Cancer Control Opportunities In Low and Middle Income Countries; From

Prevention to Early Screening, Coordinated Response And Implementation

Research
Dr. Cosmas Mugambi

The Burden At A Glance

The cancer burden is rising globally, exerting significant strain on populations and health systems at all income
levels. The International Agency for Research on Cancer (IARC) estimated 18.1 million new cases and 9.6 million
deaths across the globe in 2018. This translates to one out of six deaths globally and far exceeding the number of
deaths from HIV and AIDS, Malaria and Tuberculosis combined. Cancers of the breast, colorectum, lung, cervix uteri
and thyroid are most prevalent among females while those of the lung, prostate, colorectum, stomach and liver are
top among males. The disease burden is greatest in low-income and middle-income countries (LMICs), where 70% of
cancer deaths occur with the sub-Saharan Africa region projected to have more than an 85% increase in cancer
incidence by 2030. This sharp increase is being attributed to demographic changes such as ageing and population
growth, changing prevalence of cancer risk factors, increased exposure to risk factors such as environmental
carcinogens, urbanization, unsafe food and water, infectious agents, lifestyle changes such as obesity, increased
alcohol and tobacco use.

Many cancers can be prevented. Others can be diagnosed early in their development, treated and cured. Even with
late stage cancer, the pain can be reduced, the progression of the cancer slowed, and patients and their families
helped to cope. Effective prevention efforts have been shown to reduce the number of new cases while early
initiation of treatment has been shown to improve treatment outcome and survival rates. However, there is a
limited public awareness on cancer symptoms. This coupled with geographical inaccessibility of services, cost of
treatment, social cultural factors, poor referral and post referral follow ups and other social determinants of health
delay timely diagnosis. The consequence is significant physical, financial and emotional strain on cancer patients and
their families. Ultimately, prolonged disability and premature mortality have substantial social and economic impact
on LMICs.

In May 2017, world governments made a commitment to further invest in cancer control as a public health priority,
passing the World Health Assembly Resolution 70.12 on cancer prevention and control. However, historically, cancer
has received little attention from global policymakers and donors with only 5% of global spending on cancer directed
to LMICs while only 1% of global health financing is directed to Non-Communicable Diseases (NCDs). Thus, LMICs are
finding it increasingly difficult to respond to the cancer challenge on national health systems.

Behavioural Interventions
At an individual level; avoid tobacco use-using any type of tobacco puts one on a collision course with cancer; eat a
healthy diet- making healthy selections at the grocery store and at mealtime can reduce your risk, therefore ensure
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plenty of fruits and vegetables on your plate; eat lighter and leaner- reduce high-calorie foods, including refined
sugars and fats; if you choose to take alcohol, do so only in moderation; limit processed foods; maintain a healthy
weight and be physically active- strive to get at least 150 minutes a week of moderate aerobic activity or 75 minutes a
week of vigorous physical activity-and if you can do more, the better; avoid tanning beds and sunlamps while at the
same time protecting yourself from intense midday sun; get vaccinated against Hepatitis B and Human Papilloma
Virus (HPV)-if within the recommended HPV vaccine age bracket; avoid risky behaviors such as unsafe sex and
sharing of injectable drug needles which can lead to HIV, as well as Hepatitis B and Hepatitis C — which can in turn
increase the risk of liver cancer; lastly, get regular medical checkups--regular self-exams and screenings for various
types of cancers can increase your chances of “catching it early”-ask your doctor about the best cancer screening
schedule for you.
Biomedical Interventions
The first step in the event of a diagnosis with cancer would be to find the right doctor for the specific disease
followed by designing of a treatment plan and creation of a social support system. Treatment aims to cure disease,
prolong life, and improve the quality of life after diagnosis with cancer. The most effective and efficient treatment is
linked to early detection programmes and follows evidence-based standards of care. Patients can benefit either by
cure or by prolonged life, in cases of cancers that although disseminated are highly responsive to treatment-this
component also addresses rehabilitation aimed at improving the quality of life of patients with impairments due to
cancer. Palliative care meets the needs of all patients requiring relief from symptoms, and the needs of patients and
their families for psychosocial and supportive care ultimately improving the quality of life and the ability to cope
effectively.
Structural Interventions
In view of the complex nature of the disease and the fragmented and uncoordinated interventions in LMICs, taking a
systems approach in cancer control plans tailored to regional and national priorities would address the challenge
more holistically. This underscores the need for: cancer registries for informed and evidence-based interventions;
integration of cancer control interventions with the prevention of chronic diseases and other related health
interventions (such as reproductive health, HIV and AIDS etc.) at the primary health level; strengthening regional
and sub-regional partnerships for cancer management to improve geographic accessibility; strengthening referral
pathway; creating national networks connecting rural practices to large cancer centres full with pathological
diagnosis in view of specialized health care workers shortage; provision of comprehensive, resource-appropriate and
evidence-based cancer service packages and; making cancer treatment regimens accessible to all patients as per the
country specific clinical practice guidelines and as a minimum, making those on the WHO Model List of Essential
Medicines available and affordable.
Future Research Priorities in Oncology
Moving forward, research on oncology in LMICs needs to focus on: (1) risk reduction and early detection aimed at
determining specific genetic, biological, and behavioral risk factors for cancer and evaluating innovative models to
improve screening and increase early diagnosis and (2) survivorship and symptom science aimed at reducing
treatment-related symptoms and enhancing survivorship.

The Author Is An Implementation Scientist Based in Nairobi

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