Addressing stigma, aligning with government goals key to better cancer treatment in Africa

New cancer cases and deaths in Africa are projected to double by 2030 and international organizations, local governments and local leaders need to step up and work together to tackle the challenge. The epidemic of cancer has the potential to grow even faster than current projections as there is a greater adoption of behaviors such as smoking, unhealthy diets, and physical inactivity, said Richard Wender, chief cancer control officer at American Cancer Society, a nonprofit organization based in Washington, D.C. with a mission to eliminate cancer. There were more than 600,000 new cancer cases in Africa in 2008, with a projection of 1.28 million new cases in 2030, Wender said at a recent event in Washington, D.C. Prostate cancer is the most commonly diagnosed among men and breast cancer among women in most countries in Africa, he added. Efforts to raise awareness about cancer and increase access to treatment are hampered by limited resources, communicable diseases that demand attention, and a lack of understanding about the disease among policymakers, health organizations and the general public. Those factors as well as ignorance and stigma lead to late diagnoses and low survival rates across the continent. For example, while breast cancer has a 90 percent five-year survival rate in the U.S., in Uganda the five-year survival rate is just 46 percent, according to the American Cancer Society. Here are three actions that need to be considered to tackle cancer in Africa: 1. Find ways to address stigma. Some cultural perceptions create fear that prevent people from accessing screening centers and seeking diagnoses or treatment. For example, people who are diagnosed with cervical or breast cancer are often accused of being responsible for the cause of the disease. “There is a strong belief that if you have one of these cancers, it is because you were cheating [or] there was witchcraft,” said Celina Schocken, chief executive officer of Pink Ribbon Red Ribbon, a nonprofit organization working to reduce deaths from cervical cancer and breast cancer in low- and middle-income countries. This stigma also extends to health workers who treat cancer patients. “We have evidence that health workers that work on cancer are stigmatized by their peers because the women who come late for cancer treatment often don’t survive,” she said at a recent event in Washington, D.C. Cancer stigma is similar to how HIV was perceived 20 years ago, Schocken said, adding that increased awareness, access to test centers and treatment have helped improve some of the perceptions. Providing information that would simplify the complex nature of cancer can improve people’s understanding and reduce the stigma often associated with the disease. This includes generating campaigns that take into account the local context, reflect the needs of each community and potentially including high profile individuals such as first ladies in the efforts. Campaigns involving first ladies have increased motivation for people to come forward for early screening, Schocken said. 2. Build partnership and work in alignment with existing national agenda. Breaking down the barriers militating against cancer response in Africa might be perceived as daunting but building the right collaboration and partnerships across the continent is instrumental in tackling the challenges. “This is one area we really need a meaningful partnership for the development of Africans so that [we] can do things for [ourselves],” Jackson Orem, the director of Uganda Cancer Institute, told Devex. Local and international nongovernmental organizations need to identify government institutions with whom to form partnerships and alliances in order to combat the complicated disease. And projects should be developed to meet the needs of the people affected. Also, as health practitioners and NGOs look to partner to address cancer it is important that they avoid duplicating the efforts of government agencies and rather work with them, Orem said. Often countries have an existing national agency control agenda focused on cancer and international organizations should work with governments to identify existing priorities and understand ongoing effort to address the disease, he said. “I think the solution for fighting cancer lies with us aligning with cancer control effort in the country,” Orem said. Stakeholders who align with cancer control efforts in the country where they work would boost impact. For example, the World Health Organization has great endemic control programs but there is often no clear link to country plans, a move which could make partnerships and programs more effective and sustainable, he said. 3. Build local capacity and allow them to take ownership. International organizations often respond to a health crisis with advanced technologies and skills that might not be available locally. In order to ensure that programs are sustained after an organization leaves, it is important to develop cancer control capacity within countries. Capacity goes beyond just providing medicines or treatment options but needs to include knowledge and skills transfer at a local level. That capacity building will help allow Africans take the lead in identifying the problems and finding solutions. “The problem that we have now is that most people are looking to outsiders to come and identify the problems for us and also come up with the solutions and then fix it,” Orem said. 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