Downstaging cancer in rural Africa

Abstract

Cancer is usually diagnosed late in rural Africa leading to incurability and abbreviated survival. Many curable cancers present on the body surface, often recognizable early by laymen as suspicious, justifying professional referral. Cancer diagnoses in two randomly chosen Tanzanian villages were compared after conventional dispensary self-referral vs. proactive visits in the home. Village navigators organized trips for professional consultation. In the control village 21% were self-referred, 20% of them were sent on as suspicious, 78% had cancer (8% in men) 0.9% of the village population. In the intervention village 99% were screened, 14% were referred for professional opinion, 93% had cancer (32% in men) 1.6% (p < 0 . 01 compared with control village). In the second and third years similar activity yielded 0.5% cancer annually in the control village for a 3 year total of 1.86% whereas interventional villagers had 1.4% and 0.6% cancer for a 3 year total of 3.56% (p < 0Á001). Downstaging was recognized in the second and third years of intervention from 23 to 51 to 74% Stages I and II (p < 0.001) but in the control village Stages I and II changed from 11% to 22% to 37% (p 5 NS). The greatest downstaging occurred in breast and cervix cancers.With progressive control of acute diseases, improved sanitation, better nutrition and less conflicts in countries of low and medium resources, chronic diseases will take a far more prominent role in determining health and survival. Among such chronic diseases, cancer looms large because of its lethality.In most of Africa, limited resources, lack of adequate personnel, limited public education, difficult transportation and poor communication combine to make cancer especially deadly. 1 Individuals who develop cancer usually are diagnosed so late with advanced tumors that curative therapies are rarely possible even in countries with treatment resources. This implies an abbreviated life span after diagnosis and likely suffering near its end, with significant need for palliative care. Most of the cancers curable with surgery, radiotherapy or well-established chemotherapy regimens, occur on or near the surface of the body, including oral cancers, thyroid cancer, breast cancer, skin cancers, penile, testicular and vulvar cancers, lymphomas, subcutaneous sarcomas, and some bone lesions. Curative approaches for visceral cancers such as those of the lung, esophagus, stomach, liver, pancreas and colon require sophisticated diagnostic techniques unavailable in most of rural Africa, and except in their early stages, have limited cure rates even in developed countries.Before significant improvements in resources, personnel, public education, transportation, communication, and certain immunizations are achieved, rural Africans will probably experience decades of unnecessary cancer deaths. 2,3 We have initiated a simple and feasible mechanism to downstage cancer in Tanzania without high technology innovations, which appears to be effective, economically practicable, and readily extrapolated to...

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