At the end of September, three African countries embarked on a pilot program to improve the overall care of breast and cervical cancers, which account for more than half of female cancers in Africa. This initiative is a step in the fight against this scourge, which began at the turn of the 2010s on the continent.
Supported by Ivory Coast, Kenya and Zimbabwe with the support of the World Health Organization (WHO) and the pharmaceutical laboratory Roche, it consists of integrating the entire chain of care for these female cancers into a comprehensive public health policy, from the promotion of basic care dedicated to women to early detection, including prevention and treatment.
“In our constrained economies, despite the problems of hierarchy of emergencies, the idea of global health has emerged, key to our development, testifies Professor Cheikh Tidiane Cissé, head of the gynecology-obstetrics department of the Institute of social hygiene polyclinic of Dakar, who presented, Tuesday October 10, during the congress of the International Federation of Gynecology and Obstetrics in Paris, the experience of Senegal in the fight against cancer of the cervix and breast. We are moving away from the compartmentalization of care. To do this, we must continue to invest in the prevention of these non-communicable diseases. »
Doubling of cases over the next twenty years
If cancers − but also cardiovascular pathologies, hypertension, diabetes, obesity − have long remained in the shadow of major infectious diseases, a health priority for the continent for decades, the International Agency for Research on Cancer ( IARC) predicts a doubling of cases over the next twenty years in sub-Saharan Africa. The WHO projects that by the end of the decade, cancer-related mortality will exceed that of malaria, tuberculosis and HIV combined, which killed about 1.5 million people on the continent in 2021.
Long considered the lot of rich countries, cancers and other non-communicable diseases have become a part of the lives of Africans as “junk food”, a sedentary lifestyle, pollution, smoking and alcohol consumption have taken over major cities. cities, whose population doubles every twenty years. The aging of the continent, where life expectancy has increased by ten years since 2000, also has an impact on this explosion.
“It’s a double burden for Africa and a paradox,” explains Professor Maïmouna Ndour Mbaye, director of the National Diabetology Center in Dakar, Senegal. We are living longer and that is good news, but by adopting a Western lifestyle, we now have time to develop chronic pathologies while we are not yet free of malaria or tuberculosis. . »
On the cancer front, over the last ten years, much has been done. Most African countries have adopted national control plans and numerous radiotherapy centers have been built. In 2022 and 2023 alone, eleven have been built, particularly in sub-Saharan Africa – Benin is due to open its own in 2024 – and 39 countries on the continent out of 54 are now equipped, according to data from the international register of centers of radiotherapy. But there is still a lack of money to ensure comprehensive patient care and a quality care pathway remains the privilege of an urbanized middle class.
Patients often diagnosed too late
The continent, which bears a quarter of global cancer deaths, only invests 1% of total health spending in the fight, according to the report published in 2019 by the Institute for Health Metrics and Evaluation at the University of Washington, while only 2% of multilateral and bilateral aid, the pillar of emerging health systems, benefits non-communicable diseases, including cancers, according to an analysis carried out the same year by the British Medical Journal. Finally, Africa has two to four times fewer oncologists than the recommendations of the International Atomic Energy Agency.
On the ground, patients are therefore often diagnosed too late and access to care remains complicated and expensive, even when States provide partial coverage. Thus, Senegal, which decreed in 2019 total free chemotherapy for breast and cervical cancers, can still only subsidize half of the treatment for other cancers.
Patients must therefore still pay numerous “additional” diagnostic or follow-up costs, such as mammography or analyses, as well as numerous travel expenses. Because, outside the Maghreb, South Africa and Kenya, which are well equipped with radiotherapy centers, patients often have to travel tens, or even hundreds of kilometers, to be treated in the capital or the largest city. closer.
“Most families go so far as to go into debt to care for their loved ones,” explains Hélène Kane, an anthropologist from the University of Rouen who is leading a special report on cancers in the Sahel for the social sciences journal L’Ouest saharien to be published. early 2024. Worse, they often have to interrupt treatment due to lack of resources. We manage to pay for the first treatment, we sell our goods for the second, we go into debt for the third, and we abandon the fourth. »
Strengthen screening
Patient aid associations and national cancer leagues, more and more numerous and often created by formerly cured patients, provide financial support, support and even accommodation through mutual aid networks. . But here too, resources are limited.
Prevention, much less expensive for States, therefore remains crucial. Vaccination, when possible, in particular against human papillomaviruses (HPV, very contagious, responsible for cancers of the cervix but also of the anus, penis, mouth or throat) or hepatitis B and C (liver), is being generalized on the continent. According to WHO data, more than 21 African countries have achieved 70% HPV coverage.
As for screening, if it must be strengthened for an effective fight and less expensive for health systems when it is early, “it poses a real ethical problem for doctors who cannot ensure all the care of their patients, testifies Hélène Kane, who worked for more than ten years in Mauritania. It is a real suffering for them. This must raise the question of palliative care, which is almost non-existent in sub-Saharan Africa. But, whatever the progress of the fight and the means, we must face it, because this “epidemic”, which has remained invisible for a long time, is indeed taking place. »