This op-ed by Wilfred Ngwa and Richard Marlink of Rutgers Global Health Institute appeared in Health Policy Watch in recognition of World Cancer Day on February 4, 2023.
Cancer kills nearly 10 million people a year, but the risk of dying from cancer varies greatly depending on where in the world you live. About 70% of these deaths are in low- and middle-income countries – and the disparity is worsening.
A Lancet Oncology Commission report, published in May 2022, highlights that, in Africa, cancer deaths are expected to more than double, reaching roughly 1.4 million deaths annually by 2040. Meanwhile, in the U.S., the latest American Cancer Society statistics point to a 28-year, 32% decline in cancer deaths.
With President Joe Biden’s reignited Cancer Moonshot initiative, the U.S. is doubling down on its commitment to save lives. The initiative aims to reduce the cancer death rate by at least 50% over the next 25 years.
Although the immediate goals are domestic, the ambitions of the Cancer Moonshot extend globally, recognizing the disparities in death rates and the value of international collaborations. During the U.S.-Africa Leaders Summit in December, the White House announced $200 million in new and renewed commitments to fighting cancer in Africa.
This is a step in the right direction, but far more is urgently needed. This week, the World Health Organization’s Executive Board reviewed and approved updated recommendations on “best buys” for noncommunicable diseases, with cancer high on the list. This, and World Cancer Day, observed today, 4 February, makes it a good time to turn our focus to the rapidly escalating crisis of cancer in Africa and what must be done about it.
Sub-Saharan Africa particularly alarming
In the region of sub-Saharan Africa, the situation is particularly alarming. The Lancet Commission found the cancer incidence rate to be higher there than in other world regions of comparable social and economic development, as measured by the Human Development Index (HDI).
Compared with people in the world’s most developed regions (identified as “very high HDI regions” in the report), the Lancet Commission found that people in sub-Saharan Africa seem to face a lower risk of getting cancer but a much higher risk of dying from it. The mortality-to-incidence ratios were seven in 10 for sub-Saharan Africa and three in 10 for very high HDI regions.
How do we explain this?
First, there are crucial differences in detection, diagnosis, and treatment. Wealthy countries have many resources at their disposal; sub-Saharan African countries don’t. Shortages are widespread: not enough healthcare providers trained in oncology, inadequate diagnostic equipment, and limited access to treatments such as radiotherapy and chemotherapy are among the barriers. This means that cancer takes a long time to be diagnosed, let alone treated. Many patients die, needlessly, from cancers that have high survival rates in wealthy, well-equipped regions of the world.
Second, it is likely that cancer cases are vastly underreported in sub-Saharan Africa, where population-based cancer registries – the gold standard of information on cancer incidence in a population – are scarce. Also, cancer is underdiagnosed in sub-Saharan Africa, partly because of severely limited diagnostic capacity and societal barriers in seeking health care.
Highest rates of cervical cancer in the world
Even with limited data, sub-Saharan Africa has the highest rates of cervical cancer in the world, and cervical cancer is the leading cause of cancer deaths in the region, followed by breast cancer. In sub-Saharan African men, prostate cancer leads in both incidence and mortality. There are various reasons why these kinds of cancers are common in sub-Saharan Africa, including rising rates of obesity, higher rates of HIV infection, and genetics. While these root causes have no simple solutions, all three cancer types have highly effective preventive care and early detection protocols that, if implemented, would save many lives.
We live in a world that has made remarkable scientific and medical advancements in cancer detection, diagnosis, and treatment, but a person’s chances of surviving cancer hinge arbitrarily on where they were born. This is unacceptable.
The Lancet Commission, in its May 2022 report, recommended several urgent actions. Among them are: the creation of early detection and prevention programmes; building and supporting national cancer registries; establishing workforce training; raising community awareness; and – a lesson from Covid – investing in telehealth.
Begin in one country and prove change is possible
If the prospect of introducing changes in so many areas throughout sub-Saharan Africa seems insurmountable, begin in one country and prove change is possible there. This is the aim of the Botswana-Rutgers Partnership for Health, through which Rutgers University and Rutgers Health are collaborating with Botswana’s government to implement needed cancer care and prevention strategies.
Recently, the partnership launched Cancer Kitso, an education and training initiative that responds to urgent specialty workforce needs in oncology. Using both on-site and virtual training components, Cancer Kitso aims to improve cancer care and prevention knowledge and skills among health care professionals in Botswana.
To close the breast cancer screening gap, the partnership also is piloting a rapid “screen and treat” clinical approach for early breast cancer detection and treatment. This effort includes evaluating evidence-based interventions in primary care clinics, as well as training nurses to administer clinical breast examinations and to provide breast self-care education to women.
Universities, companies, and philanthropies all can take more active roles in collaborating with African governments to confront cancer. Hearts, minds, and funding will follow – at a level that could move mountains.
Precedent exists: In the late 1990’s and early 2000s, the sub-Saharan African country of Botswana faced the most severe HIV epidemic in the world. Botswana’s government partnered with outside universities, pharmaceutical companies, and private foundations to launch an aggressive and highly successful national HIV/AIDS prevention, treatment, and care initiative. Based largely on Botswana’s success, President George W. Bush in 2003 allocated billions of dollars to establish a global HIV/AIDS response that has gone on to save more than 25 million lives in many countries worldwide.
HIV/AIDS once seemed like too big a problem to fight in Africa, and no one believed it would work – until it did, and attitudes and priorities changed.
Cancer is threatening sub-Saharan African populations to a degree that demands a large-scale response. There are many interventions that we know will work, and we have no time to wait. Millions of lives hang in the balance.
Wilfred Ngwa, a principal faculty member at Rutgers Global Health Institute, is a professor of global health and radiation oncology and chair of the Lancet Oncology Commission on cancer in sub-Saharan Africa. Richard Marlink is the director of Rutgers Global Health Institute and one of the creators of the Botswana-Rutgers Partnership for Health.