World's deadliest cancer getting little attention, says medic

It is the deadliest form of cancer in the world but appears to receive little attention in Kenya.

According to the World Health Organisation, lung cancer has the highest mortality globally, killing about 1.80 million people in 2020—more than any other cancer.

According to Dr Sitna Mwanzi, a medical oncologist at the Aga Khan University Hospital in Nairobi, many Kenyan patients are diagnosed when it is too late due to low awareness.

“Unlike globally, where lung cancer is one of the most commonly diagnosed cancers, in Kenya it's about the 17th most common cancer,” she told the Star.

Dr Sitna said the incidence is rising, but most patients are diagnosed at stage three or four where the prognosis is poor.

She said this is because the symptoms of lung cancer are similar to other diseases such as tuberculosis and chronic airway disease.

“One of the commonest symptoms is a cough. But as you know, cough is a very common symptom. If you have a normal cold, you get a cough, if you have pneumonia, you will come with a cough. If you have asthma, you'll have a cough. So how do you know you could be having lung cancer?” She posed.

Dr Sitna is the immediate former chair of the Kenya Society of Haematology and Oncology and also lectures at the Aga Khan University Hospital.

She said a cough that lasts for more than two weeks needs to be evaluated.

Other symptoms include chest pain, shortness of breath, wheezing, coughing up blood, tiredness and weight loss.

“But by the time a patient is presenting with symptoms, most of the time, that disease is at an advanced stage,” Dr Sitna said.

According to the Kenya National Cancer Screening Guidelines, 2018, late-stage presentation is extremely common.

“Data from Kenyatta National Hospital shows that between 2014 and 2016, approximately 64 per cent of cancer patients were diagnosed at stage III or IV, when treatment for cure is difficult to achieve,” the guidelines show.

Part of the reason is lungs are an internal organ, which makes it difficult for lung cancer to be detected early, and symptoms only occur once it has advanced.

“And if you are talking about advanced or stage four disease, it means that maybe both of the lungs are affected, the covering of the lungs are affected or cancer has spread to the liver or the bone. More often than not it can spread to the brain,” Sitna said.

Treatment depends on the stage. It involves surgery to remove the tumour, and chemotherapy, which is the use of drugs to kill cancer cells. Sometimes, radiotherapy is also recommended.

There are also new advances in treatment, such as immunotherapy, where drugs are used to stimulate the immune system to kill cancer cells.

Dr Sitna said in the past, most patients with advanced disease had short survival from the time of diagnosis, mostly not more than two years.

Improvements in treatments mean people are now living even more than five years.

The main risk factor for lung cancer in Kenya is cigarette smoking, Dr Sitna said.

According to the US Centres for Disease Control, people who smoke tobacco are 15 to 30 times more likely to get lung cancer or die from lung cancer than people who do not smoke. 

Sitna said cigarettes have many chemicals in them some of which have the ability to change cells to develop cancer.

“And the cigarette smoking is not just about the person who's smoking,” she said. “There's also the risk of secondhand smoke. So you could be in your house but your spouse or partner is smoking, and you think that you're not at risk, but actually you are actually ingesting, you're inhaling more of the toxin than the person who's smoking.”

She said smokers need help to quit. This is through treatments approved by the Pharmacy and Poisons Board and also behavioural changes.

She praised the Ministry of Health for banning public smoking through the Kenya Tobacco Control Act.

“Even cigarette companies have to put labels that say that the substance you're taking is dangerous so there has to be a multi-sectoral approach to reducing the risks of cigarette smoking and exposure to other chemicals.”

Head of the Kenya Tobacco Control Alliance, a health promotion lobby, Joel Gitali, told the Star higher taxes are also key in reducing cigarette smoking.

“There are about 2.5 million smokers in Kenya according to the Kenya Global Adult Tobacco Survey. To reduce this number we need high tax levies for cigarette companies,” he said.

Sitna said outdoor and indoor air pollution from biofuels such as wood can also predispose people to cancer.

Those working in areas with asbestos, mines, or textile industries also need protective equipment to reduce exposure.

She said those with a family history of lung cancer, should also reduce their risk by avoiding risk factors such as smoking.

-Edited by SKanyara