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SA cancer cases climb as unequal treatment causes ‘needless deaths’

As the World Health Organisation predicts that global cancer rates are likely to soar by 77% by 2050, another global report says that black South Africans experience more hurdles than whites because 70% of cancer specialists in the public sector are white and hindered by language barriers.

Cancer cases in South Africa country are projected to rise from about 62 000 in 2019 to 121 000 in 2030, yet obstacles hindering early treatment and access to cutting-edge drugs are causing needless deaths, said authors of the World Cancer Day 2024 equity report by the Union for International Cancer Control (UICC).

Public sector patients in South Africa are not only diagnosed late, often resulting in treatment failure, poor quality of life, and death, but other factors like gender and education levels often create prejudices when accessing cancer treatment.

Only five provinces offer cancer care, meaning that many people who develop cancer are screened late, reports TimesLIVE.

Apart from the expensive transport and accommodation costs of travelling to bigger centres or cities for treatment, once they’re there, the oncology drugs are often not available because of pricing.

Ann Steyn, president of Reach for Recovery International (RRI), an umbrella body for cancer organisations, and a past UICC board member, said the “healthcare system in South Africa shows significant disparities, despite a progressive Constitution that recognises human rights”.

She said there was frequently a shortage of diagnostic and radiation equipment, especially in public hospitals not linked to academic institutions, and despite some cancer drugs being on the essential medicines list, oncology medicines were often unavailable.

Challenges with diagnostic and radiation equipment was “compounded by poor maintenance, lack of funds and lack of trained staff”.

“Only 20% of healthcare professionals are in the public sector, with 70% of them being white males treating a majority of patients who are people of colour. This can often create challenges for diagnosis and treatment if there is not mutual language understanding or cultural background consideration.”

There are also challenges in the private sector, and only 10% can access high-cost cancer medicines because treatment guidelines differ between health insurance schemes. This means many medical aid members have hefty out-of-pocket expenses obtaining treatment, or have to seek substitute treatments.

With cancer incidence and mortality set to rise, gender and racial equity must be addressed with increased urgency as integral to improving cancer outcomes.

The report said introducing early screening programmes would ensure timely treatment, irrespective of patients’ ability to pay, and heavily regulating carcinogenic products like tobacco, alcohol and ultra-processed foods and beverages could help manage the disease.

Steyn added: “Where you live, how much money you make, your age, your health, your gender, or the colour of your skin shouldn’t dictate whether you have access to cancer care.”

Meanwhile the WHO’s International Agency for Research on Cancer (AIRC), which has just released the latest global burden of cancer estimates, predicts 35m new cancer cases by 2050, a 77% increase from the 20m in 2022.

About 9.7n people died of cancer in 2022. About one in five people develop cancer in their lifetime.

The global survey showed only 39% of participating countries covered the basics of cancer management as part of their financed core health services. Only 28% of countries covered care for people needing palliative care and pain relief.

Lung cancer was the most common cancer with 2.5m new cases worldwide, accounting for 12.4% of the total new cases. It was also the leading cause of cancer deaths, resulting in 1.8m deaths. Breast cancer ranked second with 2.3m cases or 11.6%, followed by colorectal cancer (1.9m cases, 9.6%).

Lung cancer’s re-emergence as the most common cancer is probably related to persistent tobacco use in Asia.

Prostate cancer ranked fourth with 1.5m new cases, or 7.3%, while stomach cancer ranked fifth with just more than 1m cases, or 5%.

Colorectal cancer was the second leading cause of deaths, resulting in about 900 000 deaths (9.3%) worldwide. Liver cancer ranked third with 760 000 deaths – 7.8%.

The survey blamed the rapidly growing global cancer burden on “population ageing and growth, as well as changes to people’s exposure to risk factors, which are associated with socioeconomic development”.

It revealed that tobacco, alcohol and obesity are key factors behind the increasing incidences of cancer, with air pollution still a key driver of environmental risk factors.

The estimated number of people who were alive within five years of a cancer diagnosis was 53.5m. About one in five people develop cancer in their lifetime, and approximately one in nine men and one in 12 women die from the disease.

Three major cancer types in 2022: lung, breast and colorectal cancers

The new estimates available on IARC’s Global Cancer Observatory show that 10 types of cancer collectively comprised around two-thirds of new cases and deaths globally in 2022. Data cover 185 countries and 36 cancers.

There were some differences by sex in incidence and mortality from the global total for both sexes. For women, the most commonly diagnosed cancer and leading cause of cancer death was breast cancer, whereas it was lung cancer for men. Breast cancer was the most common cancer in women in most countries (157 of 185).

For men, prostate and colorectal cancers were the second and third most commonly occurring cancers, while liver and colorectal cancers were the second and third most common causes of cancer death. For women, lung and colorectal cancer were second and third for both the number of new cases and of deaths.

Cervical cancer was the eighth most commonly occurring cancer globally and the ninth leading cause of cancer death, accounting for 661 044 new cases and 348 186 deaths. It is the most common cancer in women in 25 countries, many of which are in sub-Saharan Africa.

Even while recognising varying incidence levels, cervical cancer can be eliminated as a public health problem through the scale-up of the WHO Cervical Cancer Elimination Initiative.

