AORTIC 2011, Cairo, Egypt 30 November–2 December 2011

Reduction of cancer burden across Africa

Dr Chris Wild – International Agency for Research on Cancer, Lyon, France

I think it’s not often appreciated that cancer is already an important public health problem but because of the way the population is growing and getting older, and cancer is a disease of aging, then that burden of cancer is going to increase dramatically over the next twenty years, almost doubling the number of new cancer cases every year. So I’ve been trying to draw attention to that and also to promote the knowledge about the causes of cancer and the opportunities for prevention on this continent.

What are some of those opportunities?

First of all, if we look at the types of cancers that are very common, cervical cancer in women is one of the two most common cancers, along with breast cancer. And there there are very effective ways of detecting the disease early through screening and treatment of those pre-cancerous conditions and also now a vaccine against human papilloma virus which is becoming increasingly affordable. So there’s really a good strategy there to reduce the burden of that cancer. Liver cancer is another cancer that’s very common in particularly sub-Saharan Africa and, again, there’s a very effective vaccine against Hepatitis B virus which is a major cause of that cancer. So those are just two examples across a range, but particularly as well I’ve tried to highlight again the importance of tobacco and blocking the importation of this habit to the African continent. It’s probably the single most important thing that we could do to battle against total cancer burden on African soil.

What can be done about the lobbying of tobacco companies?

Increasingly there’s an international response to that. There’s the first treaty on a health issue, the WHO Framework Convention on Tobacco Control which is really a set of measures to control tobacco and those are established internationally and the countries sign up to that convention. I think that gives the governments a platform for action which is consistent internationally, and that’s quite a powerful tool in the sorts of challenges that you’ve just outlined with the tobacco companies.

What is needed, specifically in Africa, in regards to cancer care?

One of other things that’s important that’s become very clear at this conference is that we really need to strengthen the cancer registries across Africa. So these are the organisations that actually count the number of cancers and that’s important because it helps for planning of health services but it also describes which are the most important cancers across the continent and gives us clues to the causes of the cancer and also the best approaches to prevention. At the moment, only about 1% of the African population is covered by high quality registers, so one of the things our agency is trying to do is work with partners in different countries to strengthen cancer registration and hopefully change that situation.

How are these registries funded?

At the moment we have a small amount of money that we can fund individual registries to support them, particularly at the beginning of establishing a registry. But we actually, as an agency, have launched this year a global initiative on cancer registry development and we’re now in the process of looking for sponsors to support that development and really establish a number of centres of excellence or regional hubs, as we’re calling them, in different parts of the world that will themselves take on the task of training other cancer registrars in the region.

What progress has been made in combatting cancer in Africa?

What we’re seeing is increasingly the diseases associated with infections are being tackled successfully and that’s great progress. At the same time, therefore, the population is aging and cancer is becoming increasingly important. So if we wait until the problem is really on our doorstep, I think it’s too late, so there’s an opportunity to react now and perhaps prevent some of that impending burden. The proverb that we’ve used, an African proverb, in our manuscript recently is that one should put out the fire while it’s still small. It’s a Kenyan saying and I think it captures very well both the fire of cancer, the risk that it presents, but also that if we deal with it while it’s small then it’s much more effective than trying to deal with it when it’s raging throughout the building.

How can we get the drug companies to reduce costs?

Part of this whole picture which our agency is less involved in but I’m certainly aware of is the need for access to affordable treatments. There are cancers which are curable almost to 100% in the Western world where people are still dying from those cancers in Africa. An example is the childhood cancer Burkitt’s lymphoma. So I think there really is an onus on partners from the private sector, the NGOs and governments, to find ways to make these affordable treatments accessible to the African population.