Putting the Brakes on Cancer in Africa

Research on prevention, screening, and treatments seeks to head off a growing burden of disease

A runaway train.

That's how experts describe cancer in sub-Saharan Africa, which claims around half a million lives annually among a billion people. The toll is expected to climb to 900,000 within a decade, as the region's population ages and increasingly adopts western lifestyles that boost risk.

The embattled health systems addressing this pandemic face every kind of challenge. “Anticancer therapies are available in only 22 of the 54 countries in Africa,” points out Lynette Denny, MD, PhD, professor of obstetrics and gynecology at the University of Cape Town in South Africa. “The capacity for diagnosis, treatment planning, and treatment are totally inadequate as is the training in anticancer therapy, ranging from chemotherapy to radiation to surgical oncology.”

Given that at least 30% of cancers in sub-Saharan Africa are infection related, Denny calls for a strong push on prevention. “Two very important cancers, hepatitis B–associated liver cancer and human papilloma virus–related diseases, are vaccine preventable,” she points out. “We need to develop the appropriate infrastructure to administer prevention programs effectively.”

To gain support for taking such steps, clinicians and researchers across the region must advocate for cancer awareness among governments, clinicians, and communities, says Isaac Adewole, MB, BS, vice-chancellor of the University of Ibadan in Ibadan, Nigeria, and president of the African Organization for Research and Training in Cancer (AORTIC) in Capetown. “This will generate momentum for creating better awareness, improve health-seeking behavior, and mobilize support for evidence-based policy and funding.”

Additionally, Adewole and his AORTIC colleagues are campaigning for progress in producing and implementing national cancer control programs; promoting lifestyle modifications such as antismoking, safe sex, diet, and exercise; and investing in oncology workforce development and infrastructure.

Another key ingredient, Adewole says, is research on prevention, screening, diagnosis, and treatments appropriate.

“The infrastructure for delivering cancer care in Africa is so thin that adding the burden of research is really, really difficult for those incredibly busy clinicians,” comments David Kerr, MD, DSc, professor of cancer medicine at Oxford University in England and cofounder of the Africa Oxford Cancer Foundation. “But when we ask our African colleagues if research is icing on the cake, the answer is a resounding no. You can't separate cancer care and research; they are hungry for new knowledge and eager to add an African dimension to how we develop cancer control globally.”

“If you could put it in a single sentence, the problem of sub-Saharan Africa in cancer is stage, stage, stage,” Kerr remarks. “Patients present with advanced disease way beyond the capacity to cure. If we could detect cancer earlier, it would give us a fighting chance to do more about it, and to offer in some cases the potential of cure.”

“For us, research on screening and diagnosis is a very key ingredient in improving the outcomes of our patients,” says Jackson Orem, MD, director of the Uganda Clinical Institute (UCI) in Kampala. UCI sees 22,000 new patients annually, and 90% of them die within a year. “Screening for cervical cancer is very important, and we need to develop new ways of screening for other common diseases such as lymphomas and Kaposi sarcomas.”

Those 3 cancers are driven by infection, and UCI's alliance with the Fred Hutchinson Cancer Research Center in Seattle, WA, began with a common interest in such cancers. “Uganda has among the highest rates of cancers caused by infections of anyplace in the world,” says Corey Casper, MD, MPH, an associate member of the Hutchinson Center's Vaccine and Infectious Disease Division and co-scientific director of the alliance.

Some of the 25 research projects under way in the alliance look at how people acquire chronic infections that can cause cancer and the natural history of these diseases. “Seventy percent of people in the world have infections that could cause cancer, but less than 1% go on to develop it,” notes Casper.

Another major thrust for the alliance is comparing genetic differences between cancer in African and U.S. populations.

Along similar lines, the Men of African Descent and Carcinoma of the Prostate (MADCaP) consortium includes 9 partner cancer centers in sub-Saharan Africa. “We keep as much of the work in Africa as possible and build as much scientific capacity there as we can,” says consortium leader Timothy Rebbeck, PhD, associate director for population sciences at the Abramson Cancer Center in Philadelphia, PA. For this illness, “there's a lot of heterogeneity in the African continent,” Rebbeck says. “We're asking basic epidemiologic and genetic questions and also starting controlled studies to see the risk factors.”

“We're trying to understand the African situation and get the best treatment approaches for Africa,” Rebbeck emphasizes. “We can't necessarily take the U.S. experience in screening and treatment and just export it to Africa. The needs are different, the values are different, the resources are different, and some of the public health and clinical needs are very local and idiosyncratic. It's also important to think about what we all can learn from Africa, gaining important information on different genetic patterns and the natural histories of disease.” –Eric Bender

For more news on cancer research, visit Cancer Discovery online at http://CDnews.aacrjournals.org.