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Monday, March 23, 2015

Cancer is an urgent public heath issue

Between 40,000 and 80,000 new cancer cased are diagnosed each year. According to a report published in 2010 and posted on the website of Kenya Network of Cancer Organization, 18,000 cancer deaths were reported in 2005. Cancer kills about 27,000 Kenyans every year, a majority of them in the prime age.

About 80 percent of reported cancer cases are diagnosed when it is too late. In 2006, 65 percent of women who were diagnosed with cervical cancer died. The National Cancer Control Strategy 2011-2016 admits that cancer is the third as a leading cause of death after infectious and cardiovascular diseases.

The proportion of the overall disease burden in sub-Saharan Africa attributable to cancer is rising, and the region is predicted to have a greater than 85 percent increase in cancer burden by 2030. Experts now believe that there is a relationship between the increase in cancer cases and the persistence of infectious diseases associated with the risk of malignancies. It is estimated that infectious viral and bacterial agents cause around 2 million cancer cases each year, most of them in Africa.

The National Cancer Control Strategy is unambiguous about what action is needed; screening, early detection and treatment; efficient referral systems, prevention, control of infectious diseases linked to cancer, enhancing access to cancer treatment services, human capacity development. But what really is going on, beyond having a strategy?

In my view, the dominant perception among health policy officials in this country is that cancer is not a serious public health problem. This perception has a significant influence on public health policy and resource allocation. That is why Kenya has only two cancer machines, both of them located at Kenyatta National Hospital in the capital city of Nairobi.

When the Cabinet Secretary Michael Kamau received the first consignment of 4000 tones of rails for the Standard Gauge Railway in January 2015, he said the government would push China Road and Bridge Cooperation to complete the 609-kilometer line before the next general election in 2017. We have not seen such urgency and zeal in addressing the plight of Kenyans suffering from cancer.

Simeon Munda, the Chief Executive Officer of Kenyatta National Hospital (KNH), revealed that 1,300 cancer patients are on the waiting list, with appointments stretching as far as 2017. Tens of thousands more cancer patients could wait beyond 2017 to receive cancer treatment at KNH.  

Cancer is an urgent public health issue, which demands immediate attention. Given that we have half decent population health records and that cancer is also linked with infectious diseases, my guess is that we are staring at a catastrophic epidemic.

Think about this. Bacteria that cause ulcers can cause stomach cancer. The parasite responsible for bilharzia can lead to bladder cancer. People infected with HIV have a substantially higher risk of some types of cancer. Three of these cancers, AIDS-defining malignancies are Kaposi sarcoma, cervical cancer and non-Hodgkin lymphoma. Moreover, people with HIV are five times more likely to be diagnosed with liver cancer.

We need national and county population-based cancer registries. This means that we must step up screening and diagnostic capacity at the county level. The registry system should be used to report on cancer incidence, cancer type, gender, age, socio-economic status, race/ethnicity, year of diagnosis, trends, survival and prevalence. 

The data will be critical to supporting cancer research to understand the specific causes and developmental mechanisms of cancers that are prevalent in our society, and specific to socio-economic, infectious disease and genetic risk factors. The data will also help build public awareness and provide evidence for advocacy for funding as well as put pressure on the government to implement the National Cancer Control Strategy 2011-2016 before it expires.

The conversation about cancer must go beyond the outrage about the breakdown or shortage of radiation therapy devices. It must be about the strategies and action needed to build a health infrastructure, leveraging both public and private investments to cope with the double burden of infectious and non-communicable diseases.

We must address the crippling shortage of healthcare personnel. Over 1,800 doctors and hundreds of nurses have resigned from the public sector since the management of health services was devolved to the counties.

Without enough doctors, nurses and community health workers the gains against infectious diseases will be reversed and we will certainly, not forestall the onslaught of cancer and other non-communicable diseases.

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