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February 20, 2019

ALEX AWITI: Early detection and management of cancer now possible in East Africa

Immuno Histo Chemistry (IHC), a Cancer-screening machine which was acquired by Kenyatta National Hospital on August 9. The machine is a product of Roche. It has the capability to hold 30 slides and every test carried out runs for 3 and a half hours./FILE
Immuno Histo Chemistry (IHC), a Cancer-screening machine which was acquired by Kenyatta National Hospital on August 9. The machine is a product of Roche. It has the capability to hold 30 slides and every test carried out runs for 3 and a half hours./FILE

Non-Communicable Diseases (NCDs) are the leading cause of death globally. NCDs kill an estimated 15 million people a year, with 85 per cent of these premature deaths occurring in low–and middle–income countries.

 According to WHO, the global cancer burden is estimated to have risen to 18.1 million new cases and 9.6 million death is 2018.

New data from WHO shows that Kenya accounts for about 40 per cent of the total cancer deaths in Kenya, Uganda and Tanzania. Health systems in poorer countries have evolved to cope with infectious diseases and acute threats to child and maternal health — not chronic conditions, which require lifelong management.

 The convergence of the burden of NCDs and communicable disease in Africa, especially, presents a huge challenge, which is compounded by low levels of public investment in physical resources (hospitals and equipment) and human capital (doctors, pharmacists, nurses, and technologists).

In many cases too, existing public and private health resources are overwhelmed by deplorable, incompetent management.

 For many cancers, overall incidence rates in countries with high or very high Human Development Index (HDI) are generally two to three times those in countries with low or medium HDI.

However, according to the Institute of Health Metrics and Evaluation (IHME) of the University of Washington, 60 per cent of cancer deaths occur in developing countries.

 Two reasons account for this rather alarming differential mortality.

First, lower-HDI countries have a higher frequency of certain cancer types associated with poorer survival.

These include lung, tracheal and bronchial (TBL), oesophageal, cervical and oral cancers.

For example, it is estimated that over 80 per cent of individuals diagnosed with oesophageal and lung cancer die within five years. Second, there is limited access to diagnosis and effective treatment.

 Advances in medical diagnostics offer hope and present a real opportunity for patients and caregivers to manage the growing cancer burden.

But the technology and the associated diagnostic capability have until recently not been available locally. Access to timely diagnosis, treatment or management has been the preserve of the privileged minority who can afford to seek care in countries like the India.

 The launch of the Positron Emission Tomography/ Computed Tomography (PET/CT) and Cyclotron Services at Aga Khan University Hospital, by the First Lady Margaret Kenyatta, is a remarkable milestone and arsenal in the fight against cancer. 

The PET/CT uses small amounts of materials known as radiotracers and special cameras, superimposed with X-ray CT to evaluate molecular activity leading to more precise information, early detection and accurate diagnosis of disease.

 While cancer screening remains a hotly debated issue in medical practice, whole-body PET/CT with a radiotracer called fluorodeoxyglucose (FDG) has been used extensively for cancer screening in asymptomatic individuals.

FDG-PET is based on the surge of glucose metabolism in malignant tumors, which can be detected before anatomic changes.

 The East Africa region now has the capacity through PET/CT for rapid diagnosis, staging, monitoring treatment effects, and for restaging during the course of treatment. Moreover, opportunities for advanced cancer research are staggering.

 

 

Alex O Awiti is the director of the East Africa Institute at Aga Khan University

 

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