World Cancer Day 2018 — addressing Africa’s emerging needs

Today, on World Cancer Day, there’s reason for hope.  

Governments, nonprofits, and the private sector are making strides in improving treatment and expanding access to care. While cancer remains a devastating challenge, the world is getting closer to effectively combating “the emperor of all maladies.” 

Still, the progress is uneven.

{mosads}As Sub-Saharan Africa makes impressive progress in dealing with infectious diseases like AIDS, tuberculosis, and malaria, the region faces rapidly growing challenges associated with non-communicable diseases (NCDs ) — including cancer.

Each year approximately 650,000 Africans develop cancer and about 510,000 people on the continent die from the disease. The number of new cancer cases is predicted to swell to one million annually in the next five years.

Cancer diagnosed in Africa is associated with a higher mortality compared to other regions of the world due to limited availability of screening, laboratories, and pathologists. The majority of patients enter the care system with advanced disease—meaning effective treatment is nearly impossible.

Even if cancer is detected early, treatment options are limited. There are few oncologists and oncology nurses and minimal options for palliative care. And pathologists are scarce. One pathologist serves, on average, a population of more than 1,000,000 people.

Lack of resources, including health care and laboratory professionals, contribute to individuals having to wait longer to receive a diagnosis. Patients cannot start treatment until a definitive diagnosis has been made. Special stains or other supplies needed to perform lab tests, even second opinions are often required to finalize a diagnosis. As a result, people wait and wait for what should be urgent care.

The lack of these resources contributes to massive human suffering, which is largely unreported.

It’s understandable that — until recently — most health systems in the region were focused on infectious diseases. But, with growing success in these fights resulting in longer lifespans, there’s a time-sensitive need for the focus to shift to non-communicable diseases. This is both a challenge and an opportunity for health systems.

The success of infectious disease programs demonstrates what’s possible with the right focus and partnership. In just a few decades — with cooperation between high and lower-resourced countries — HIV/AIDS has gone from a certain death sentence to what’s essentially a chronic illness for millions of people around the world. Polio is on the verge of being eradicated. Malaria deaths have dropped by 60 percent since 2000.

While the need to battle infectious diseases continues, it is possible to simultaneously address the impact of cancer and other NCDs.  

International health initiatives like the Global Fund to Fight AIDS, Tuberculosis and Malaria, the U.S. President’s Emergency Plan for AIDS Relief, and the East Africa Public Health Laboratory Networking Project have laid the groundwork for effective solutions.

With new health centers, stronger supply chains for delivering medicines to low-income countries, better laboratory networks, and legions of newly-trained health-care workers, many Sub-Saharan countries have the tools necessary for success against NCDs. New facilities and capacities can be adapted and enhanced to address cancer.

Efforts to combat HIV have brought winning models for bringing early screening and treatment services to people in hard-to-reach locations. We can and should do the same for cancer.

A new initiative spearheaded by the American Society for Clinical Pathology (ASCP), my organization, the American Cancer Society and Novartis aims to connect to national health priorities in cancer, starting in Ethiopia, Rwanda, Tanzania, and Uganda.

These three organizations are working together to develop a common approach to improve access to cancer treatment. The goal is to start strengthening the whole continuum of care for cancer patients, from training for better diagnosis and care and improved access to treatment, through to advocacy for national cancer treatment guidelines.

This is one of several positive examples of organizations coming together across sectors to solve a grand challenge in global public health. ASCP will work to improve diagnosis requiring immunohistochemistry — building healthcare capacity for immunohistochemistry analysis in six hospital laboratories in Ethiopia, Rwanda, Tanzania, and Uganda.

ACS will provide training for health-care professionals in the same four countries to ensure quality processes in the transportation of biopsy samples and in administering chemotherapy.

Funding from Novartis will support the launch of a pilot program in Ethiopia and the expansion of programs in Rwanda, Tanzania, and Uganda. Overall, the work will complement that of the Clinton Health Access Initiative in improving access to affordable, quality-approved oncology medicines in the region.

A cancer diagnosis is devastating regardless of where a person lives, but the disease can be most dreadful in resource-poor settings. Just imagine facing cancer without hope of access to cancer screening, diagnosis, or treatment.

When the world noticed the suffering and lost potential associated with HIV/AIDS, polio, malaria, and other communicable diseases, people came together to take decisive action. Today, we can see the positive results.

It’s time we recognize the growing threat of cancer and similarly commit to bold solutions.

Dan A. Milner, Jr., MD, is  the chief medical officer of the American Society for Clinical Pathology.