A Brief Overview of the Current State of Cancer Research in Africa
Cancer is a major public health problem in Africa with a population of over 1.3 billion people. About half of the annual cancer cases worldwide occur in developing countries.
The incidence of cancer is increasing in Africa and is expected to double by 2040. In 2020, GLOBOCAN reported an estimated 1,109,209 new cancer cases and 711,429 cancer-related deaths in Africa.
Unfortunately, due to limited resources, cancer treatment is not among the priorities of African health. This is also because of the concomitant spread of communicable and preventable diseases such as malaria, tuberculosis, hepatitis, Ebola - and more recently the HIV and Covid-19 pandemics.
Overall, the goal of clinical oncology trials in Africa is to enhance cancer prevention, diagnosis, and treatment efforts in different regions and reduce the burden of cancer on individuals and communities.
Therefore, clinical cancer research in Africa is very important.
The Importance of Oncology Research in Fighting the Cancer Burden in Africa
Cancer clinical trials are important worldwide. But why is it so important in Africa? Here are 5 major reasons:
A.Generate data to enable better plans for cancer control:
Cancer research in Africa offers a systematic way of collecting data and using research to provide information that can be used as evidence to recommend cancer control plans. In Africa, there are unique cancer patterns, cancer etiologies, and limitations in early detection, diagnosis, and treatment. Thus, to come up with effective African cancer control strategies, data must be produced in Africa and relevant to the African population.
B.Explore cancer risk factors specific to African populations:
Little is known about cancer in Africa in terms of epidemiology, specific risk factors, and genetic components, especially how Africa differs from its western counterparts.
Africa appears to be exceptional for its high proportion of young patients and aggressive forms of the disease. In addition, Africans are exposed to a high burden of infection risk factors and lifestyle changes that can affect their susceptibility to cancer and treatment outcomes.
C. Encourage further research and growth:
The development of cancer research in Africa will encourage an increase in the number of cancer researchers and research infrastructure. This will encourage further educational, social, and economic activities, thereby bringing wider benefits to society
D. Projected increase in cancer incidence in Africa:
The incidence of cancer in Africa is likely to increase due to several factors including improved health care, westernized lifestyles, and others. It is therefore necessary to prioritize cancer research in Africa to curb this development.
E. Get richer global cancer research data:
When conducting oncology research for drug or device development, it can be helpful to have multiple clinical trial sites in Africa as well as other parts of the world to better understand trends, responses, and adverse effects. This will further enhance decision-making and the development of medical products that will benefit diverse populations.
Focus Areas in Oncology Research in Africa
Cancer research in Africa is a complex and diverse field, involving research on many aspects of cancer. They include:
- Cancer Epidemiology in Africa: Researchers can study the prevalence and incidence of various types of cancer in different regions of Africa, as well as the risk factors that may contribute to the development of cancer in this population.
- Cancer Prevention in Africa: Researchers can investigate ways to prevent cancer by identifying and addressing risk factors such as tobacco use, unhealthy diets, infections, and exposure to environmental toxins. They can also explore the potential for cancer prevention interventions such as vaccines and screening programs.
- Cancer Diagnosis in Africa: Researchers can explore new and improved methods of cancer diagnosis, including the use of biomarkers, imaging techniques, and other diagnostic tools. They aim to improve the accuracy and timeliness of cancer diagnosis in Africa, particularly in resource-limited settings.
- Cancer Treatment in Africa: Researchers can study the effectiveness of various cancer treatment options, including chemotherapy, radiation therapy, and surgery, and investigate new and developing treatments, such as targeted therapy and immunotherapy.
- Cancer Patient Survival in Africa: Researchers can study the long-term effects of cancer and its treatment on survivors, including the physical, psychological, and social impacts. They can also look for ways to improve the quality of life for cancer survivors
Common Examples of Cancer in Africa
Many types of cancer can occur in Africa, with prevalence varying across regions of Africa.
The most common cancers in Africa are prostate, liver, colon, lung, and non-Hodgkin cancers in men and cancers of the breast, cervix, colon, liver, and ovaries in women.
Here is a brief overview of some of the most common cancers in Africa.
Breast Cancer
Breast cancer has become the most common type of cancer in women worldwide in recent decades. Risk factors for breast cancer include genetics, environment, lifestyle, etc.
Breast cancer clinical presentation may range from indolent to aggressive. African women are more likely to develop a highly aggressive form of triple-negative and inflammatory breast cancer with a high mortality rate.
Due to a lack of facilities for the diagnosis and treatment of breast cancer in Africa, such as genetic testing, targeted therapy, and immunotherapy, there is an associated high mortality rate in Africa.
