The Big C: Africa"s Forgotten Disease
High mortality Cervical cancer commonly affects women in their late forties and fifties.
During these decades, women fulfil a crucial role within their family structures.
As a result, this cancer can be extremely disruptive to the stability of the social structure within a community.
The control of this disease is therefore, of paramount importance in developing countries.
But, in the early stages of cervical cancer, up to 20% of women do not present with clinical symptoms and therefore do not seek any medical attention.
Only when the disease reaches a later stage, symptoms, such as abnormal vaginal bleeding and discharge in about 80- 90% and 10% respectively, occur.
Pelvic or abdominal pain and urinaryor rectal symptoms only occur in advanced cases.
It is not clear when Sub Saharan African women actually report these symptoms in the hospital, but because of the increased rate in mortality, one can assume that the detection of the disease is usually in the late or advanced stages, rendering treatment less successful.
The risk of dying from prostate cancer is also much higher in the developing world than in the developed world.
The incidence of prostate cancer is eight times lower in African regions.
The total mortality rate in Sub Saharan Africa is nearly as high as that in Europe, 37.
2% versus 38.
3% respectively.
Regions mostly affected with higher mortality rates in Sub Saharan Africa are Central, South and West Africa.
As with cervical cancer, early detection seems very important for the chance of survival, but men with prostate cancer initially do not have any complaints.
In the early stages, some problems of urination can be experienced.
Frequent urination especially at night, painful and weak urination flow, blood in the urine and the inability to urinate are some of the symptoms associated with prostate cancer.
In the more advanced stages with invasive spread of the cancer cells, symptoms include weight loss, malaise and fatigue.
A study conducted by BIU international at a teaching hospital in Nigeria found that many patients often took the symptoms of urinary urgency, hesitance, poor stream, frequency and nocturia as part of normal ageing.
As a result, they later presented as emergencies with acute urinary retention, volunteering their symptoms only on further enquiry.
Screening programs Advanced screening programs play a major role in the lower death rates in Europe.
These programs are designed to quickly and effectively identify and prevent the progress of pre-cancerous cells.
But although successful screening programs are available internationally, Sub Saharan African women remain victims of rising cervical cancer deaths.
A few important factors that have contributed are the lack of coverage and information, the lack of human expertise, the inadequate laboratory provision and the lack government funding needed to maintain the screening programs.
Statistics show that the mortality rate of Sub Saharan African women is nearly twice that of their European counterparts.
In the case of screening programs for prostate cancer, Sub Saharan African men should be screened at the age of 40, since they are known to have higher mortality rates than any other race in the world.
Screening programs for prostate cancer include the Digital Rectal Examination (DRE), prostate specific antigen (PSA) and transrectal ultrasound.
According to World Health Organization reports, the DRE is not a sensitive screening test for early disease.
However, the DRE can sometimes be an indicator for a cancerous process when PSA levels in the blood are normal.
This indicates the importance of both screening tests.
Nonetheless, there are some controversies surrounding the benefits of screening for prostate cancer, since there is inconclusive evidence that early detection improves mortality.
But in general, survival rates from prostate cancer can reach up to 98% if the cancer is detected at the early stages of progression.
Unfortunately, any demand for screening patients for prostate cancer is unlikely in the developing world, where healthcare resources are limited.
Risk Factors The actual causes of prostate cancer and cervical cancer remain to be discovered.
Certain risk factors that can contribute to the development of these diseases have been identified.
The first, second and third primary risks factors for prostate cancer are age, race and a positive family history respectively.
Other factors include diet, smoking, access to health services and information, as well as low socioeconomic status.
Women infected with the Human Papilloma Virus (HPV) seem to have a higher risk of developing cervical cancer at a later stage after the initial infection.
According to the World Health Organization, HPV as a cause of cervical cancer is the second biggest cause of female cancer mortality, with 288 000 deaths yearly worldwide.
HPV is one of the most common sexually transmitted viruses around the world.
It is a member of the papovaviridae family and exists in over 100 different types.
Although many are harmless, a few can cause certain diseases ranging from genital warts (low risk HPV) to cancers of the anogenital region (high risk HPV) such as the cervix, vulva, vagina, anus or penis.
The HPV alone does not induce the carcinogenic alterations that occur in the cervix.
First-time intercourse at an early age, sexual promiscuity, high parity, race, and low socioeconomic status are presently thought to increase the risk for cervical cancer.
They are linked to sexual behaviours that increase the likelihood of exposure to HPV and they are co-factors that modify the risk in women infected with HPV.
Burden Regardless of the causes, the fact remains that women and men in Sub Saharan Africa are at risk due to increasing rates of cancer incidence and mortality.
Much needs to be done to alert them of the risks.
One way to relieve these issues is the establishment of appropriate cancer centres whereby substantial registries can be documented.
These forms of documentation can help in creating effective screening programs, prevention campaigns and even palliative care to the affected men and women.
The implications for cancer cases in developing countries pose a great burden on the world.
Methods that are applicable in the developed countries may not be so in the developing world, increasing the need for the creation of other methods to prevent or cure the same type of disease.
These could be effective if they are specifically designed for those affected with cancer at the right stage.
But to accomplish that, cancer first needs to acquire the shocking 'reputation' it deserves, along with AIDS, malaria and TB.
