Cancer scenario in the Gambia-Africa

Abstract

Cancer continues to be a global health challenge, significantly impacting morbidity and mortality rates. Emerging countries, including those in sub-Saharan Africa, are particularly affected by the increasing prevalence of cancer-related deaths due to limited resources, inadequate infrastructure, and lack of awareness and education about cancer. The Gambia, a small West African country with a population of under 3 million, mirrors these challenges but has made commendable progress in recent years. This essay provides a brief overview of the cancer scenario in The Gambia, highlighting key aspects of incidence rates, the most prevalent cancer types, and the prospects of cancer care. Cancer incidences in The Gambia have been rising, according to national statistics. The data indicates a significant burden of various cancers, with liver, cervical, and breast cancers being the most prevalent. In 2022, the overall national cancer incidence was 79.2/100,000 persons per year, with the most common sites in females being cervix uteri (39.4/100,000 persons per year) and the liver in males (28/100,000 persons per year).[1] The recorded number of new cases in the same year was 1196, with the number of deaths being 899. The 5-year number of prevalent cases was 2290. The vast majority of cancer cases present at late stages of the disease, highlighting the need for more awareness creation in the population. Total case numbers are thought to be higher, as not all cases are diagnosed or reported as cancers. This is a trend found in many developing nations. As cancer registries are being established and maintained in many developing countries, cancer data collection is expected to improve. The Gambia National Cancer Registry was established in 1987 and was the only population-based cancer registry in Africa at the time with national coverage. The overall cancer incidence reflects both the challenges in health-care access and the need for comprehensive cancer control strategies in The Gambia. Liver cancer, particularly hepatocellular carcinoma (HCC), is notably prevalent. It is the most common cancer in the country in men (41.5% of all male cancers) and the third-most common in women (9.2% of all female cancers). It accounted for 328 new cases and 238 deaths in 2022. The Gambia hepatitis intervention study (GHIS), initiated in 1986, was one of the first large-scale efforts to address this issue by targeting hepatitis B virus (HBV) infections, a major risk factor for HCC. Furthermore, the prolifica (Prevention of liver fibrosis and cancer in Africa) project, started in 2011 at the Medical Research Council, The Gambia, aims to reduce HCC incidence through community-based screening for HBV infection and the provision of antiviral therapy. The introduction of universal HBV vaccination in 1990 has significantly reduced the prevalence of chronic HBV infection among young Gambians. However, it may take decades for the number of HCC cases to decline as those infected before the immunization program continues to develop the disease. Cervical cancer is another major public health concern as it is the most common cancer among women in The Gambia and accounted for 389 reported new cases (48.1% of all female cancers) and 268 deaths. It is also the leading cause of cancer-related death among women in the country. It is largely attributed to human papillomavirus (HPV) infection. Efforts to combat cervical cancer include vaccination against HPV with the quadrivalent vaccine Gardasil introduced in 2019 to school-going girls aged 9–13 years.[2] There was an estimated coverage rate of 34% for the first dose and 30% for the second dose in 2021. Improved mass screening programs by health facilities and cancer advocacy groups are contributing to the earlier detection of cases. The generalization of HPV vaccination is crucial in preventing the onset of cervical cancer among young women, and self-sampling techniques have proven to be effective in early detection. Breast cancer is the second-most common cancer among women, representing 15% of all female cancers in the country, but its incidence is rapidly increasing, accounting for 788 new cases and 429 reported deaths in 2022.[3] While the observed incidence is lower compared to many industrialized countries, it remains a significant health issue. Health-care institutes and civil society associations currently play a vital role in breast cancer screening activities. Studies in various parts of the country have shown a lack of awareness as being a barrier to early diagnosis and utilizing conventional media to enhance public awareness will likely enhance the health-seeking habits of the population. These efforts are crucial in a country where health-care access can be limited. Other notable cancers include prostate cancer, which accounts for 9.2% of male cancers with 675 new cases and 417 deaths; gastrointestinal (gastric and colorectal) cancers accounted for 891 new cases and 653 deaths in 2022. According to the Gambia Demographic and Health Survey of 2020, 31.4% of men aged 25–64 years old smoked tobacco or cigarettes and the prevalence of tobacco consumption among men was thirty times higher than among women (19.3% vs. 0.65%). However, the prevalence of tobacco-related malignancies remains modest, with incidences of lung cancer at 4.6%, esophageal at 2.2%, larynx at 0.59%, and oral at 0.42% of all reported cancers in 2022. The management of cancer in The Gambia involves a multifaceted approach. The national cancer control plan being developed in collaboration with the International Atomic Energy Agency marks a significant step towards comprehensive cancer management in the country. This plan includes improving diagnostic facilities, providing training for health-care professionals, and enhancing treatment options of chemotherapy and radiotherapy. The integration of these efforts aims to provide better care for cancer patients and reduce mortality rates. This plan aims to create a sustainable framework for cancer prevention, early detection, and treatment, thereby improving patient outcomes. Looking ahead, the future of cancer care in The Gambia holds promise but also significant challenges. Key areas for improvement include enhancing prevention strategies with continued emphasis on vaccination programs and public health education to reduce the incidence of cancer. Expansion of diagnostic and treatment facilities would ensure timely and effective cancer management. Developing better health-care infrastructure and training more dedicated health-care professionals will help in supporting comprehensive cancer care. The integration of international best practices in cancer care and increased international collaboration with both industrialized and emerging nations like India can help The Gambia learn from their experiences and success stories. Concerted and sustained governmental and nongovernmental support is essential in the country’s fight against cancer. Furthermore, the success of ongoing vaccination programs and mass screening initiatives will play a crucial role in reducing cancer incidence and improving survival rates. With these measures, The Gambia can make significant strides in mitigating the cancer burden and enhancing the overall health of its population. In conclusion, the cancer scenario in The Gambia is shaped by a combination of high incidence rates, particularly of liver, cervical, and breast cancers, and concerted efforts to combat these through vaccination, screening, and management programs. The GHIS and prolifica projects have made significant strides in reducing HBV-related liver cancer, while ongoing efforts in HPV vaccination and breast cancer screening aim to improve outcomes for these prevalent cancers. The national cancer control plan, in collaboration with international partners, is crucial in managing and reducing the cancer burden. Future advancements in cancer care will depend on continued improvements in health-care infrastructure, training of health-care personnel, public health education, and international cooperation. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.