This lecture slides by Kevin Tony Okoth shows the emerging trends of cancers in Sub-Saharan Africa including Kenya at large.

1. GROWING BURDEN OF
SUB-SAHARAN AFRICA
Kevin Tony Okoth
Maseno University,
School of Medicine

2. OBJECTIVES
Brief History of Cancer
Cancer Burden, Globally, Regionally, Locally
Cancers of interest
Challenges in controlling cancers in kenya
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3. HISTORY OF CANCER
• First described by Edwin Smith Payrus (1600 BC)
• Cancer derived form the word “Karkinos”,
meaning crab by Hippocrates (460-370 BC)
• Galen (2nd Centrury AD), added “oncos” to mean
swelling thus Oncology
• Insights on cancer increased form 17th century
after discovery of microscope
• Genetic basis described in 1902
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4. • Gradual increase of incidence and prevalence
world wide
• Preventive and effective curative measures in
developed countries
• Developing countries lagging behind due to
poverty and increase in infectious diseases.
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5. GLOBAL BURDEN
• 14.1 incidence in 2012
• India, China, and other East and Central Asian
countries account for nearly half of the world’s
new cancer cases and deaths.
• Think about the Chinese foods and the efforts
they have put in management of cancers
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7. KEY FACTS (WHO)
• Leading cause of
morbidity and
mortality worldwide.
• 2nd leading cause of
death globally
• 14 million new cases
worldwide, about 8
million deaths.
• 70% deaths in low and
middle income
countries.
About 1/3 due to:
 High BMI
 Low fruit and
vegetable intake
 Lack of physical
activity
 Alcohol abuse
 Tobacco use
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8. KEY FACTS (WHO)
• Cancers due to
infectious diseases eg
Hep B and HPV cause
about 25 % of cancers in
developing countries.
• Late stage presentation
& inaccessible diagnosis
common.
• 35% of low income
countries have
pathology services in
public sector.
• 30 % treatment services
in low income countries.
• Increasing economic
impact, 1.6 Trillion US $
total annual economic
cost.
• Lack of data in low
income countries to
drive cancer policies.
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9. BURDEN IN SUB SAHARAN
AFRICA
Major public health problem due to:
Population ageing and growth
Increase prevalence of key risk factors
Social and economic transitions
Infection related cases predominate
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13. BURDEN IN KENYA
• 3rd cause of morbidity,
7% of deaths.
• Inadequate data
challenge
• 39,000 new cases
annualy, 27000
mortality annually.
• 60 % younger than 70
years old.
Leading causes:
Men: Prostate &
esophagus
Women: Breast, cervical
Childhood:
ALL, Burkitts, Wilm’s
Tumour
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14. CONTRIBUTING FACTORS TO
RISING CANCERS IN KENYA
Most are modifieable:
Infectious diseases: 33%
HIV/AIDS
Adopting Western lifestyle:
• High fat diet
• low fiber diet
• low vitamin diet,
• alcohol
• smoking
• sedentary life
• Growing population
• Exposure to outdoor &
indoor pollutants
• Exposure to occupational
carcinogens
• People living longer
• Increasing awareness
• Improving diagnosis
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15. WHICH CANCERS ARE THEY?
BREAST CANCER
• In Kenya, contributes to among
highest mortality in Africa
• Median age 48.5 years, mean
age 51.9 years
• Worldwide 1% males affected
but in East Africa, 7% males
affected.
• In western Kenya, associated
with the Tripple –Ve form,
poorer outcome.
• KikuyuLuhyaKalenjin
• Invasive Ductal Carcinoma
common
Contributing Factors
• Contraceptive use: More than ½
of Kenyan women of
reproductive age use
contraceptives
• Nulliparity: Need for smaller
families? Economic Constraints
in raising large families?
• Not breastfeeding: Women get
busy?
• Late age of first delivery: > 30
yrs, risk is twice
• Obesity, alcohol
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16. ESOPHAGAL CANCER
• 9th common cancer
worldwide, 5th common
in developing countries
• M:F 1.5:1
• Mean age of 58.7 years
• 90% are Squamous cell
carcinoma.
• Prevalent regions:
Central Nyanza, Western
and Rift Valley
Central Nyanza: Smoked
fish
Western: Carbohydrate
diet: Dietary deficiencies
Rift valley:
Mursik ( polycyclic
aromatic hydrocarbon
form charcoal),
maize meal (Mycotoxin
fumonisin in maize
mould)
busas from maize
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17. These have Nitrosamines
that when acted upon by
gut bacteria release
nitrites that irritate gut
mucosa
Smoked fish
 nyama choma, kuku
choma,
 PAH,
 mycotoxin fumonisin
 chemically preserved
foods
Other general risk factors
Lifestyle: ciggerate
smoking, betel chewing,
alcohol
Diet: Hot foods,
antioxidant deficiency,
exposure to nitrosamines
(chemically preserved
foods)
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18. COLORECTAL CARCINOMA
• Fatty Diet: unsaturated
& polyunsaturated,
omega 3 and 6
protective
• Daily alcohol intake: 2
fold increase in risk
• Ciggerate smoking
• Nitrosamine foods
• Low fibre diet
• Carbonated drinks
Point of note:
Genetic predisposition
HNPCC
FAP
Peutz jagher’s
syndrome
Turcot syndrome
Torres syndrome
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19. GASTRIC CANCER
• 3rd most common
cause of cancer related
deaths worldwide
• 3rd most common GI
malignancy in Kenya
• Low socioeconomic
status
• H.pylori infection
• Smoking
• Alcohol
• Foods high in nitrates
(Food preservatives)
• Foods high in nitrites
(smoked foods, high
salt foods, pickled
veges)
Adenocarcinoma
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20. AIDS RELATED MALIGNANCIES
• Malignancies in 40%
of immunosuppressed
patients.
• Primary cause of
death and morbidity
How does HAART
contribute to
malignancies in HIV?
 HIV stays longer
People live longer
• Mostly caused by
herpes group of
viruses
• Point of concern
during diagnosis
• HIV accelerated Hep B
and Hep C infections
• Hepatitis C associated
with Hepatocellular
carcinoma
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21. EBV malignancies increase in HIV. Examples?
AIDS defining malignancies
• NHL: Diffuse large cell
• Karposi sarcoma
• Invasive cervical
carcinoma
• Anorectal cancer
Non AIDS defining
malignancies
• Hodgkings lymphoma
• Head and neck cancers
• Melanoma
• Lung cancer
• Basal cell carcinoma of
skin
• seminoma
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Kaposi’s Sarcoma

23. HIV AIDS ADVOCACY
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25. Challenges in management
70-80% diagnosed late
due to:
Lack of awareness
Inadequate diagnostic
facilities
High cost of treatment
High poverty index
• Number of radiation
centers in Kenya are 4:
KNH, MP Shah, Nairobi
Hospital, Agakhan
• Number of treatment
facilities are 4: 2 main,
2 limited
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26. Human Capacity for
cancer treatement in
Kenya (Public Sector)
4 radiation
oncologists
6 medical oncologists
4 pediatric
oncologists
5 radiation therapy
technologists
3 oncology nurses
Cancer control
strategies & Guidelines
National Cancer Control
Strategy (2011-2016),
launched and being
implemented
National Cervical Cancer
Programme Strategic Plan
(2012-2015)
National Guidelines for
Prevention and Management of
Cervical, Breast and Prostate
cancers (2012)
National Palliative Care
Guidelines. MOH 2013
National Guidelines for Cancer
Management Kenya, MOH 2013
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