Cancer burden in Africa and opportunities for prevention

Surveillance Research Program, American Cancer Society, Atlanta, Georgia. .
Cancer (Impact Factor: 4.89). 01/2012; 118(18):4372-84. DOI: 10.1002/cncr.27410
Source: PubMed


Cancer is an emerging public health problem in Africa. About 715,000 new cancer cases and 542,000 cancer deaths occurred in 2008 on the continent, with these numbers expected to double in the next 20 years simply because of the aging and growth of the population. Furthermore, cancers such as lung, female breast, and prostate cancers are diagnosed at much higher frequencies than in the past because of changes in lifestyle factors and detection practices associated with urbanization and economic development. Breast cancer in women and prostate cancer in men have now become the most commonly diagnosed cancers in many Sub-Saharan African countries, replacing cervical and liver cancers. In most African countries, cancer control programs and the provision of early detection and treatment services are limited despite this increasing burden. This paper reviews the current patterns of cancer in Africa and the opportunities for reducing the burden through the application of resource level interventions, including implementation of vaccinations for liver and cervical cancers, tobacco control policies for smoking-related cancers, and low-tech early detection methods for cervical cancer, as well as pain relief at the palliative stage of cancer. Cancer 2012. © 2012 American Cancer Society.

Download full-text


Available from: David Forman, Oct 22, 2014
  • Source
    • "Hepatocellular carcinoma (HCC), the main form of primary liver cancer, is one of the most common cancer causes of death in many countries (Jemal et al., 2012; Yeo et al., 2013). HCC is an aggressive malignancy with over 50% of the cases dying within the first year of diagnosis (Altekruse et al., 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Hepatocellular carcinoma (HCC) is amongst the top three cancer causes of death worldwide with hepatitis B and C viruses (HBV/HCV) as the main etiological agents. An up-to-date descriptive epidemiology of the burden of HBV/HCV-associated HCC in the Arab world is lacking. We therefore determined the burden of HBV/HCV- associated HCC deaths in the Arab world using the Global Burden of Disease (GBD) 2010 dataset. GBD 2010 provides, for the first time, deaths specifically attributable to viral-associated HCC. We analyzed the data for the 22 Arab countries by age, sex and economic status from 1990 to 2010 and compared the findings to global trends. Our analysis revealed that in 2010, an estimated 752,101 deaths occurred from HCC worldwide. Of these 537,093 (71%) were from HBV/HCV-associated HCC. In the Arab world, 17,638 deaths occurred from HCC of which 13,558 (77%) were HBV/HCV-linked. From 1990 to 2010, the burden of HBV and HCV-associated HCC deaths in the Arab world increased by 137% and 216% respectively, compared to global increases of 62% and 73%. Age-standardized death rates also increased in most of the Arab countries, with the highest rates noted in Mauritania and Egypt. Male gender and low economic status correlated with higher rates. These findings indicate that the burden of HBV/HCV-associated HCC in the Arab world is rising at a much faster rate than rest of the world and urgent public health measures are necessary to abate this trend and diminish the impact on already stretched regional healthcare systems.
    Asian Pacific journal of cancer prevention: APJCP 02/2015; 16(1):265-70. DOI:10.7314/APJCP.2015.16.1.265 · 2.51 Impact Factor
  • Source
    • "The highest incidence is estimated to occur in developing countries including those in Sub-Saharan Africa [3-7]. In contrast to high-income countries where mortality caused by cervical cancer is on the 8-9th place, it is the most frequent fatal cancer in women in Sub-Saharan Africa reviewed in [2,8,9]. The incidence and mortality are expected to increase over the next 20 years [10]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Cervical cancer is the most frequent cancer of women in the Democratic Republic of Congo (DRC). Nevertheless, the level of women's awareness about cervical cancer is unknown. Knowledge, attitude and practice (KAP) are important elements for designing and monitoring screening programs. The study purpose was to estimate KAP on cervical cancer and to identify associated factors. A cross-sectional study was conducted in Kinshasa, DRC, including 524 women aged 16-78 years (median age 28; interquartile range 22-35). The women were interviewed