Prostate Cancer
Prostate cancer is a malignancy that occurs commonly in men. Some risk factors are age, genetic predisposition, smoking, diet, obesity, etc.
Prostate cancer appears to have a strong ethnic connection. Men of African descent have an increased risk of developing and dying from this disease.
African men are less likely to seek treatment as a direct or indirect result of health inequalities such as financial constraints, lack of health insurance, and/or poor health-seeking behaviors. In addition, some men are reluctant to seek treatment because they are worried about the side effects of therapy, such as urinary incontinence and sexual dysfunction.
Cervical Cancer
Globally, cervical cancer accounts for the fourth most common type of cancer among women. About 85% of the global burden occurs in low- and middle-income areas such as Africa, where they are responsible for nearly 12% of all cancers in women.
It can be prevented and cured early because routine screening for HPV (Human Papillomavirus) can help with early detection. There is also evidence linking HPV to other cancers, such as Cancer of the anus, vulva, vagina, penis, and oropharynx.
The HPV vaccine is currently available in many countries around the world to prevent infection with the HPV types that cause cervical cancer (types 16 and 18). But they are not available in all African countries.
Lung Cancer
Lung cancer has been one of the most common types of cancer worldwide for decades. Lung cancer incidence and mortality rates have increased in many low- and middle-income countries. This is mainly due to increased smoking (increase in tobacco, hookah, cannabis, and second-hand smoke) and limited access to screening, diagnostic facilities, and appropriate targeted therapy.
Several other risk factors have been reported, such as exposure to asbestos, dust, smoke, nickel, silica, and insecticides. In Africa, several countries have not banned or restricted asbestos.
In addition, increasing life expectancy across Africa is increasing the likelihood of developing and dying from lung cancer.
Stomach Cancer
Stomach cancer is another common cancer in Africa. Several risk factors are implicated in the development of gastric cancer, including a diet high in salt and smoked foods, a diet low in fruit and vegetables, a family history of gastric cancer and gastric polyps, long-term gastritis, pernicious anemia, and smoking. , and Helicobacter pylori (H. pylori) infection.
Africa has the highest H. pylori infection rate with a prevalence of 70.1%.
H. pylori infection causes chronic inflammation and significantly increases the risk of duodenal and gastric ulcers and gastric cancer. Stomach cancer has also been shown to be more common in men than women
Colorectal Cancer
Colorectal cancer is usually diagnosed at an advanced stage in Africa, with most cases metastasizing. Therefore, the mortality rate is quite high. Possible risk factors such as genetics, diet, lifestyle, socioeconomic status, urbanization, previous infection with schistosomiasis, Crohn's disease, and diabetes mellitus predispose to colorectal cancer.
Colorectal cancer cases are increasing in all African countries regardless of gender bias.
Esophageal Cancer
Esophageal cancer (EC) is another common example
Risk factors for developing EC include smoking and chewing tobacco, heavy alcohol consumption, drinking hot beverages, exposure to polycyclic aromatic hydrocarbons (PAHs), consumption of red meat, poor oral hygiene, low intake of fresh fruit and vegetables, and acid reflux. In addition, several viral infections also predispose to esophageal cancer, such as human papillomavirus, herpes simplex virus, cytomegalovirus, and Epstein-Barr virus.
EC often first appears as Barrett's esophagus, which may or may not develop into cancer. In the Western world, Barrett's esophagus is diagnosed early, monitored, and sometimes treated. Such early detection is beyond the reach of most Africans.
Liver Cancer
Although the risk factors are known and avoidable, the mortality rate from this cancer remains very high. Hepatitis viruses and human immunodeficiency virus (HIV) are known to increase the lifetime risk of liver cancer. In addition, rapidly increasing urbanization has driven a large increase in additional risk factors such as co-infection, alcoholism, aflatoxin exposure, iron overload, type 2 diabetes mellitus, and obesity.
Men have a higher incidence than women, which may be related to higher exposure to carcinogens such as tobacco and alcohol, and the natural protective effect of estrogen against liver inflammation.
Major Challenges in conducting oncology research in Africa
Expanding clinical oncology trials in Africa is key to responding to the current and projected increase in the burden of cancer in Africa. However, efforts to improve cancer research outcomes are hampered by several constraints across the continent. 6 major challenges in conducting oncology clinical trials in Africa are:
- Limited resources and infrastructure
There is very little research funding from private companies in Africa and most funding co or international donors.
Sophisticated equipment for CT, MRI, positron emission tomography, gamma cameras or nuclear medicine, and others are not available in most centers in Africa. Such devices are often needed to detect certain types of cancer or are required for treatment.
