, told IPS.

“Africa and its leaders have failed to recognise cancer as a high-priority health problem despite millions of people succumbing to the disease,” added Thabane.

Most of Africa’s 2,000 plus languages have no word for cancer. The common perception in both developing and developed countries is that it is a disease of the wealthy world, where high-fat, processed-food diets, alcohol, smoking and sedentary lifestyles fuel tumour growth.

While many cancers are linked to unhealthy diets and smoking, a large number – particularly in Africa – are caused by infections like hepatitis B and C which can lead to liver cancer and the human papillomavirus (HPV) that causes almost all cervical cancers.

An HPV vaccine treatment costs 350 dollars for three doses over six months in most sub-Saharan African countries, whereas in Zimbabwe radiotherapy costs between 3,000 and 4,000 dollars for a whole session.

A study published in 2011 found that since 1980 new cervical cancer case numbers and deaths dropped substantially in rich countries, but increased dramatically in Africa and other poor regions. Overall, 76 percent of new cervical cancer cases are in developing regions, and sub-Saharan Africa already has 22 percent of all cervical cancer cases worldwide.

According to Zimbabwe’s Ministry of Health and Child Care, the country only has four oncologists catering to over 7,000 cancer patients nationwide. “The shortage of cancer doctors stands as an impediment to comprehensive treatment and care for cancer patients here,” Dr Prosper Chonzi, director of Health Services in the Zimbabwean capital, Harare, told IPS.

The shortage of cancer specialists is also seen in West Africa.

Last year, The Vanguard, a Nigerian newspaper, reported that there were an estimated 60 oncologists serving over 300 million people in the West African sub-region with fewer than 20 oncologists serving 160 million Nigerians. Ghana has only seven for 24 million people, Burkina Faso two and Cote D’Ivoire just one. Sierra Leone has more than six million people and no cancer doctors.

Across the continent in Kenya, cancer accounts for approximately 18,000 deaths annually, with up to 60 percent of fatalities occurring among people who are in the most productive years of their life. Men are most commonly diagnosed with prostate or oesophageal cancer, and women are most frequently affected by breast and cervical cancer.

Zimbabwe’s health activists blame the absence of cancer education for the upsurge of fatal cases in the African nation. “Very few people, including government, consider cancer a real threat to the health delivery system,” Agnes Matutu, director of the Zimbabwe Cancer Alliance, an anti-cancer lobby group here, told IPS.

Melody Hamandishe, a retired government nutritionist, told IPS she blamed imported genetically modified foods. This contributes to cancer, she said, as does the abuse of alcohol, often causing liver cancer.

In Zambia, anti-cancer activists accuse the government of not prioritising the fight against the disease. “People are perishing in huge numbers because of cancer here in Zambia while government is seized with fighting HIV/AIDS,” Kitana Phiri, a cervical cancer survivor, now a devoted anti-cancer activist based in the Zambian capital, Lusaka, told IPS.

In Tanzania, cancer is also wreaking havoc. A January 2014 report by the Ocean Road Cancer Institute (ORCI), the only specialised facility for cancer treatment in this east African nation, said there are 100 new patients in every 100,000 population out of the country’s population of 45 million.

Finally, in Namibia, uranium workers were reported to have elevated rates of cancers and other illnesses after working in one of Africa’s largest mines.

Rio Tinto’s Rössing uranium mine extracts millions of tonnes of rock a year for the mineral. “Most workers stated that they are not informed about their health conditions and do not know if they have been exposed to radiation or not. Some workers said they consulted a private doctor to get a second opinion,” say researchers at Earthlife Namibia and the Labour Resource and Research Institute who collaborated in a study.

“The older workers all said they know miners dying of cancers and other illnesses. Many of these are now retired and many have already died of cancers,” says the study report.

Cancer is not beyond us in terms of cancer control and reducing the impact of the disease, declared the Cancer Association of South Africa (CANSA) on World Cancer Day this year.

“The global cancer epidemic is huge and set to rise,” said Elize Jourbert, head of CANSA. “In South Africa, more than 100 000 are diagnosed annually. This day helps us spread the word and raise the profile of cancer”.

