AT FIRST, Florence Agyei put the bleeding down to the
birth of her daughter 18 months earlier. "I thought maybe something had
been left inside me," she says. She didn't think it was a disease and
had never even heard the words kokoram awotea amo – cancer of the neck of the womb.
After enduring the pain and bleeding for
seven months, it was a radio programme that finally prompted Florence, a
Ghanaian market stall vendor, to seek help. At 36, she was diagnosed
with advanced cervical cancer.
Cancer is often seen as a disease of the
affluent, hitting people in their twilight years. Yet more than half of
cancers now affect people in developing countries – often in the prime
of their life. Africa recorded 681,000 new cancer cases in 2008 and that
is predicted to double by 2030
– even before increased tobacco use and lifestyle changes are taken
into account. Similar rises are expected in Latin America and some
countries in Asia – attention was drawn to China this week when it was
claimed the nation's youngest lung cancer patient is just 8 years old – but Africa is the least well equipped to deal with the increase.
The good news is that there are vaccines
that could prevent many cancer deaths – if the infrastructure and the
political will are there to deliver them.
This week sees the start of a programme
trialling the introduction of the cervical cancer vaccine in Ghana, and
Niger and Madagascar will begin similar programmes later this month. The
vaccines are supplied by the GAVI Alliance, but countries will have to
demonstrate that they can deliver them in limited areas before
vaccination is rolled out more widely. Rwanda is expected to be the
first African country to start offering vaccination to all teenage girls
early next year.
Infectious agents account for just 3 to 4
per cent of cancers in Western countries, but in Africa they're
responsible for one-third, mostly because screening programmes aren't in
place to catch the precancerous signs.
Cervical and liver cancer, which can be
caused by the human papillomavirus (HPV) and hepatitis B virus
respectively, each account for about 10 per cent of cancer deaths – and
vaccines exist for both. It is hoped that combining vaccination with
other preventative measures like screening, and encouraging people to
eat well and give up smoking, could make a serious dent in Africa's
cancer death toll.
"There's a big opportunity to avoid some of the mistakes of Western countries," says Christopher Wild,
director of the World Health Organization's International Agency for
Research on Cancer. "We're trying to convince people that they need to
act now to prevent the problems of tomorrow."
That's difficult though, because many
African governments already have their hands full reducing deaths
related to childbirth and fighting diseases like HIV and malaria. They
don't necessarily want to hear about something that is going to cause
problems in a decade or so.
Yet breast and cervical cancer have already overtaken childbirth-related deaths in Asia and Latin America, and by 2030, African deaths from non-communicable diseases
including cancer and heart disease are expected to eclipse the combined
toll from infectious disease, malnutrition and death during childbirth.
"We're not suggesting that we need to take
resources away from other areas like HIV, but we need to start
re-evaluating our allocation of resources," says Vivien Davis Tsu of
PATH, a non-profit organisation in Seattle.
One possibility is piggybacking existing
health infrastructures that have been set up to tackle HIV, using it to
offer cancer screening at the same time as people come to collect
antiretroviral medication, for example (see "Vinegar: The acid test for cancer").
Access to drugs and radiotherapy to treat advanced cancers is also a
necessity, but remains largely unaffordable for many countries.
There are already signs that vaccination
may work. Rwanda was the first African country to pilot HPV vaccination
in 2011 and, unlike the vaccine's lukewarm reception in the US, where
uptake has stagnated at around 50 per cent, Rwanda achieved 93 per cent
coverage (Bulletin of the WHO, doi.org/pvf).
"Because we have a country where
vaccination for other diseases has really paid off and people are seeing
their children live, we have created trust," says Agnes Binagwaho, Rwanda's heath minister. "In America, there are so many treatments. They don't understand that prevention is less expensive."
Hepatitis B vaccination is also now being offered to infants in most African countries, and vaccines against Helicobacter pylori – a bacterium that causes stomach cancer – and a more effective vaccine for HPV are in development.
Although vaccination won't prevent other
burgeoning cancers like breast cancer, the hope is it will at least
facilitate discussion about them. "HPV vaccination is the first
concerted effort to address a cancer in developing countries," says Tsu.
"This could be the thing that opens the doors to other cancer efforts."
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