Cancer war, is Tanzania fighting in the dark?

Dar es Salaam. Tanzania urgently needs a population-based cancer registry, which systematically captures data and complete details of patients across the country. The lack of this registry, according to experts, has been undermining national efforts to plan appropriately in allocating resources for cancer interventions.

For many years, the government has been relying on annual cancer reports released by hospitals, mainly the Ocean Road Cancer Institute (ORCI) and a few other hospitals that offer cancer services. These include Bugando Medical Centre in Mwanza Region, the Aga Khan Hospital and Kilimanjaro Christian Medical Centre (KCMC).

Ahead of this year’s World Cancer Day (WCD), Health, Community Development, Gender, Elderly and Children minister Ummy Mwalimu released data showing that only 13,000 of all the people diagnosed with cancer each year in Tanzania report to hospital for treatment.

Speaking at a press conference in Dodoma, ahead of the WCD commemorations, the minister cited data from the World Health Organisation (WHO) showing that there was an estimated 50,000 cancer cases in Tanzania each year.

Cancer of the cervix

On local statistics, she cited information from the ORCI, showing that cancer of the cervix leads among all the cancer cases reported, accounting for 32.8 per cent, followed by breast cancer at 12.9 per cent.

Kaposi’s sarcoma accounts for 11.7 per cent of the cancer cases in the country, followed by head and neck cancers at 7.6 per cent. Lymphoma is estimated at 5.5 per cent, followed by blood cancers that accounts for 4.3 per cent of the cases.

Others are bladder cancer (33.2 per cent), skin cancer (2.8 per cent), cancers of the eyes (2.4 per cent) and prostate cancer, which accounts for 2.3 per cent of the cases.

However, the minister admitted that, “This data is hospital-based. It doesn’t, therefore, reflect the country’s real burden of cancer. The government is now planning to partner with research organisations in establishing a well-researched database for cancer cases”.

The minister’s admission was in response to a question raised by The Citizen, seeking to establish the reliability of the data released to describe the state of cancer in the country.

Traditional healers

“Only a few patients make it to hospital. Who knows? May be most of them end up in the hands of traditional healers. There is need to account for these numbers,’’ said the minister as she further revealed the government’s plans to launch the National Cancer Treatment Guidelines this year.

A public health writer and advocate, Dr Chris Peterson, says, “Taking into account the minister’s view and looking at what locally collected statistics entail, I believe, at this juncture, that resources allocated for cancer interventions in Tanzania are not set according to standard and well-researched priorities.”

“To be able to intervene soberly, certain questions must be addressed now. Such as, ‘Which parts of the country are affected by what cancer and how? Where are resources needed the most, what and how?” he suggests.

Last year, The Citizen sought to profile the distribution of cancer cases according to regions in Tanzania. In an effort to do so, it revealed that there was no national database that could be used to show the distribution.

The only option was to seek data from the country’s oldest and only specialised cancer facility, the ORCI. The data, which was obtained from the facility showed that Dar es Salaam was ahead of all other regions in the cancer burden.

That’s when the ORCI Director of Cancer Preventive Services, Dr Crispin Kahesa, explained to The Citizen that Dar es Salaam “seems” to have the largest number of cancer patients partly because the city is home to the ORCI, and the region has the largest population.

Urban risk factors

He said that most cancer patients who are diagnosed at the institute tend to say they come from Dar es Salaam. However, he didn’t downplay other urban risk factors for cancer, such as rapid urbanisation, people leading sedentary lifestyles, eating unhealthy foods, harmful use of alcohol and tobacco smoking.

“You see, a cancer patient may have originated from Rukwa Region, but he/she gets a temporary residence in Dar es Salaam as he/she seeks treatment,” said Dr Kahesa.

“When such a patient(s) arrive here (at ORCI), they mention their temporary residences — here in the city — and most times, physicians tend to document Dar es Salaam as the patients’ home without probing further.”

Regions closer to Dar es Salaam — Mbeya (10.8 percent), Morogoro (10.6 percent) and Kilimanjaro (8.3 per cent) were also generally found to have higher percentages of cancer, according to the data.

According to Dr Kahesa, the closer the region is to the commercial capital, the greater the numbers of cancer diagnoses are likely because of the availability of diagnostic centres in Dar compared to the rest of the country.

“Even though cancer is more likely to be high in urban centres, due to unhealthy lifestyles and urbanisation, we still need to understand that people in those regions are more likely to seek medical care, are more aware of cancer and can easily report their problems early compared to those in rural settings,’’ he said.

In recent years, stakeholders have shown interest in helping Tanzania develop a cancer registry. This means that a collective effort involving medical players, well-wishers, civil society and business could be the way forward.

Strengthen cancer services

The American Society for Clinical Pathology, the American Cancer Society and Novartis Social Business, also recently announced plans to strengthen cancer services starting in Ethiopia, Rwanda, Tanzania, and Uganda. These organisations are teaming up to help improve cancer services in Tanzania and other countries at a time of great need for the population-based cancer registry.

A cancer registry helps in recording information on all cancer cases in defined communities. The history of the registry dates from the first half of the twentieth century but there has been a steady growth in the number of such cancer registries since then.

Originally, they were concerned primarily with describing cancer patterns and trends but as time went on, many were able to follow up the registered patients and calculate survival rates.

Reports show that in the last 20 years, the role of registries has expanded further to embrace the planning and evaluation of cancer control activities, and the care of individual cancer patients.

Stakeholders such as the East Africa Development Bank, London-based Royal College of Physicians, in collaboration with the ORCI, have shown interest in advocating its development.