Under the tagline ‘Not beyond us’, World Cancer Day in South Africa focused on taking a positive and proactive approach to the fight against cancer, highlighting that solutions do exist regarding cancer care and early detection and that they are within reach.

Meanwhile, Ellen Awuah-Darko, the 75-year-old founder of the Accra-based Jead Foundation for breast cancer, says it was her personal experience of finding a breast lump and ending up paying tens of thousands of dollars to be treated in the United States that made her start to push for change.

“In America I had to put down 70,000 dollars before they’d even talk to me,” she said in an interview with Reuters. “I was lucky, I could afford it after my husband died and left me money, but I thought ‘why should I get treatment when others can’t’.”

Now, every Wednesday, Awuah-Darko goes with healthcare workers into communities in the Eastern Region of Ghana to offer women a simple breast examination and show them how to check themselves.

“Early detection can save your life,” she said. “I want everybody to know that. It’s not something people should be ashamed of or embarrassed about.”

Edited by Lisa Vives/Phil Harris    

Local women's NGO, Vois Blong Mere, campaigns for women's rights in Honiara, capital of the Solomon Islands. Credit: Catherine Wilson/IPS

By Catherine Wilson
SYDNEY, Jan 28 2015 (IPS)

Women now face a better chance of surviving breast cancer in the Solomon Islands, a developing island state in the southwest Pacific Ocean, following the recent acquisition of the country’s first mammogram machine.

But just a week ahead of World Cancer Day, celebrated globally on Feb. 4, many say that the benefit of having advanced medical technology, in a country where mortality occurs in 59 percent of women diagnosed with cancer, depends on improving the serious knowledge deficit of the disease in the country.

"While cancer is included on the NCD [non-communicable diseases] list, very little attention and resources are specifically addressing women and breast cancer awareness." -- Dr. Sylvia Defensor, senior radiologist at the Ministry of Health and Medical Services in Fiji
“Breast cancer is a health issue that women are concerned about in the Solomon Islands, but adequate awareness of it among women is not really prioritised,” Bernadette Usua, who works for the local non-governmental organisation, Vois Blong Mere (Voice of Women), in the capital, Honiara, told IPS.

Rachel, a young 24-year-old woman living with her two children, aged three and five years, in one of the country’s many rural villages, did not know what breast cancer was when she detected a lump in her breast in August 2013.

But the lump grew larger prompting her to travel to Honiara several months later to see a doctor.

“She went to the central hospital and was advised to have her left breast removed, but due to the little knowledge that she and her husband had about what it would be like, both were afraid of the surgery,” Bernadette Usua, who is Rachel’s cousin, recounted.

“So they just left the hospital without any medication or other assistance, and went home,” she continued.

Rachel tried traditional medicine available in her village, but the cancer and pain became more aggressive. Usua remembers next seeing her cousin in July of last year.

“She was sitting on her bed night and day with extreme pain, unable to lie down and sleep. But she was still brave as she nursed herself, washed herself and cooked for her children. She cried and prayed until she passed away in September,” Usua recalled.

Breast cancer is the most common cancer in women worldwide and in the Solomon Islands, where it accounted for 92 of more than 200 diagnosed cases in 2012. But its incidence in the developing world, where 50 percent of cases and 58 percent of fatalities occur, is rapidly rising.

Low survival rates of around 40 percent in low-income countries, compared to more than 80 percent in North America, are due mainly to late discovery of the disease in patients and limited diagnosis and treatment offered by under-resourced health centres.

Last year Annals of Global Health revealed that of 281 cancer cases identified in women in the Solomon Islands in 2012, 165 did not survive, while in Papua New Guinea and Fiji fatalities occurred in 2,889 of 4,457, and 418 of 795 diagnosed cases, respectively.

Insufficient public knowledge about the disease is an issue across the region.

