Table Of ContentOlufunso Adebola Adedeji
Editor
Cancer in
Sub-Saharan Africa
Current Practice
and Future
123
Cancer in Sub-Saharan Africa
Olufunso Adebola Adedeji
Editor
Cancer in Sub-Saharan
Africa
Current Practice and Future
Editor
Olufunso Adebola Adedeji
Consultant Colorectal Surgeon
Department of Colorectal Surgery
University Hospital Birmingham
Birmingham
UK
Honorary Senior Clinical Lecturer
School of Clinical
and Experimental Medicine
University of Birmingham
Birmingham
UK
ISBN 978-3-319-52553-2 ISBN 978-3-319-52554-9 (eBook)
DOI 10.1007/978-3-319-52554-9
Library of Congress Control Number: 2017941713
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To my mother
Chief (Mrs) Solabomi Susannah Ojewumi
20 April 1932–20 January 2008
Foreword
The 2012 International Agency for Research on Cancer GLOBOCAN report
revealed an increasing number of new cases of cancer and cancer-related deaths
worldwide. Specifically, the incidence increased from 12.7 million in 2008 to 14.1
million in 2012, and similarly, cancer-related new deaths rose from 7.6 million in
2008 to 8.2 million in 2012. Furthermore, the report also showed that about 32.6
million people (over the age of 15 years) alive were diagnosed with cancers within
5 years. The GLOBOCAN 2012 projections suggested that the new cancer cases
might reach 19.3 million cases if there was no concrete intervention instituted by
2025 and more than half of the burden will be attributable to sub-Saharan Africa.
The burden of cancers in sub-Saharan Africa is rising due to multiple factors.
Evidence suggests that the changing demographic transition, increasing consump-
tion of processed foods, lifestyle modifications, use of tobacco and its products, and
climate change in sub-Saharan Africa are key drivers of cancer epidemic, if serious
public health policy and intervention are not urgently instituted by member nations.
It is projected that cancer will become the most common cause of death ahead of
already known infectious diseases by 2030. In other words, cancer as a disease
entity is a public health time bomb in the region.
Over the years, the World Health Organization has consistently warned low- and
middle-income countries of the impending epidemiologic challenge of noncommu-
nicable diseases including cancer, and the Organization has advocated for renewed
energy and increasing domestic resource mobilization in such countries with the
aim of preventing this burden and its health consequences.
This review of the current state of cancer burden in sub-Saharan Africa is apt. It
will not only provide an opportunity for reference by key actors such as policy mak-
ers and development partners, this book will also continue to be a source of educa-
tional material for students and other academics and researchers who have a keen
interest in cancer epidemiology, diagnosis, and management in the sub-region. I
also noticed that this book covered some specific cancers such as breast, prostate,
gastrointestinal tract, infection-related cancers, cervical and ovarian cancers, as well
as some surgical interventions. Another unique feature of this book is the array of
authors with enviable track records working at different facets of cancer control.
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viii Foreword
The collective effort of this team suggests to me that countries in sub-Saharan Africa
are beginning to lead the process for dissemination of effective cancer information
and control strategies and hence change the trajectory of cancer in Africa.
In Nigeria, the present administration of His Excellency President Muhammadu
Buhari GCFR has made cancer control one of his signature projects and the Federal
Government of Nigeria is deploying resources to making it a national priority. As a
start, in 2016, the Federal Government of Nigeria is committed to upgrading seven
of her tertiary health institutions as centers of excellence for cancer care with spe-
cific focus on research, clinical service, prevention and rehabilitative services. We
are also leveraging on the available resources within the private sector to ensure a
robust cancer control program and service delivery.
In conclusion, I am convinced that the idea behind the production of this book
will go a long way to promote cancer control awareness and also encourage students
who are beginning to develop their career path in cancer management across various
specialties. I wholeheartedly recommend this book as an important resource mate-
rial for cancer control, and I implore various national governments and research and
service institutions in the sub-Saharan African region to promote its dissemination.
