Grappling With Rising Cases of Cancer

Jacob Ng'etich
From an obscure and insignificant disease that was known to affect a few old or rich people, cancer has now risen to become one of the leading causes of death in Kenya.
Studies by the Kenya Medical Research Institute indicate that cancer is the third cause of death after infectious diseases and cardiovascular diseases.
The disease has claimed the high and mighty, and the poor in the country.
Its latest victim is the celebrated environmentalist and Nobel Peace Prize winner, Prof Wangari Maathai, who died of ovarian cancer on Sunday night at Nairobi Hospital.
The increase in cancer cases has been attributed to, among other reasons, changing lifestyles.
Medical Services minister Prof Anyang' Nyong'o, himself a cancer survivor, says the disease accounts for seven percent of Kenya's total mortality every year.
The minister says every year, over 28,500 new cases of cancer are diagnosed. The country loses 22,100 people to the disease each year.
"It is sad because over 60 percent of those affected are below the age of 70. In Kenya, the risk of getting cancer before the age of 75 years has increased significantly over the years," said Prof Nyongo in an interview with the Saturday Nation.
However, the vice-chairman of Kenya Cancer Association, Mr David Mukami, gives a higher figure of new cases recorded annually.
"There are 18,000 deaths of cancer in the country annually, based on the ministry's statistics, though the figures are very modest given that there are no proper records on the disease.
"Even the 82,000 figure for new cases annually is modest because it does not include cases from rural areas," says Mr Mukami.
His assertion is supported by the Global Medicine (2011) report, which repeatedly states that the incidents of cancer in Kenya are on the rise, with over 82,000 new cases reported annually.
"Based on 2002 data from the Nairobi Cancer Registry, of all the cancers registered, breast cancer accounted for 23.3 percent, cervical cancer for 20 percent and prostate cancer for 9.4 percent. In 2006, around 2,354 women were diagnosed with cervical cancer and 65 percent died," says Prof Nyongo.
The 2010 study by KEMRI found that of the 2,292 cancer-related deaths recorded in Nairobi during a two-year period, oral tumours claimed the biggest percentage of victims.
According a policy brief on the analysis of cancer in Kenya, prepared by Parliament's department of research, cancer now ranks third as one of the most common diseases causing death in the country.
The report identifies the most common forms of cancer as breast and cervical cancer among women. Men are affected by cancer of the oesophagus, neck and prostate.
In children, the commonest cancers are blood (leukemia) and lymphomas. Dr Paul Wangai, a consultant physician and a doctor at Aga Khan, says the eating habits of Kenyans, especially in urban areas, exposes them to cancer.
"Cases of the rich-man-disease (the consumption of too much sugar and fats) are alarming. More people are complaining of diabetes and cardiovascular diseases. The trend is worrying. It causes a lot of problems, including cancer," says Dr Wangai.
Former Kenyatta National Hospital chief executive officer, Dr Jotham Micheni, agrees that there is a serious increase in non-communicable diseases related to lifestyle.
Dr Micheni says KNH received between 120,000 to 140,000 new cases related to lifestyle diseases per week. "There is a worrying trend," says Dr Micheni.
"Most of the cancer cases are related to what we consume. For instance, the over-consumption of red meat has increased cases of cancer of the oesophagus, intestines, stomach," he says.
The KEMRI study notes that cancer treatment is improving in the developed world.
Unfortunately, in Kenya, these advances are yet to be realised due to lack of resources and trained personnel, the prohibitive cost of chemotherapy drugs and the advanced stage of a majority of the cancer cases at the time of presentation.
The parliamentary report recommends that the government, through Parliament, must fast-track policy measures to address the rising cases of cancer.
Among others, the report suggests that at least one hospital in each county, if not constituency, should be equipped with facilities and specialists to handle cancer cases.
Prof Nyong'o says over 40 percent of cancer cases can be prevented through cost-effective interventions based on reduction in exposure to risk factors.
He says this can be achieved through the implementation of comprehensive tobacco control programmes.
"Other interventions include the promotion of healthy diets, physical activity and control of alcohol abuse," says Prof Nyong'o.
"Environmental risk reduction includes identification and removal of hazardous occupational and environmental exposures like asbestos and chemical effluents from industries," he adds.
"The prevention of other infectious diseases that are associated with cancers, such as immunisation against the human papilloma virus, which causes cervical cancer, and hepatitis B, which causes liver cancer, will also go a long way."
There are very few public facilities that cater for cancer cases. At the moment, Kenyatta National Hospital, according to the Global Medicine (2011) study, is the public institution that hosts most of the cancer experts and technology in Kenya.
The country's referral national hospital is currently overwhelmed with inpatient and outpatient cases and cannot cope.
The report notes that the government ought to give cancer the same weight it gives malaria and HIV since more than 70 percent of cancer cases are preventable through a healthy lifestyle.
Kenya does not have a cancer registry and surveillance to help determine the cancer burden.
The parliamentary report called for the establishment of a government medical centre, incorporating a cancer institute, in Nairobi, which could be an autonomous centre for research, diagnosis and treatment of cancer.
Dr Sridar Susheela, a consultant oncologist at Healthcare Global Enterprise in India, says the cost of diagnostic services such as CT scans, MRI, ultrasound and radio-isotopes scans in the country was exorbitant compared to India and other Asian countries.
"In Kenya, a CT scan costs up to Sh50,000 while it costs about Sh14,000 in India. A consultant would easily charge Sh6,000 in Kenya, while patients pay Sh400 to Sh500 for the same consultation in India," said Dr Susheela.
Kenya needs to train more specialised manpower to meet the demands of rising cases of cancer.
According to the Kenyatta National Hospital's Cancer Unit's Report (2011), there are only five clinical oncologists, four medical oncologists and about eight oncologists, in Kenya.
The reports states that 95 percent of the oncologists practice in Nairobi. Training one clinical oncologist is estimated to cost at least Sh8 million.
The parliamentary report blames the rise of cancer cases to the presence of pollutants, carcinogens, lack of information, consumption of roast meat and the consumption of tobacco products.