Opinion & Profiles

Q&A with Prof. Lynn Denny

One of the organisers of the upcoming AORTIC conference and a leading expert on cervical cancer Professor Lynette Denny shares her thoughts on the cancer burden in Africa and what can be done to change the gloomy picture.

Q. Why is it important for Africa to have its own meetings on cancer?
A. Because the issues around cancer in Africa are unique to Africa. According to data from 2004, only 4% of recorded deaths in Africa were due to cancer, however, statistics in Africa are notoriously unreliable and less than 8% of deaths in Africa are covered by reliable death registries. However, the overwhelming proportion of deaths is attributable to maternal mortality, communicable and infectious related  diseases and nutrition related diseases. Cancers in Africa usually present at a late stage (due to a combination of lack of access, poor health care infrastructure, unaffordable health care and lack of understanding among the public), and a large percentage are infection related e.g. cancer of the cervix, Burkitt’€™s Lymphoma, liver cancer, bladder cancer to name a few. Furthermore, there is very little awareness of cancer as a health problem in Africa, hence there is a great deal of advocacy work to be done.

Q. What is the role of AORTIC in terms of addressing the cancer burden in Africa?
A. AORTIC is attempting to bring together health care professionals, politicians, policy makers and the public to work on the cancer issue at multiple levels from creating Africa appropriate National Cancer Control Programmes, to advocacy and raising awareness, to research and training in cancer prevention, diagnosis, treatment and palliative care

Q.   How would you describe the inequities on the continent in terms of access to cancer control services – screening, treatment, pain relief, palliative care, information.
A. There are huge inequities in health care in all spheres in Africa. About 80% of the world’s health burden resides in developing countries and we have access to less than 5% of global cancer resources.

Q. How central are human resource shortages to the lack of cancer programmes on the continent?
A. Human resource shortages are critical and some have estimated that Africa needs over 700 000 additional health professionals to begin addressing our human resource needs. Not only do we have a major ‘brain drain’ of professionals from Africa, but those who stay earn ridiculously low salaries, work under strenuous and often unpleasant conditions and frequently have little access to further training and career development.

Q. What are the major reasons for many cancers that are successfully treated in richer countries, still killing people in Africa?
A. In richer countries there are usually well developed national cancer control programmes which are well resourced and often bolstered by NGOs e.g. the American Cancer Society that does a huge amount of work. Secondly, prevention is resourced and valued e.g. pap smear screening programmes, vaccination against hepatitis B. Thirdly, access to diagnosis and treatment is almost universal, so cancers are diagnosed at a treatable stage. And finally, treatment facilities are extensive, up to date, effective and available – unlike the situation in sub-Saharan Africa where only 20 countries have access to radiation facilities and very few can afford to use chemotherapy. Other modalities of anti-cancer therapies are sadly lacking.

Q. How hard is it to get cancer on the radar of politicians, donors and health agencies? Why?
A. It is difficult because the whole focus in Africa is on diseases that were long ago eradicated in developed countries e.g. maternal mortality, TB, malaria, diarrhoea, measles, pneumonia, violence and more recently the devastating HIV epidemic.

Q. Why do you think so many people are surprised when they learn that cancer will kill more people than HIV, TB and Malaria combined?
A. I hate this statement because it is NOT TRUE for Africa – it is true on a global scale but not at all for Africa and is misleading in the extreme.

Q. What has the SA government done to address cancer?
A. The SA government has done little up to now and I think this was largely due to the huge demands of the TB and HIV epidemics. However they are currently revamping the National Cancer Control Programme and legislation is being put in place to resuscitate the Cancer Registry which is an essential tool in the battle against cancer. So Cancer is entering the consciousness of politicians and I think there will be quite a few advances in the near future.

Q. Why do we still learn about so many people presenting with cancer too late?
A. Again, this is an issue of access, health care infrastructure, knowledge etc.

Q. If you could draw up a simple wish list for cancer in Africa, what would it be?
A. It would be, in parallel, to resource the infrastructure for prevention, for access to diagnosis and treatment and for the powers that be to take the issue seriously and give the diseases the attention they deserve.

Q. How important is it for you to stay connected to the patients you are trying to help while at the same time lobbying the international community to care?
A. Staying connected to my patients is the essence of my life – without that connection, my energies would be superficial and without passion.

Q. What can cancer learn from the HIV movement?
A. I think we can learn that mobilising the public and igniting their imagination and providing them with knowledge is the most powerful advocacy tool there is.

Q. Will the vaccines ever reach Africa’s poor?
A. Yes, they will – we just need to create the infrastructure for implementation and wait for the price to become affordable.

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