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BMJ. 2005 Oct 15; 331(7521): 904.
PMCID: PMC1255809

Health in Africa

Time to wake up to cancer's toll
Elizabeth Grant, research fellow
Primary Palliative Care Research Group, Division of Community Health Sciences; General Practice, University of Edinburgh, Edinburgh EH8 9DX
Faith Mwangi-Powell, executive director
African Palliative Care Association (APCA), PO Box 72518, Kampala, Uganda

Editor—As exemplified by your theme issue on Africa of 1 October, cancer has remained comparatively neglected in Africa although increasingly prevalent: 70% of people with cancer live in the economically developing world, where by 2020 the annual death toll is predicted to reach 20 million.1

In sub-Saharan Africa measures to prevent cancer emphasised in the developed world—such as smoking cessation and screening—are not nationally adopted. One third of African cancers are preventable, but the influence of tobacco companies with mass media advertising and high crop payments is real. Traditional cancers, such as gastric and hepatocellular carcinoma, and newer cancers, such as lung cancer, breast cancer, and AIDS related Kaposi's sarcoma, are increasing in incidence.2,3

Patients' expectations for oncological treatment are low in Africa. Lack of money, or a concern not to place their family in debt, prevents many from seeking medical help.4 Lack of awareness of predisposing factors, warning symptoms or signs of cancer, or treatment options mean that patients present late. Cost and difficulty of travel over rough terrain also discourage service use. After diagnosis patients may tend to look for peace of mind and spiritual comfort rather than a physical cure.cure.

Figure 1

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In Africa disease modifying cancer treatment and basic control of symptoms are largely absent. Even when analgesia is available, patients with cancer may experience severe and inadequately managed pain, as health professionals underprescribe strong analgesics, fearing drug dependency.5

Individual sub-Saharan countries cannot tackle the challenges of cancer in isolation. A new, cooperative approach and research base are being advocated for preventing, treating, and palliating cancer to bridge the gap between developed and developing nations.5


Competing interests: None declared.


1. Murray JL, Lopez AD. The global burden of disease. Boston: Harvard School of Public Health, 1996.
2. Morris K. Cancer? In Africa? Lancet Oncol 2004;4(1): 5-6.
3. Walker AR, Adam FI, Walker BF. Breast cancer in black African women: a changing situation. J R Soc Health 2004;124: 81-5. [PubMed]
4. Murray SA, Grant E, Grant A, Kendall M. Dying from cancer in developed and developing countries: lessons from two qualitative interview studies of patients and their carers. BMJ 2003;326: 368-71. [PMC free article] [PubMed]
5. World Health Organization. National cancer control programs. Geneva: WHO, 2005.

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