“Currently public health education and promotion is focussing heavily on the control of NCDs [non-communicable diseases] as a whole. While cancer is included on the NCD list, very little attention and resources are specifically addressing women and breast cancer awareness,” said Dr. Sylvia Defensor, senior radiologist at the Ministry of Health and Medical Services in Fiji, a Pacific Island state home to over 880,000 people.

In the Solomon Islands, mammograms, or x-rays of the breast, will now be free to all female citizens who comprise about 49 percent of the population of more than 550,000. This is after installation of digital mammography equipment, funded by the national First Lady’s Charity, in Honiara’s National Referral Hospital.

Dr. Douglas Pikacha, general surgeon at the hospital, explained that mammograms were vital to early detection of breast disease and the saving of women’s lives through early treatment, such as surgery and chemotherapy.

Mammography is considered the most effective form of breast cancer screening by the World Health Organisation (WHO), with some evidence that it can reduce subsequent loss of life by an estimated 20 percent, especially in women aged 50-70 years.

But with more than 80 percent of the population residing in rural areas and spread over more than 900 different islands, Josephine Teakeni, president of Vois Blong Mere, is deeply concerned about the fate of many women who are located far from the main health facilities in the capital. An estimated 73 percent of doctors and all medical specialists in the country are based at the National Referral Hospital.

She says that reliable breast cancer screening and diagnosis is urgently needed in provincial hospitals if the mortality rate is to be reduced. Most patients must travel an average of 240 kilometres to reach the National Referral Hospital, commonly by ferry or motorised canoe, given the prohibitive expense of internal air services.

There is also a critical shortage of health care workers in the country with 0.21 doctors per 1,000 people and Teakeni claims that “while waiting for an operation the delay can result in full advancement of the cancer and death.”

However, there is a further challenge with almost half of all women diagnosed with breast cancer refusing a mastectomy, which involves the partial or entire surgical removal of affected breasts, even though it may result in the patient’s recovery, the Ministry of Health reports.

“Many prefer traditional treatment to mastectomy because they believe it is more womanly to have their breast than to live without it,” Pikacha said.

The high risk of cancer mortality is another factor impacting gender inequality in the Pacific Island state where entrenched cultural attitudes and widespread gender violence, experienced by 64 percent of women and girls, hinders improvement of their social and economic status.

Teakeni believes that an urgent priority is dramatically improving “awareness among women about the signs and symptoms of breast cancer, and even simple tests that women can do themselves, such as checking the breast for lumps while having a shower,” as well as the importance and impact of medical treatment.

Still, the installation of the new mammogram machine gives women on this island something, however small, to celebrate.

Edited by Kanya D’Almeida

A tsunami is looming on the horizon and the world is unprepared for it. This one won’t be a massive wall of water but a tidal wave of disease – and experts say the international community needs to act fast to keep it from crashing.

“Non-communicable diseases (NCDs) – cancer, heart disease, diabetes and chronic respiratory diseases, among others – have become the leading cause of death worldwide,” Jeffrey Sturchio, senior partner at the U.S.-based consulting firm Rabin Martin, told a conference organised by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) on World Cancer Day in Geneva.

“Some 36 million people die from (NCDs) every year, 80 percent of them in low and middle income countries – a figure that will increase by 17 percent in the coming years and by 25 percent in Africa,” he added.

Tuberculosis and malaria, in comparison, kill one to two million people around the world every year.

“The disease burden is shifting to NCDs, but since developing countries still have to fight infectious diseases, they face a double burden,” Sturchio warned.

However, developing countries do not appear to be paying adequate attention to the impending crisis.

“In 2010 HIV/AIDS was responsible for 3.5 percent of deaths worldwide, malaria for 1.5 percent, cancer for 12.6 percent and heart diseases for 14 percent,” Cary Adams, chief executive officer of the Union for International Cancer Control, told IPS on the sidelines of the conference on Feb. 4.

These statistics alone should be sufficient for governments to put NCDs high on their list of national priorities. “But in sub-Saharan Africa, HIV/AIDS caused 13.3 percent of deaths, malaria 6.7 percent and cancer 4.5 percent”, he said, which explains why African health ministers keep putting cancer on the back burner.

