With the incidence of cancers in South Africa predicted to almost double by 2030, government's strategy to combat cancer has not been updated for two years, writes Chris Bateman for MedicalBrief.
The National Health Department director for non-communicable diseases, Dr Busisiwe Ndlovu, told a recent workshop that the official new cancer prevention and control strategy to replace the expired one was on the "verge” of being signed by the Director-General of Health, Dr Sandile Buthelezi. The expired strategy was still being used by the department but needed ‘evaluation and revision’, she added. She also admitted that the ministerial advisory committee on cancer prevention and control was defunct and needed to be re-established.
This comes as cancer was dubbed ‘the new HIV,’ by several among three dozen top cancer research and innovation experts attending the workshop in Durban recently. NCDs such as heart disease, cancer and diabetes are now the leading cause of death worldwide and in many countries have surpassed communicable diseases as the primary cause of mortality. The workshop is a collaboration between the University of Pretoria’s Nuclear Medicine Research Infrastructure (UP-NuMERI), the SA Medical Research Council (SAMRC), the Department of Science, Technology and Innovation (DSTI), the National Department of Health (NDOH). They form part of a broader effort to map the current cancer research landscape, assess key challenges, identify national priorities, and collaboratively shape a robust forward-looking strategy.
Cancer today accounts for 10% of national deaths annually. It’s the leading cause of mortality, which can be partly explained by patients presenting late with advanced disease in a state system where the experts agree that the lack of early detection and referral upward to proper diagnostic care and treatment are proving fatal. Cancer incidence now surpasses other highly prevalent local non-communicable diseases such as tuberculosis, HIV/AIDS, and malaria.
Two actuaries and public health experts1 have warned of the dire implications for public health that the current underfunding for cancer screening and prevention has. In a paper published in the SA Journal of Oncology in August last year, they2 cited Stats SA and Discovery Health data estimating some 62 000 cancer deaths in 2019 and project this mortality, based on existing trends, to 121 000 people by 2030. The authors conclude that the high cancer mortality rate comes down to the inequities in prevention, screening, diagnosis and treatment – which also leads to poor health outcomes.
In a presentation to the workshop, National Cancer Registry (NCR) senior epidemiologist, Dr Judith Mwansa-Kambafwile, said the 2023 registry of laboratory confirmed cases showed 63 778 new cancer cases diagnosed. However, this was an underestimation because it did not include cancers that were diagnosed clinically or radiologically.
Her data shows that if you’re a South African between the ages of 60 and 70, your chances of developing seven of the most common cancers are greatest, with prostate cancer hitting men the hardest and breast cancer women the worst.
Mwansa-Kambafwile warned that cervical cancer is still diagnosed in the above 60-year-old brackets in spite of the national screening guidelines recommendation that women above 60 years not be screened.
She emphasised another anomaly: the breast cancer guidelines recommend that provider-initiated screening should be done in women aged 40 years and above. However, about 10% of women diagnosed with breast cancer were found to be under 40-years-old.
A study of HIV/cancer co-morbidity between 2004 and 2021, shows that of 9.4m people with HIV, more than 92 000 had cancer diagnoses. This South Africa HIV Cancer Match (SAM) Study is so far, the largest virtual cohort of HIV positive individuals.
Dr Mary Kawonga, a public health specialist in the Gauteng Department of Health and Associate Professor at the Wits School of Public Health, said that while South Africa has excellent policies, programmes and tools to prevent cancer it fails dismally when it comes to implementation with several service delivery models unfit-to-task. Too many of those public sector patients who are lucky enough to secure care only begin treatment on their sixth visit.
Singling out cervical cancer, she said biomedical interventions and applications were insufficient, with too few diagnostic tools available.
“What you need to make technology work in the real world are pap smears, DNA testing and service delivery models that enable referrals for women. They need to get to the next step. We talk about ‘implementation failure ‘- we can have wonderful tech, but it often fails and is not feasible or appropriate for the setting. We’re not implementing things in ways that work,’ she said.