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By Henry Owino
Nairobi, Kenya: Around KES 100 billion (US$1 billion) would be needed to manage cancer in Kenya. This figure covers prevention, screening, and palliative care nationwide.
Githinji Gitahi, CEO of Amref Health Africa, stresses that Kenya must prioritize readily achievable solutions to alleviate the financial strain of cancer. These “low-hanging fruits” primarily involve a three-pronged approach applicable to all cancer types: early screening, early diagnosis, and early treatment.
Many consider the four pillars of cancer care—screening, diagnosis, treatment, and prevention—to be synonymous with oncology. In reality, oncology is a branch of medicine that deals with the study of the 4 pillars.
Secondly, decentralized cancer care in all 47 counties so that every part of the country has at least a cancer care centre. The counties need to ensure they are part of critical cancer basic care.
Surely, cancer is a monster, as the government prioritizes cancer hub centres across all 47 counties, it should be a priority in the national budget as well. This is because it is a killer disease that, if it can be nipped early enough by screening, the better, to avoid a financial burden to individuals and their families.
Thirdly, Kenya should aim to achieve a 70-80% human papillomavirus (HPV) vaccination rate among young girls aged 9-14. It is crucial to make every effort to vaccinate girls before they turn 15 to prevent cervical cancer.
Human papillomavirus (HPV) is a common sexually transmitted infection that can affect the skin, genital area, and throat.
“If we don’t do that, then our burden of cervical cancer is not going to reduce, but increase. Apart from government cancer initiatives, a lot still needs to be done; community participation, health workers’ presence, and school-based programs to achieve the target 80 percent,” Dr. Gitahi affirmed.
While cervical cancer is often preventable and curable with early detection and effective management, it remains a significant global health concern, particularly in low- and middle-income countries due to limited access to screening and treatment.
Dr. Gitahi regretted that at least 70% of cancer screening cases are diagnosed in stages 3 and 4, which is already too late to treat. This drives up the cost of palliative care, leading to an estimated budget of KES 1 billion.
“If we want to downstage the cost of this burden, then there are several things we need to do. Let me mention just a few that are key; focus on early screening through Social Health Authority (SHA), early diagnosis, and early treatment,” Dr. Gitahi emphasized.
Adding “And my assessment thus will bring down the burden cost of cancer significantly in the country, and it is possible. It should encompass all forms of cancer”.
He stated that many other types of cancers, breast cancer, colorectal cancer, and many others, are also related to diets. The WHO has put guidelines on the control of industrial trans fats and hydrogenated oils. Unfortunately, Kenya has never really moved forward to implement the 2grams per 100grams intake that could reduce the consumption of trans fats to start making gains on these other cancers: breast, prostate, and colorectal.
“If the government implements this guideline by WHO on trans fats, Kenya would become one of the three States in Africa to have implemented the WHO recommendation on control of industrial trans fats,” Dr. Gitahi advised.
The WHO recommends a maximum limit of 2 grams of industrially produced trans fats per 100 grams of total fat in all foods. This recommendation is part of the WHO’s initiative to eliminate industrial trans fats from the global food supply by 2023. The goal is to reduce the burden of non-communicable diseases (NCDs).
These remarks were made during the 2nd National Cancer Summit, hosted by the National Cancer Institute of Kenya (NCI-Kenya), at Edge Convention Centre, Nairobi, Kenya.
The crucial event brought together cancer researchers, healthcare professionals, policymakers, students, advocates, and stakeholders to discuss the latest advancements in cancer care, prevention, policy, and other key issues related to cancer.
According to WHO, cervical cancer is the fourth most common cancer in women globally, with around 660,000 new cases in 2022. In the same year, about 94% of the 350,000 deaths caused by cervical cancer occurred in low- and middle-income countries.
The highest rates of cervical cancer incidence and mortality are in sub-Saharan Africa (SSA), Central America, and South-East Asia. Regional differences in the cervical cancer burden are related to inequalities in access to vaccination, screening, and treatment services, risk factors including HIV prevalence, and social and economic determinants such as sex, gender biases, and poverty.
Women living with HIV are 6 times more likely to develop cervical cancer compared to the general population. An estimated 5% of all cervical cancer cases are attributable to HIV Cervical cancer is a leading cause of maternal mortality in younger women, accounting for 20% of all cancer-related maternal deaths.
Almost all sexually active people will be infected at some point in their lives, usually without symptoms. In most cases, the immune system clears HPV from the body. Persistent infection with high-risk HPV can cause abnormal cells to develop, which go on to become cancerous.
Typically, it takes 15–20 years for the abnormal cells to become cancerous, but in women with weakened immune systems because of neglected treatment of HPV, this process can be faster and take 5–10 years.
Risk factors for cancer progression include: the grade of oncogenicity of the HPV type, immune status, the presence of other sexually transmitted infections, number of births, young age at first pregnancy, hormonal contraceptive use, and smoking.
As low- and middle-income countries scale up cervical screening, more cases of invasive cervical cancer will be detected, especially in previously unscreened populations. Therefore, referral and cancer management strategies need to be implemented and expanded alongside prevention services.
The WHO record shows all countries have committed to eliminating cervical cancer as a public health problem. Currently, the WHO global strategy defines elimination as reducing the number of new cases annually to 4 or fewer per 100,000 women and sets three targets to be achieved by the year 2030 to put all countries on the pathway to elimination in the coming decades:
- 90% of girls are vaccinated with the HPV vaccine by age 15
- 70% of women screened with a high-quality test by the ages of 35 and 45
- 90% of women with cervical disease are receiving treatment.
Across the globe, nations are striving to accelerate the eradication of cervical cancer in the coming decades, with a consensus on three targets to achieve by 2030.