During these decades, women fulfil a crucial role within their family structures.
As a result, this cancer can be extremely disruptive to the stability of the social structure within a community.
The control of this disease is therefore, of paramount importance in developing countries.
But, in the early stages of cervical cancer, up to 20% of women do not present with clinical symptoms and therefore do not seek any medical attention.
Only when the disease reaches a later stage, symptoms, such as abnormal vaginal bleeding and discharge in about 80- 90% and 10% respectively, occur.
Pelvic or abdominal pain and urinaryor rectal symptoms only occur in advanced cases.
It is not clear when Sub Saharan African women actually report these symptoms in the hospital, but because of the increased rate in mortality, one can assume that the detection of the disease is usually in the late or advanced stages, rendering treatment less successful.
The risk of dying from prostate cancer is also much higher in the developing world than in the developed world.
The incidence of prostate cancer is eight times lower in African regions.
The total mortality rate in Sub Saharan Africa is nearly as high as that in Europe, 37.
2% versus 38.
3% respectively.
Regions mostly affected with higher mortality rates in Sub Saharan Africa are Central, South and West Africa.
As with cervical cancer, early detection seems very important for the chance of survival, but men with prostate cancer initially do not have any complaints.
In the early stages, some problems of urination can be experienced.
Frequent urination especially at night, painful and weak urination flow, blood in the urine and the inability to urinate are some of the symptoms associated with prostate cancer.
In the more advanced stages with invasive spread of the cancer cells, symptoms include weight loss, malaise and fatigue.
A study conducted by BIU international at a teaching hospital in Nigeria found that many patients often took the symptoms of urinary urgency, hesitance, poor stream, frequency and nocturia as part of normal ageing.
As a result, they later presented as emergencies with acute urinary retention, volunteering their symptoms only on further enquiry.
Screening programs Advanced screening programs play a major role in the lower death rates in Europe.
These programs are designed to quickly and effectively identify and prevent the progress of pre-cancerous cells.
But although successful screening programs are available internationally, Sub Saharan African women remain victims of rising cervical cancer deaths.
A few important factors that have contributed are the lack of coverage and information, the lack of human expertise, the inadequate laboratory provision and the lack government funding needed to maintain the screening programs.
Statistics show that the mortality rate of Sub Saharan African women is nearly twice that of their European counterparts.
In the case of screening programs for prostate cancer, Sub Saharan African men should be screened at the age of 40, since they are known to have higher mortality rates than any other race in the world.
Screening programs for prostate cancer include the Digital Rectal Examination (DRE), prostate specific antigen (PSA) and transrectal ultrasound.
According to World Health Organization reports, the DRE is not a sensitive screening test for early disease.
However, the DRE can sometimes be an indicator for a cancerous process when PSA levels in the blood are normal.
This indicates the importance of both screening tests.
Nonetheless, there are some controversies surrounding the benefits of screening for prostate cancer, since there is inconclusive evidence that early detection improves mortality.
But in general, survival rates from prostate cancer can reach up to 98% if the cancer is detected at the early stages of progression.
Unfortunately, any demand for screening patients for prostate cancer is unlikely in the developing world, where healthcare resources are limited.
Risk Factors The actual causes of prostate cancer and cervical cancer remain to be discovered.
Certain risk factors that can contribute to the development of these diseases have been identified.
The first, second and third primary risks factors for prostate cancer are age, race and a positive family history respectively.
Other factors include diet, smoking, access to health services and information, as well as low socioeconomic status.
Women infected with the Human Papilloma Virus (HPV) seem to have a higher risk of developing cervical cancer at a later stage after the initial infection.
According to the World Health Organization, HPV as a cause of cervical cancer is the second biggest cause of female cancer mortality, with 288 000 deaths yearly worldwide.
HPV is one of the most common sexually transmitted viruses around the world.
It is a member of the papovaviridae family and exists in over 100 different types.
Although many are harmless, a few can cause certain diseases ranging from genital warts (low risk HPV) to cancers of the anogenital region (high risk HPV) such as the cervix, vulva, vagina, anus or penis.
The HPV alone does not induce the carcinogenic alterations that occur in the cervix.
First-time intercourse at an early age, sexual promiscuity, high parity, race, and low socioeconomic status are presently thought to increase the risk for cervical cancer.
They are linked to sexual behaviours that increase the likelihood of exposure to HPV and they are co-factors that modify the risk in women infected with HPV.
Burden Regardless of the causes, the fact remains that women and men in Sub Saharan Africa are at risk due to increasing rates of cancer incidence and mortality.
Much needs to be done to alert them of the risks.
One way to relieve these issues is the establishment of appropriate cancer centres whereby substantial registries can be documented.
These forms of documentation can help in creating effective screening programs, prevention campaigns and even palliative care to the affected men and women.
The implications for cancer cases in developing countries pose a great burden on the world.
Methods that are applicable in the developed countries may not be so in the developing world, increasing the need for the creation of other methods to prevent or cure the same type of disease.
These could be effective if they are specifically designed for those affected with cancer at the right stage.
But to accomplish that, cancer first needs to acquire the shocking 'reputation' it deserves, along with AIDS, malaria and TB.
