Cancer survival in Africa
Survival rates for black cancer patients in Zimbabwe among lowest ever reported
For black cancer patients in Zimbabwe, survival rates are very low, not exceeding 55 percent after 5 years for any of the most common cancers. A new study published July 30, 2004 in the online edition of the International Journal of Cancer – the official journal of the International Union Against Cancer (UICC) – suggests that lack of access to care accounts for much of the problem. The full study will be available online via Wiley InterScience at http://www.interscience.wiley.com/journal/ijc.
Comprehensive population-based cancer survival estimates from southern Africa are now available for the very first time, and they are sobering. In Harare, a large city in Zimbabwe, cancer rates have risen dramatically, largely as a result of the AIDS epidemic that has led to increases in the incidence of AIDS-associated Kaposi sarcoma and squamous cell carcinoma of the conjunctiva. Survival rates of patients with cancer, which were assessed for the first time, have been found to be disturbingly low.
To better understand cancer in Africa, an international research team, involving the Zimbabwe National Cancer Registry, the International Agency for Research on Cancer, and the Department of Epidemiology at the German Centre for Research on Ageing collected the population-based estimates for survival for black and white cancer patients in Harare and compared them to each other, and to those of black and white American cancer patients.
The researchers used a sample of patients in Harare who were diagnosed with one of the area's fifteen most common cancers between 1993 and 1997, as reported to the Zimbabwe National Cancer Registry. They followed up with each patient through a search of death certificates, hospital records, and if necessary, home visits to ascertain the vital status of the patient as of December 31, 1999. They then calculated the absolute and relative survival rates for black and white Zimbabwean patients. The researchers also compared the results to survival rates of black and white American cancer patients, who had been diagnosed with the same cancers during the same time period.
Survival rates for black Zimbabweans were very poor, none exceeding 55 percent. White Zimbabwean patients had, for most cancer sites, substantially higher survival rates that black Zimbabwean patients. However, survival rates for both black and white patients in Zimbabwe were significantly lower than those for black and white American patients.
"These patterns suggest that for most cancer sites, differential access to effective medical care, rather than ethnic difference, accounts for most of the observed differences in survival," the authors report.
Compared to data from other developing countries, Zimbabweans' survival was particularly low for patients with cancer of the colon and rectum, larynx, breast, cervix, prostate and the bladder and for lymphomas, indicating that Zimbabweans lack access to the early detection and treatment methods that are better available elsewhere.
Furthermore, the survival estimates for Zimbabwe reported in this study may be too optimistic, rather than too pessimistic, due to certain limitations of the study – including a low proportion of histologically verified cancers, and a high proportion of patients lost to follow-up or located by death certificate only who were not included in survival analyses.
Good national cancer control programs address prevention, detection, diagnosis, treatment, rehabilitation and palliative care. In particular, early diagnosis and treatment can maximize patients' chances of survival. This study indicates that cancer patients in Sub Saharan Africa would certainly benefit from earlier diagnosis and better access to treatment facilities.
"Equitable distribution of resources is an important ethical concern in cancer treatment," the authors conclude. "It is clear that, in Zimbabwe at least, and probably in much of the continent, there is plenty of scope for improvement in this respect."
Source: Eurekalert & othersLast reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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