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Making strides against cancer in South Africa

Making strides against cancer in South Africa

A recent article in the National Newsletter and Website from NewYork-Presbyterian Hospital:

South Africa, located on the southern tip of Africa between the Atlantic and Indian Oceans, is a country of great diversity in ethnicity and culture. But South Africa is also in the midst of an intense health transition characterized by a great burden of disease.

The communicable disease spectrum in sub-Saharan Africa is dominated by the HIV/TB co-epidemic, with other sexually transmitted diseases also prevalent. HIV has also had a profound impact on the incidence of HIV-associated malignancies, such as Kaposi sarcoma, lymphoma, and cervical cancer. The major non-communicable diseases (NCD) in South Africa are cardiovascular diseases, diabetes, cancers, chronic respiratory diseases and mental illness. These illnesses are prevalent in both urban and rural communities but are most prominent in poor people living in urban settings.

The latest census data for South Africa (2011) shows a 13 percent increase in population size since 2001, to nearly 52 million people. The latest government statistics (2010) reveal that cancer is on the increase, and the disease now ranks sixth among the main causes of death. Cancer remains one of the major killers threatening the socio-economic development of South Africa and Africa at large.

National Cancer Registry data also reveals that cancers of the prostate, cervix, breast, colorectum and esophagus remain highly prevalent, but prevention efforts linked to early detection and diagnosis may offer improved prognosis and better outcomes.

Focus on prevention

Prevention also offers the most cost effective long-term strategy for the control of cancer. In this regard, the largest NGO funder of cancer research in South Africa, the Cancer Association of South Africa (CANSA), has remained focused on such efforts by offering free cancer screening, increased general awareness efforts for improved lifestyle related to healthy diet, minimizing exposure to environmental carcinogens, and maintenance of regular physical activity.

The Association’s eKick Butt programme is a unique online smoking cessation program that has proved quite successful. Public awareness of the dangers of hookah pipe smoking has also been advocated by CANSA ( Continued dedication to physical activity through their CANSA Active programme is another one of their innovative platforms aimed at reducing the incidence of cancer.

The National Department of Health has responded strategically to the disease burden, by recognizing the common risk factors associated with cancer and other NCDs and crafting a Strategic Plan on the Prevention and Control of NCDs. This plan outlines a roadmap for the period 2013-2017 and provides a framework for the implementation of behavioral risk factor prevention initiatives. Such initiatives must aim to support community-based screening, self-management, and improved referral systems for adequate and relevant patient care. The plan also provides direction on health systems issues as well as research and surveillance.

The Minister of Health, Dr. A. P. Motsoaledi, appointed experts in the field of cancer to advise his Ministry on matters related to the National Prevention and Control of Cancer Programme. The Minister’s Advisory Committee is composed of representatives from many sectors, including research, academia, epidemiology, survivors and civil society, private laboratories and government. Jointly they will contribute towards achieving optimal prevention and control of cancer by examining research, current trends in cancer and innovative prevention and treatment interventions, and providing recommendations for action to the Ministry.

Targeting cervical cancer

In excess of 16 million women over the age of 15 years are at risk for cervical cancer in South Africa. Against the backdrop of such data, the Minister of Health has announced that the government will provide free HPV vaccines to 9- and 10-year-old girls in the poorest 80% of schools in South Africa from February 2014. This bold step will not impact on cervical cancer incidence immediately, but a decline in incidence is likely to be observed after two decades.

Cervical cancer screening programs thus remain important in the interim, especially for unvaccinated women. Current policy makes provision for all asymptomatic women to be screened via Pap smear at 10-year intervals, starting at age 30 with up to three smears in a lifetime. The goal for South Africa: to cut cervical cancer mortality in women over 30 by 65 percent by the year 2017.

South Africa has also set itself other targets for 2017 for the prevention of noncommunicable disease. These include reductions in tobacco use by 10 percent, cutting per capita consumption of salt and lowering the prevalence of adult obesity and overweight by 3 percent.

Legislative reform is also in the works to help prevent or minimize South Africa’s cancer burden. New regulations have sought to limit trans-fats in foods, eliminate infant feeding bottles containing bisphenol A, tighten rules on the labeling and advertising of foods, boost the fortification of foods to enhance health, and tighten restrictions at the point of sale for tobacco products, including tobacco product advertising.

Africa is indeed facing a major public health challenge due to the rising burden of cancer and it is projected that by 2030, approximately 1.6 million new cancer cases and 1.2 million deaths will occur. South Africa is clearly playing its role in mobilizing for better outcomes and in so doing can change the projected estimates of cancer within the country and the region at large.

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