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Rising burden of cancer in Ghana: A wake-up call

BY: Dr Francis Hasford

Cancer is a major public health problem worldwide and Ghana has not been spared of this ever-growing health canker, which falls under target three of the Sustainable Development Goals (SDG 3).

The medical definition of cancer is a disease that is associated with abnormal growth of the cells in the body.

These cells multiply in an uncontrolled manner and invade nearby tissues. In some cases, cancer cells do spread to other parts of the body through the blood and lymphatic systems.

There are several types of cancers and the available treatment options include surgery, chemotherapy, immunotherapy and radiation therapy.

To date, studies have not been able to prove that a behaviour or substance is responsible for cancer.

It is almost impossible to understand why some persons develop cancers and others do not.


However, research has shown that certain risk factors increase a person’s chance of developing the disease.

Tobacco usage, excess weight and obesity and unhealthy diets are the major cancer risk factors worldwide.

Estimates

Other factors include a lack of physical inactivity, exposure to viruses, individual’s family history, alcohol intake, individual’s age, exposure to radiations and reproductive factors.

The World Health Organisation (WHO), through its cancer research agency, International Agency for Research on Cancer (IARC), estimated a total of 14 million new cancer incident cases worldwide in 2012, of which 8 million deaths were recorded.

Most of the cancer deaths are recorded in less developed countries although the developed regions of the world record more cancer incidences comparatively.

Approximately 70 per cent of deaths from cancer occur in low and middle-income countries. It is projected that by 2030, about 10 million cancers would be diagnosed each year in less developed countries.

In the developing world, cancer has been identified to kill more people than HIV/AIDS, malaria and tuberculosis combined.

According to WHO 2012 cancer data, the five most common cancers in the world are cancers of the lung (13 per cent), breast (12 per cent), colorectum (10 per cent), prostate (nine per cent) and stomach (seven per cent).

Research indicates that one out of eight women will develop breast cancer in her lifetime while one out of seven men will develop prostate cancer in his lifetime, due to existence of risk factors.

Tobacco is found to be a risk factor for at least 14 different types of cancers and is associated with causing about 30 per cent of the world’s cancer cases.

In Ghana, the most dominant cancers reported in females are breast and cervical cancers, while for males, prostate, head and neck cancers dominate.

The Ministry of Health in Ghana launched a five-year National Cancer Control Strategy in 2011 to address the four key components of cancer control: cancer prevention, early detection, diagnosis and treatment, and palliation.

However, Ghana has been faced with significant challenges in each of these components. In most developed countries, there exist dedicated cancer centres for screening, diagnosis, treatment and research.

Coupled with these is free access to cancer care within the health systems of such countries.

Constraints

Ghana is, however, constrained in this direction, with limited cancer centres and the treatment cost also being expensive.

A lack of coverage for cancer treatment under the NHIS in Ghana makes it difficult for the less privileged to access and sustain cancer care at any stage of the disease.

A lack of affordability for the treatment then results in high rates of treatment abandonment, which in turn leads to patients seeking traditional and other means of treatment that has over the years not proven to be helpful.

Records at the nation’s cancer centres indicate that majority of cancer cases are presented late when the disease has reached terminal stages.

Many of these late presentations are attributed to factors such as inadequate or lack of cancer awareness and inability of most patients to finance their cancer care.
As many advanced cancer cases are presented for treatment, palliative care and pain relief becomes very critical.

At those stages, effective treatment of the condition eludes the hardworking cancer care professionals.

Ghana falls in the category of countries with less than 25 per cent of cancer patients able to access radiation treatment.

With a population of over 26 million, the country is estimated to record over 65,000 new cancer incident cases yearly.

Out of these cases, more than half would require radiation therapy for treatment.

However, not more than 5,000 new cancer cases are treated per year in the country’s three radiotherapy centres.

This leaves the country with an average shortfall of about 30,000 new cancer cases that would require radiation treatment yearly.

The big question is, “How and where do such people access treatment?”

Centre

The Ghana Atomic Energy Commission (GAEC), in collaboration with the Ministry of Health, in an attempt to solve the national cancer problem, established two national radiotherapy centres at the Korle Bu and Komfo Anokye Teaching hospitals, in cooperation with the International Atomic Energy Agency (IAEA).

The two centres, together with the privately-owned SGMC Cancer Centre and pathology units in the nation’s major hospitals, have contributed to cancer care in the country over the years.

Data from IAEA suggests that developed countries averagely have one radiation therapy machine per 250,000 population. This observation is in sharp contrast to what pertains in Ghana, where only one radiation treatment machine is available for a population of four million.

In the face of increasing cancer incidences in the country, challenges such as improperly coordinated cancer awareness programme, lack of dedicated cancer prevention and screening centres, inadequate medical imaging and cancer treatment centres, and over-aged cancer management facilities and equipment should be well addressed.

Among other measures, the country should embark on concerted effort to develop a better strategy for cancer control and invest in the setting up of well-equipped cancer centres for early detection, diagnosis, treatment and research to fully achieve the SDG 3 target by 2030.

The government has a big role to play in this and so are relevant stakeholders and the public at large. We can make it as a country if we set our priorities right and put our shoulders to the wheel. God bless Ghana!

The writer is the recipient of IUPAP Young Scientist Award 2016
Medical Physicist (Senior Research Scientist)
Radiological and Medical Sciences Research Institute
School of Nuclear and Allied Sciences
Ghana Atomic Energy Commission