- Poor training of personnel
There are very few high-quality cancer registries in Africa. As a result, information on the cancer burden in Africa is insufficient or non-existent. In addition, the number of oncologists and other clinical cancer specialists remains insufficient to meet the current cancer burden. The situation does not appear to be improving due to the depletion of health personnel, an outflow of scarce professional resources ("brain drain"), and the few available health workers being overwhelmed by the growing burden of cancer.
- High burden of cancer at advanced stages
The lack of early and accurate diagnosis poses a challenge to adequate treatment. More than 80% of patients in Africa are diagnosed with advanced cancer. Prevention options are largely underutilized. For example, cervical cancer is the leading cause of cancer-related death among women in 40 of 48 countries in sub-Saharan Africa, but many countries have limited HPV screening (PAP testing) and vaccination services.
- Limited treatment options
Cancer awareness is low in Africa. Many believe that cancer is a spiritual curse and therefore do not seek timely medical help. Available treatment methods are limited and most of the masses cannot afford them.
Palliative care is very important in cancer treatment because most patients come at an advanced stage. But it is limited because fewer than 11 countries in sub-Saharan Africa have access
to oral morphine. Functional palliative care or home care for the terminally ill patient is rare.
- Lack of confidence in the research findings
It can be difficult for research sponsors and governments to trust the results of cancer research in Africa. This is due to the high level of corruption and possible falsification of results. This causes research results not to be applied and/or largely ignored after publication.
Duplicate research is also another possibility that can lead to the wastage of scarce research resources.
- Language barrier
The common language of communication in research in English or French. These languages are not native to all parts of Africa. Consequently, it will be difficult for local researchers to apply for grants or publish results in their mother tongue
Ongoing Efforts to Increase Cancer Research in Africa
Cancer research in Africa must be effective and sustainable globally and locally. There are several ways to address the problems and challenges of cancer research in Africa:
1. Increase funding for cancer research: Many African countries have limited resources for cancer research, which can make it difficult to conduct high-quality oncology clinical trials. Increasing funding for cancer research in Africa could help to increase the quantity and quality of research being conducted in the region.
2. Better access to infrastructure: One solution to this problem is providing funds to purchase the necessary equipment for better diagnosis, treatment, and monitoring of cancer patients.
Another option is to build partnerships with organizations that have access to specialized equipment. An example of such an organization is Infiuss Health. Infiuss Health is a CRO in Africa with access to centers with specialized equipment that can be used to support cancer research in Africa.
3. Research capacity building: This could include training local researchers in cancer research methods, providing access to research infrastructure, and establishing partnerships with international research institutions. One of Infiuss Health's main goals as a Contract Research Organization in Africa is to provide training opportunities for oncology researchers in Africa. This may include providing training in specific research techniques, regulatory requirements, or data management and analysis.
4. Increasing access to cancer treatment: Many people in Africa do not have access to quality cancer treatment, making it difficult to conduct cancer clinical trials and other forms of research. Increasing access to cancer care in Africa could help increase the number of patients available for oncology research. Infiuss Health helps oncology researchers identify and partner with good cancer treatment centers in different African countries.
5. Encourage collaboration and networking: Collaboration and networking can help facilitate the sharing of ideas and resources and increase the effectiveness of cancer research in Africa. This could include building regional or international research networks and encouraging researchers to share their findings and collaborate.
6. Addressing regulatory and ethical challenges: There are often regulatory and ethical challenges that can hinder cancer research in Africa. Addressing this challenge may include working with relevant authorities and agencies to establish clear research policies and regulations and ensure research is carried out ethically and responsibly. Infiuss Health has a team of PIs and study monitors in place in various African countries to ensure that clinical trials are approved by the local ethical committees and regulatory authorities in each country before they get underway.
7. Improve data access and make information auditable:
One solution to this problem is to invest in improving cancer registration systems and building capacity for data collection and analysis. Furthermore, researchers can obtain access to platforms that allow them to verify the identities of each patient and track the progress of their studies. Infiuss Health provides such a platform - PROBE, which allows tracking the progress of clinical trials in Africa.
Conclusion
Cancer research in Africa has the potential to make a significant contribution to reducing the burden of cancer in the region and improving the lives of affected patients and their families.
There are untapped opportunities to reduce global burdens and inequalities through cancer research in Africa. Cancer research will enable the development of medical products that will benefit the entire continent by understanding specific risk factors in Africa or a region of Africa.
Infiuss Health is a CRO in Africa, enabling sponsors to conduct clinical trials in Africa, and helping to reduce the burden of cancer.