The challenge of determining cancer’s burden in Africa

Breast cancer rates worldwide, 1980-2010

Guest post by Katie Leach-Kemon, a policy translation specialist from the University of Washington’s Institute for Health Metrics and Evaluation.

Nurse, Sierra Leone
Nurse, Sierra Leone
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In last week’s Humanosphere podcast, former National Public Radio health reporter and current University of Washington journalism educator Joanne Silberner spoke about the stigma surrounding cancer in Uganda. (Yesterday, she also talked to NPR.)

Cancer is a big killer in poor countries as well as in the rich world, but it has not been high on the global health agenda in part because many saw most forms of cancer as either too complex or too expensive to treat in the developing world.

That is not always the case and many advocates are trying to push cancer higher up on the list as part of a broader effort to move from a predominant focus on infectious disease to include non-communicable diseases like heart disease, cancer and diabetes.

Many Ugandan women who find lumps in their breast see it as a death sentence, Silberner reports, in part because of lack of access to many therapies we take for granted in the West. But Ugandan women with breast cancer are also unlikely to seek medical care partly for fear that their husbands will leave them if they have a mastectomy.

Another challenge to building the case for cancer care in the developing world is getting accurate information about the disease burden.  The screen grab below shows the leading causes of death in women ages 15 to 49 in sub-Saharan Africa in 1990 (left) and 2010 (right), according to the Global Burden of Disease study 2010 (GBD 2010).

Causes of death young women Africa The column on the far right shows the median percentage increase over this 20-year period. The lines in the middle of the screen grab indicate increases or decreases in ranking. Deaths from cervical cancer increased by 32% (rank 13 in 2010), deaths from breast cancer grew by 105% (rank 20), and deaths due to liver cancer increased by 26% (rank 28) between 1990 and 2010. Infectious diseases are major drivers of two of these cancers, cervical cancer and liver cancer, specifically HPV and Hepatitis B and C, respectively, which can both be prevented through vaccination. In the Humanosphere podcast, Silberner discusses how relatively simple interventions such as vinegar are successfully being used in low-resource settings to screen for cervical cancer.

A second screen grab shows estimates of deaths from cancer in men and women across the life span in South Africa. Deaths from cancer were highest among ages 55 and older, and lung and esophageal cancers caused the highest number of deaths. Visit the live visualization tool online to explore estimates of cancer deaths in men and women in South Africa as well as 186 other countries.

Cancer IHMEIn addition to being a region where stigma and lack of resources hinder access to cancer treatment, sub-Saharan Africa is a cancer data desert. South Africa was one of six countries in sub-Saharan Africa for which GBD researchers had access to useable cancer registry data for the year 2000 or later, representing six different cancer registries.

“This is a stark contrast to wealthier areas,” said IHME professor and GBD co-author Mohsen Naghavi. “For example, Italy alone has 64 cancer registries.”

In many sub-Saharan African countries, cancer registry data were either unavailable or unusable due to lack of detail. An example of data lacking sufficient detail would be a cancer registry that reported total cancer cases instead of cases of different types of cancer. GBD estimates that there were a total of 352,043 cancer deaths in the region in 2010, but this number could be as low as 318,370 or as high as 381,781. The uncertainty surrounding cancer estimates in sub-Saharan Africa could be reduced by increasing the availability and quality of cancer registry data in the region.

Faced with the challenge of lack of cancer registry data, the authors of the GBD study have used other data sources to estimate the burden of cancer in sub-Saharan Africa, such as cause of death data. Naghavi notes, however, that cancer death data “aren’t very accurate.” To further improve GBD cancer estimates, researchers used data on many different factors related to cancer, such as alcohol use, smoking, Hepatitis B and C prevalence, indoor air pollution, and obesity/overweight.

Lack of cancer registry data in sub-Saharan Africa is a major limitation for evidence-based health decision-making. While GBD researchers are using all available data and innovative methods to estimate cancer burden, strengthening countries’ ability to monitor cancer cases is key for improving the global health community’s understanding of and response to this disease.

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