Cancer mortality could double by 2030 in sub-Saharan Africa

In sub-Saharan Africa, without rapid intervention, cancer-related mortality could double by 2030 to one million deaths per year, with an incidence of 1.4 million new cancer cases each year. This is the alert of a commission within “Lancet Oncology”, which calls for improving access to cancer care, but also cancer prevention and diagnosis. A national control plan is proposed for each country.

“The projected trends underscore the devastating costs of inaction on cancer incidence rates and cancer mortality in sub-Saharan Africa.emphasizes the president of this commission, Professor Wilfred Ngwa. While the list of obstacles standing in the way of effective cancer control in the region is long, the search for robust registries, effective national plans, early screening and detection, and the integration of palliative care into the care pathway is particularly critical.

Most affected women

This analysis, along with recommendations, is accompanied by a series of articles and comments, including a study by the International Agency for Research on Cancer (IARC), carried out in particular from the GloboCan database for the year 2020 According to this work, women in the region are more affected than men, with respective prevalences of 139 versus 119.4 per 100,000.

Breast cancer (129,400 cases per year) and cervical cancer (110,300 cases per year), the most common in the region, are responsible for three out of ten cancers. And, a woman in the region has a 14% risk of developing cancer before the age of 75, with breast (4.1%) and cervical (3.5%) cancers responsible for half of that risk. As a result, while women in sub-Saharan Africa make up 14% of the global female population, they account for more than a third of all cervical cancer deaths worldwide.

Among men, prostate cancer has the highest incidence (77,300 cases per year) and is the main cancer responsible for death in 26 countries in the region. In terms of incidence, it is followed by liver cancer (24,700 cases/year) and colorectal cancer (23,400 cases/year). In children, the prevalence of cancer is now 56.3 cases per million and, according to current projections, half of the world’s childhood cancer cases will occur in Africa by 2050.

Both structural and sociocultural causes

Various factors are involved, and for some exacerbated by the pandemic. In addition to environmental exposures, population aging, and the growing adoption of westernized lifestyles (dietary and sedentary), the region faces structural challenges related to infrastructure problems and a shortage of personnel and qualified establishments for diagnosis, treatment, and prevention. .

Sociocultural factors also come into play with a low educational level and traditional beliefs that attribute, for example, cervical cancer to supernatural causes or to a strategy of men to have more than one wife.

Specifically, prevention programs have participation rates of less than 50% and, in some cases, less than 10%. At the same time, cancer risk factors remain poorly understood, while obesity is skyrocketing with increases of 1,400% in Burkina Faso and more than 500% in Ghana, Benin, Ethiopia, and Ethiopia over the last three decades. Togo. The trend is similar for smoking, with an expected increase of 41%, from 12.8% in 2010 to 18.1% in 2025.

And for diagnosis and treatment, sub-Saharan Africa has the lowest availability of facilities in the world, which remain concentrated in urban areas. According to a survey carried out in 2020 among 34 centers, the structures are under-equipped: while all have standard radiology, computed tomography and ultrasound, only 67.6% have magnetic resonance imaging and 11.8% positron emission tomography.

In addition, a second IARC study indicates high levels of treatment abandonment. For patients caring for a non-metastatic cancer, they need a chimiothérapie, le traitement n’a été entrepris dans les 3 mois que chez 66% des patients, et n’a été achevé de manière adéquate que chez 35% d’entre they.

Some local hits to stream

To curb the growth of cancer cases, the “Lancet” commission highlights regional examples, and in particular Rwanda’s implementation of a national HPV vaccination program, which has allowed the country to achieve the highest vaccination coverage against the virus in the world.

The recommendations are also related to the development or updating, in each country, of cancer control plans, including in particular prevention, management of comorbidities such as HIV and malnutrition, a reliable and predictable supply in medicines and the development of psychosocial care and palliative care. “The plans must also include traditional, complementary and alternative medical practices, used by more than 80% of the populations of sub-Saharan Africa”, is recommended. Finally, the commission suggests extending universal health coverage and investing in telehealth.