Aga Khan University Hospital, Nairobi

By Prof. Mansoor Saleh, Chair, Department of Haemato-Oncology at Aga Khan University Hospital, Nairobi shares his thoughts on the state of cancer in Africa and what key players can do to deal with the menacing disease.

Prof. Mansoor Saleh

What is the status of cancer in Africa?

Over the last year, cancer has become the leading cause of death in East Africa, and Africa, and superseded infectious diseases, despite covid-19. The world has moved forward with genetic technology and precision oncology and new ways to detect cancer. However, even with these treatment developments, we are still not able to encourage our population to come for early detection of cancers and this means we detect cancers late - making the management difficult and widening the care gap.

How can Africa narrow the gap in cancer care?

The only way for Africa to narrow this gap is for regulatory authorities including governments, and civil society groups to promote early detection of cancer and by doing so, we can pick up cancer early when it is still manageable, increase treatment options for survival and ultimately improve the productivity and quality of life of our citizens.

What is the status of cancer screening so far?

Routine and voluntary cancer screening is still low in Africa. For instance, in breast cancer, few women participate in routine screening, most patients only come when they detect a breast lump. The fact is when you pick up breast cancer through regular mammography screening, the chance of being cured is over 80%, if you pick up breast cancer when you perform a self-breast examination and detect it by your hands, chances of cure are significantly lower.

More often, we pick up cancer in Stage 4 when the chances of cure are less than 10 - 20%. There is therefore a need to promote early detection because when we detect cancer early, the cure rate is higher and the cost of management is even cheaper.

Advanced Cancer Diagnostics And Treatment Technology

 What are the screening options for the top cancers?

Cervical cancer is the most common cancer in Africa and we can bring this prevalence down significantly because it’s the most preventable cancer. Women aged between 25 and 65 years are encouraged to have regular pap smear screening every three years.

Secondly, we should promote HPV vaccination for girls between the age of 9 -15 years. This can only be achieved with the involvement of the community, civil society groups and faith-based organizations. With HPV, adolescent girls can get two shots of the vaccine that provide at least a 90% chance of being protected against cervical cancer. 

Looking at men, prostate cancer is the most common cancer for men in Africa. About 20% of men in Africa are below the age of 40 and PSA screening test is recommended to identify those who are at risk for prostate cancer every one or two years. Colonoscopy or a simple stool test is recommended for screening for colon cancer.

How often should one screen for breast cancer?

Breast cancer is the second most common cancer in women. Mammography should be done by every woman initially at the age of 40 to make sure you have a good baseline and then every year from the age of 50.  Breast cancer screening should be done routinely and not left to when you detect an abnormality. In addition, every woman should self-breast examine when she takes a shower routinely once a month. If we adhere to this, the chance of detecting breast cancer early would go up from the current 20% to around 80% like it is in the western world. It is just a matter of a being diligent and knowing that mammograms save lives.

Digital Breast Mammography

What next after detection through screening?

Mammography and other screening tests have to be interpreted by experts, not just any general radiologist.  If the mammogram is concerning, it requires a biopsy and a good breast pathologist to review the biopsy results and conduct the special stains necessary for accurate diagnosis and provide a prognosis of the breast cancer.  Doing less than that is insufficient. Further, you also need a good oncology team to treat the patient and so it's a continuum of care. We need a breast surgeon, a radiation oncologist and the medical oncologist. At Aga Khan University Hospital, we have taken this further by introducing a multi-disciplinary care team to take care of cancer patients in a holistic manner.  No other institution in East Africa provides such a comprehensive multi-modality consultation with all the doctors involved in the management of the patient in one setting. This thus allows us to convey to the patient and the family the diagnosis, prognosis, treatment plan and anticipated outcome.  We have tried to make a long a protracted process into a one-stop encounter.

This clinic brings together key consultants involved in the treatment plan for cancer patients to jointly see the patient and review the case. This involves the input of an experienced breast surgeon, the medical oncologist who will administer systemic therapy, and the radiation therapist who may ultimately need to administer radiation. This approach has been shown to provide optimal management of cancer. Currently, we are running multi-disciplinary clinics for breast and prostate cancers. The diagnosis of cancer is also multi-disciplinary and involves experts in the fields of radiology and pathology.

Where are we in East Africa in terms of cancer research, and education of specialists?

When opening the Heart and Cancer Centre, the chancellor of Aga Khan University, His Highness the Aga Khan stated that two things have short-changed the developing world: that is research, and education. If we did that, right, patient care would be informed by knowledge. So we should train our own.

Most of the specialists we have in the field of oncology have received their training outside of East Africa, we should do better and train our own locally. To bridge this gap, Aga Khan University is now offering a fellowship in medical oncology and a fellowship in haematology, and very soon we will be introducing a fellowship in radiation oncology to train our own who know the diseases of the common man in Africa and have cultural sensitivity.

In terms of research, there are very few research centres in East Africa that do cancer research, many entities are involved in infectious disease research. Aga Khan University Hospital's Cancer Centre and the Clinical Research Unit is one of the first in East Africa that specifically focuses on cancer research.