at home by trained field workers using a standardized questionnaire. The women's score on knowledge, attitude and practice were dichotomized as sufficient or insufficient. We used binary and multiple logistic regression to assess associations between obtaining sufficient scores and a series of socio-demographic factors: age, residence, marital status, education, occupation, religion, and parity. The women's score on knowledge was not significantly correlated with their score on practice (Spearman's rho = 0.08; P > 0.05). Obtaining a sufficient score on knowledge was positively associated with higher education (adjusted odds ratio (OR) 7.65; 95% confidence interval (95%CI) 3.31-17.66) and formal employment (adjusted OR 3.35; 95%CI 1.85-6.09); it was negatively associated with being single (adjusted OR 0.44; 95%CI 0.24-0.81) and living in the eastern, western and northern zone of Kinshasa compared to the city centre. The attitude score was associated with place of residence (adjusted OR for east Kinshasa: 0.49; 95%CI 0.27-0.86 and for south Kinshasa: 0.48; 95%CI 0.27-0.85) and with religion (adjusted OR 0.55; 95%CI 0.35-0.86 for women with a religion other than Catholicism or Protestantism compared to Catholics). Regarding practice, there were negative associations between a sufficient score on practice and being single (adjusted OR 0.24; 95%CI 0.13-0.41) and living in the eastern zone of the city (adjusted OR 0.39; 95%CI 0.22-0.70). Although 84% of women had heard about cervical cancer, only 9% had ever had a Papanicolaou (Pap) smear test. This study shows a low level of knowledge, attitude and practice on cervical cancer among women in Kinshasa. Increasing women's awareness would be a first step in the long chain of conditions to attain a lower incidence and mortality.
    BMC Women's Health 02/2014; 14(1):30. DOI:10.1186/1472-6874-14-30 · 1.50 Impact Factor
  • Source
    • "Cancer is an emerging public health challenge in Africa, and African nations need to develop well designed population-based studies in order to better define the impact and spectrum of malignant disease in the backdrop of HIV infection and AIDS. [36], [37] As we approach the midpoint of the fourth decade of the AIDS pandemic, the emergence of non-AIDS-defining cancer in HIV-infected individuals, nearly a third of cases based on this survey in Nairobi, is likely to evolve in Africa as it did around the turn of the century in the developed world. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Sub-Saharan Africa cancer registries are beset by an increasing cancer burden further exacerbated by the AIDS epidemic where there are limited capabilities for cancer-AIDS match co-registration. We undertook a pilot study based on a "strength-of-evidence" approach using clinical data that is abstracted at the time of cancer registration for purposes of linking cancer diagnosis to AIDS diagnosis. The standard Nairobi Cancer Registry form was modified for registrars to abstract the following clinical data from medical records regarding HIV infection/AIDS in a hierarchal approach at time of cancer registration from highest-to-lowest strength-of-evidence: 1) documentation of positive HIV serology; 2) antiretroviral drug prescription; 3) CD4+ lymphocyte count; and 4) WHO HIV clinical stage or immune suppression syndrome (ISS), which is Kenyan terminology for AIDS. Between August 1 and October 31, 2011 a total of 1,200 cancer cases were registered. Of these, 171 cases (14.3%) met clinical strength-of-evidence criteria for association with HIV infection/AIDS; 69% (118 cases were tumor types with known HIV association - Kaposi's sarcoma, cervical cancer, non-Hodgkin's and Hodgkin's lymphoma, and conjunctiva carcinoma) and 31% (53) were consistent with non-AIDS defining cancers. Verifiable positive HIV serology was identified in 47 (27%) cases for an absolute seroprevalence rate of 4% among the cancer registered cases with an upper boundary of 14% among those meeting at least one of strength-of-evidence criteria. This pilot demonstration of a hierarchal, clinical strength-of-evidence approach for cancer-AIDS registration in Kenya establishes feasibility, is readily adaptable, pragmatic, and does not require additional resources for critically under staffed cancer registries. Cancer is an emerging public health challenge, and African nations need to develop well designed population-based studies in order to better define the impact and spectrum of malignant disease in the backdrop of HIV infection.
    PLoS ONE 01/2014; 9(1):e85881. DOI:10.1371/journal.pone.0085881 · 3.23 Impact Factor
Show more