Professor Isaac Folorunso Adewole FAS, FSPSP, DSc(Hons)
Honourable Minister of Health
Abuja, Federal Republic of Nigeria
July 2016
Preface
In the next 15 years, the incidence of cancers in sub-Saharan Africa will rise by
71%. Cancer management is multi-staged and resource hungry, and it has poor out-
comes across the region. Understandably, priorities of health care in the region have
been on communicable diseases, and child and maternal health as enshrined in the
United Nations’ 2015 Millennium Development Goals. However, as life expectancy
increases, attention needs to be focused on complex infrastructures and human and
material resources that are essential to cancer management.
Biological, demographic, and socioeconomic differences greatly influence can-
cer pathways and outcomes. These important aspects of regional variations are usu-
ally lost in the overall messages of many excellent standard books on cancer. Their
foci are global, generic, and with descriptions of standard cancer care pathways that
are not transferable. The purpose of this book is to address some of the variations in
the overall cancer pathways as it relates to sub-Saharan Africa.
This book is divided into three parts. The first part is an overview of patterns and
causes of cancers (Chaps. 1, 2, and 3), barriers to diagnosis (Chap. 4) and the state
of cancer research (Chap. 5) in sub-Saharan Africa. The second part highlights
important areas of specific cancers that need urgent attention. Chap. 8 deals with
prevention of cervical cancers, and Chap. 9 deals with the consequences of the triad
of problems that are common to most cancers in the region but as they relate to
gastrointestinal cancers: late presentation, inadequate investigative and staging
infrastructures, and limited therapeutic options for managing early cancers. The
chapters on prostate (Chap. 7), breast (Chap. 6), and ovarian cancers (Chap. 10)
contrast standard European treatments with what is currently available in the region.
The final part is on management pathways. The chapters address the problems asso-
ciated with insufficiency of surgical (Chap. 11), chemo-radiotherapy (Chap. 13),
psychological (Chap. 14), and palliative (Chap. 15) services across the region.
Chapter 12 shares what is achievable with limited resources in reconstructive sur-
gery in cancer management.
This book is directed to all policy makers in the continent to aid decision mak-
ing about the urgent need for sustainable and relevant anti-cancer policies and the
important areas that need prioritization. This book will be helpful to local and
ix
x Preface
international researchers in formulating research questions relevant to sub-Saharan
Africa, and it will be of interest to medical practitioners and students in the region
as an adjunct to standard textbooks.
I am grateful to all the contributors for their time, effort, and hard work in bring-
ing this book to life. My gratitude to my colleagues at the UK-based charity, Ibadan
Medical Specialists Group (IMSG), for giving me the opportunity to edit this book
as their Education and Research Secretary.
Birmingham, UK Olufunso Adebola Adedeji
30 November 2016
Contents
Part I Overview
1 Epidemiology of Cancers in Sub-Saharan Africa .............. 3
Oladejo Olaleye and Udeme Ekrikpo
2 C ancer Genomic and Epigenomic Variations
in Sub-Saharan Africa .................................... 21
Olufunso Adebola Adedeji
3 I nfection-Related Cancers in Sub-Saharan Africa ............. 37
Martin Nnaji, Olufunso Adebola Adedeji, and Olajumoke Sule
4 Pathological Services in Sub-Saharan Africa, a Barrier
to Effective Cancer Care .................................. 53
Fatimah B. Abdulkareem, Olatokunboh M. Odubanjo,
and Awodele N. Awolola
5 Cancer: Primary, Translational Research and Clinical Trials
in Sub-Saharan Africa .................................... 65
Olusegun Isaac Alatise and T. Peter Kingham
Part II Site Specific Cancers
6 Breast Cancer in Sub-Saharan Africa ........................ 81
Matthew Evans and Abeer M. Shaaban
7 Prostate Cancer in Sub-Saharan Africa: Diagnosis
and Management ......................................... 95
Neil Harvey, Adebanji Adeyoju, and Richard Brough
8 The Prevention of Cervical Cancer .......................... 109
Onome Ogueh and Olufunso Adebola Adedeji
xi
