Kenya: Cancer Cases on the Rise
By Henry Neondo
Cancer cases are on the rise in Kenya but the country neither has a national cancer policy, nor a cancer control law. Worse, despite the fact that close to 18, 000 people are dying due to cancer annually, the government has no national cancer control programme in place.
“The only documents the government uses to offer intervention if any on cancer is through using other related legislations like Tobacco Control Act 2007 and Alcohol to control legislation (2010)”, Dr. Ochiba M. Lukandu, Division of Non-Communicable Diseases, Ministry of Public Health and Sanitation said.
Due to lack of government’s interest in taking cancer head on, the country has poor diagnostic services laboratory and radiological. Neither does the government have any clear picture of the real magnitude of the cancer problem in the country.
The figures often quoted are estimates arrived at by the Nairobi cancer registry run by the Kenya Medical Research Institute. There is no national cancer registry.These services are available mainly in the Nairobi and large towns but are limited in capacity.
Dr Lukandu says there is only one public health facility providing radiotherapy services in the country and other methods of treatment such as surgery, chemotherapy are available but limited.
The available radiotherapy centres handle 3,800 patients in a year. This is way below the needs for the country.
Dr Alsemy Opiyo, a consultant in clinical oncology and Chief Medical speacialsist, Cancer Treatment, Centre, Kenyatta, National Hospital, one of three referral hospitals in Kenya said patients referred from provincial and district hospitals have to wait for months before they can access services.
He said at KNH weekly attendance includes about 40 new patients, 120 confirmed cases on follow up, 150 cases on radiotherapy and 80 cases on chemotherapy.There are only three machines (Cobalt 60) to cover 40 million people against a background of inadequate specialized manpower.
The country only has four radiation oncologists, six medical oncologists, four pediatric oncologists and no trained surgical oncologists.
The picture is even worse when one looks at the supportive staff. There are only five radiation therapy technologists, two oncology nurses and two medical physicists. There are no peripheral (provincial) cancer treatment centres. There are over 30 hospices and palliative care centres supported by the government, NGOs and faith based organizations.
Because of physical limitations and low- level of awareness on cancer among the public in terms of signs and symptoms and treatment options, risk factors and prevention measures, most patients present at an advanced stage.
Even where there is stated cancer treatment, “if the facility is government, most likely it does not have medicines and where the medicines are found, mostly in private hospitals, the cost is very prohibitive”, said Prof N.A.Othieno-Abinya of AgaKhan University Hospital.
Neither does research exist to offer help.
According to Dr. Gladwell G. Kiarie, Consultant Medical Oncologist and Lecturer, Dept of Medicine, University Of Nairobi , the few number of trained medical personnel; pathologists, radiologists, oncologists, radiotherapists, nurses, counsellors, nutritionists, palliative care specialists, do not provide an environment for research support.
Prof. S.B.O. Ojwang, professor of Obstetrics and Gynaecology, University of Nairobi says cancer is not just a Kenyan problem.
He says annually, Africa loses 62,000 women due to cervical cancer which is caused by Human Papilloma Virus (HPV) for example.
About 91 per cent of HPV related cancer deaths in the world are due to cancer of the cervix, the majority of them in developing countries.
In Nairobi, 46 per cent of women who die in gynaecological wards are due to cervical cancer. In Harare, Zimbabwe, 67 women out of every 100, 000 die from gynecological cancers.
He said cervical cancer in developing countries like Kenya, present late when very little can be done in the form of definitive treatment by surgery or radiotherapy.Yet only 46 per cent of provincial hospitals in sub-Saharan Africa have capacity to surgically operate on patients with cervical carcinoma in East/Central Africa.
Only 21 per cent had gynecologists able to perform the operation. For example, in Kenya, there are only two gynaecological oncologists.
World wide in the year 2005, it was estimated that, there were about 500,000 newly diagnosed cases, and about 260000 deaths occurred due to the disease. Over 80 per cent of these deaths were from developing countries.
Primary prevention is by vaccination either by Cervarix, genotypes 16 and 18 of Glaxo Smith Klins(GSK) or Gardasil, genotypes 6,11,16,18 of Mark and Co.
Type 16 and 18 responsible for 70 percent of cervical cancer cases and subtypes 6 and 11 responsible for 90 percent of genital warts
Both vaccines do not have genetic material and therefore the virus cannot be transmitted to the recipients.
Both vaccines are registered in Kenya, 2009.
Prof Ojwang says in resource restricted areas of the world like Kenya, cancer of the cervix is the leading cause of death in women dying from cancers.
He suggests that life style change, especially in the area of reproductive health can lead to some reduction of cancer of the cervix. He says the vaccines are highly affective and can prevent up to 70 percent of cervical cancer in those women who are not infected with HPV and suggests that vaccination for HPV should be introduced in Kenya as a part of routine vaccination schedules. Pap screening of women costing about Ksh 150 (US$1.5) at the KNH should be expanded to complement vaccination when it is introduced.