“But the (reality) is, the problem will double in the next 15 years. There is a tsunami of NCDs approaching and we need to tackle it today,” Adams stressed.

To tackle this “tsunami”, four health federations – the International Diabetes Federation, the Union for International Cancer Control, the World Heart Federation and the Union against Lung Disease and Tuberculosis – came together to form the Non-communicable Diseases Alliance. With a network of over 2,000 non-governmental organisations based in over 170 countries, it seeks to amplify the voice of civil society in the global debate on NCDs.

The Alliance was also instrumental in pushing the United Nations General Assembly to organise, in September 2011, a high-level meeting that officially declared NCDs a “challenge of epidemic proportions”, which, if it is to be addressed, requires the cooperation of governments, civil society and the private sector.

“This is not an easy thing to do,” Adams, who chairs the NCD Alliance, conceded to IPS. “We have tried to work on a common agenda and find consensus, but some NGOs would not talk to us because we engage with the private sector. We try to embrace the private sector without compromising on integrity and independence and everything we do is based on science.”

Still, the mobilisation has borne some fruits. Five years ago, non-communicable diseases were barely on the agenda. The U.N.’s political declaration and a series of follow-up activities built tremendous momentum, resulting in a plan of action that stretches to 2025, with clear targets such as reducing NCD-related deaths by 25 percent in that time frame.

But financial resources are stretched thin, and it is unlikely that the funds needed to launch a massive global campaign will be readily available.

“The reality is that in the last 20 years, tens of billions of dollars in official development assistance have gone to developing countries, mainly (to fight) HIV/AIDS, and it is unrealistic to think that the same will happen again,” Sturchio admitted.

It will therefore be necessary to capitalise on existing investments and reallocate some of the resources already in circulation, he said.

“Hundreds of HIV clinics were created across sub-Saharan Africa that can also be used for NCDs. When patients come to these clinics, they can also be tested for other infections or provided with vaccines,” he suggested.

For Margaret Kruk, a professor at Columbia University’s school of public health, primary care must be reconceptualised to tackle NCDs in low and middle-income countries.

“In theory, many NCD services can be provided in primary care, like primary prevention of hepatitis B, immunisation, smoking cessation, cholesterol and glucose testing, mammography and opportunistic screening for depression,” she said.

“But primary care in (developing) countries is not able to meet NCD challenges. The patient is not seen in a holistic way.”

She added that the challenge is most severe in sub-Saharan Africa, where, for the last half a century, national health plans have been oriented towards the “traditional killers” like infectious diseases, and have also focused heavily on maternal and child health.

This is partly due to the fact that the eight Millennium Development Goals (MDGs) laid out by the United Nations Millennium Summit in 2000 placed a great deal of emphasis on these “preventable causes of death”.

But as the 2015 deadline for achieving these targets draws closer, priorities will have to be re-examined.

Adams believes that one of the Alliance’s most important tasks over the next two years will be to make non-communicable diseases central in the post-2015 international development process.

Indeed, relatively simple public policy measures can go a long way in reducing NCDs – such as pushing people to consume less sugar and salt, eat less fatty foods, give up smoking and exercise more.

Already developing countries are becoming conscious that they don’t need additional funding for those measures. But when it comes to drugs, costs are much higher in developing countries than in the United States, for example.

From the manufacturer to the wholesale distributor, to the intermediaries and the clinics, monopolies, taxes, regulations and administrative hurdles push the price of medicines up to prohibitive rates in the global South.

The Southern African Development Community and the East African Community have undertaken initiatives to harmonise regulations at the regional level, but for Sturchio these are not enough: “Countries must be able to make sovereign decisions on the medicines they use, but today a lot of duplications make the supply chain inefficient.”

He does not believe intellectual property issues constitute an obstacle to stemming the wave of NCDs.

“Most of the medicines needed to treat NCDs are off patent,” he told IPS. “The challenge is to find ways to bring them to the people. Hundreds of medicines (to treat cancer) are very inexpensive and yet unavailable.”