Striking cancer inequity by Human Development Index (HDI)

Global estimates reveal striking inequities in the cancer burden according to human development, especially for breast cancer. In countries with a very high HDI, one in 12 women will be diagnosed with breast cancer in their lifetime and one in 71 die of it. By contrast, in countries with a low HDI; while only one in 27 women is diagnosed with breast cancer in their lifetime, one in 48 women will die from it.

“Women in lower HDI countries are 50% less likely to be diagnosed with breast cancer than women in high HDI countries, yet they are at a much higher risk of dying of the disease due to late diagnosis and inadequate access to quality treatment,” said Dr Isabelle Soerjomataram, deputy head of the Cancer Surveillance Branch at IARC.

WHO’s global survey of HBPs also revealed significant global inequities in cancer services. Lung cancer-related services were reportedly four to seven times more likely to be included in a HBP in a high-income than a lower-income country. On average, there was a four-fold greater likelihood of radiation services being covered in a HBP of a high-income than a lower-income country.

The widest disparity for any service was stem-cell transplantation, which was 12 times more likely to be included in a HBP of a high-income than a lower-income country.

“WHO’s new global survey sheds light on major inequalities and lack of financial protection for cancer around the world, with populations, especially in lower income countries, unable to access the basics of cancer care,” said Dr Bente Mikkelsen, director of the Department of Non-Communicable Diseases at WHO.

“Where someone lives should not determine whether they live. Tools exist to enable governments to prioritise cancer care, and to ensure everyone has access to affordable, quality services. This is not just a resource issue but a matter of political will,” said Dr Cary Adams, head of UICC.

Cancer claims rise

In South Africa, cancer claims are rising, according to Discovery Health Medical Scheme, which said this week that its 2023 cancer claims payouts were almost 19% higher in rand terms year on year, and that it paid out more than R3.2bn for cancer treatment and maintenance therapy last year.

The data, from January to October, last year showed the highest related payout being R1.8m for a patient with multiple myeloma, which affects the white blood cells.

News24 reports that during the period, there was a 2.7% increase in members diagnosed with breast cancer to 1 843 members, as well as a 17% increase in members diagnosed with cervical cancer – at 122.

There was also an 8.6% increase in members diagnosed with prostate cancer and an increase by 1.8% in diagnoses of colorectal cancer, to 784.

The age range of DHMS members claiming for cancer treatments between January and October 2023 was 23 to 98 for breast cancer; 25 to 82 for cervical cancer; 19 to 96 for prostate cancer; and 17 to 94 for colorectal cancer.

Data from the Discovery Vitality HealthyFutures model, along with data from the US-based surveillance, epidemiology and end results programme (SEER), show that, on average, someone diagnosed with early-stage breast cancer has a 2.3 times higher likelihood of survival over five years. That translates into a 96% five-year survival rate.

Conversely, there is a 41% five-year survival rate for those diagnosed with late-stage breast cancers. At age 40, diagnosing breast cancer at an early stage improves life expectancy by 22 years, relative to later stage 3 and 4 cancer diagnoses.

For someone aged 40, detecting prostate cancer at an early stage improves life expectancy by 35 years.

Those diagnosed with early-stage colorectal cancer have a 93% five-year survival rate, compared to 25% for late-stage colorectal cancer. For a 40-year-old, identifying colorectal cancer at an early stage improves life expectancy by 22 years.

Pandemic lag

The 2023 screening rates for breast cancer, the most common cancer among DHMS members, exceeded 2019 rates by 8.1%, with 367.7 screens completed per 1 000 eligible person years. The epidemiological concept of “person-years” is a way to measure the amount of time people in a study have been exposed to a certain risk or condition and helps researchers understand the incidence rate of a disease or event over a given period.

Screening for prostate cancer, the second most common cancer for DHMS members and generally the most common cancer among men, dropped in 2020 from 577.5 to 515.5 screens per 1 000 eligible person years, a 10.7% drop from the previous year.

There was some recovery in screening rates in 2021 before testing rates increased to 637.6 screens per 1 000 eligible person years in 2023 – 10.4% higher than 2019 levels.

Colorectal cancer screening rates have recovered to above pre-pandemic levels, with a 24.4% increase in 2023 compared to 2019, which translates to 36.6 screens per 1 000 eligible person years in 2023.

Unfortunately, DHMS said screening for cervical cancer continued to lag, noting a steady decrease in screenings from 2016 to 2019, with screenings then suffering a 20% drop in 2020.

While cervical cancer screening improved somewhat from 2021, rates are still not back up to pre-pandemic levels, with just 512 screenings per 1 000 eligible person years.

 

Int Agency for Research on Cancer (Open access)

 

World Cancer Day Equity Report (Open access)

 

TimesLIVE article – SA’s cancer treatment obstacles are causing ‘needless deaths’ (Restricted access)

 

WHO article – Global cancer burden growing, amidst mounting need for services (Open access)

 

News24 article – SA cancer payouts jumped almost 20% to R3.2bn last year, says Discovery (Open access)

See more from MedicalBrief archives:

 

Lack of basic care hastens colorectal cancer deaths in Africa – global analysis

 

Steep climb in under-50 cancer cases, global study finds

 

Experts call for comprehensive, large-scale response to slash Africa’s cancer burden

 

Cancer Alliance: R50bn needed for cancer over next decade

 

 

 

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