At the end of September, three African countries launched a pilot program to improve the overall management of breast and cervical cancers, which account for more than half of all female cancers in Africa. This initiative is a milestone in the fight against the issue, which began on the continent at the turn of the 2010s.
Supported by Côte d'Ivoire, Kenya and Zimbabwe, with the backing of the World Health Organization (WHO) and the pharmaceutical company Roche, the project aims to integrate the entire treatment chain for these female cancers into a comprehensive public health policy, from the promotion of basic care for women to early detection, prevention and treatment.
"In our constrained economies, despite problems in the hierarchy of emergency, the idea of global health has emerged as key to our development," said Professor Cheikh Tidiane Cissé, head of the obstetrics/gynecology department at the Institut d'Hygiène Sociale Polyclinique de Dakar (Dakar Institute of Polyclinical Social Health), who presented Senegal's experience in the fight against cervical and breast cancer at the congress of the Fédération Internationale de Gynécologie et d'Obstétrique (International Federation of Gynecology and Obstetrics) in Paris on Tuesday, October 10. "We're in the process of moving away from a compartmentalized approach to treatment. To achieve this, we need to continue investing in the prevention of these non-communicable diseases."
While cancers – as well as cardiovascular disease, hypertension, diabetes and obesity – have long remained in the shadow of the major infectious diseases that have been the continent's health priority for decades, the International Agency for Research on Cancer (IARC) predicts that the number of cases will double over the next 20 years in sub-Saharan Africa. The WHO predicts that by the end of the decade, cancer-related mortality will exceed that of malaria, tuberculosis and HIV combined, which killed around 1.5 million people on the continent in 2021.
Once thought to primarily afflict wealthy nations, cancers and other non-communicable diseases have settled into the lives of Africans as "junk food," sedentary lifestyles, pollution, smoking and alcohol consumption have spread to large cities, whose populations are doubling every 20 years. The aging of the continent, where life expectancy has risen by 10 years since 2000, is also having an impact on this explosion.
"It's a double burden for Africa and a paradox," explained Professor Maimouna Ndour Mbaye, director of the National Diabetes Center in Dakar, Senegal. "We're living longer, and that's good news, but by adopting Western lifestyles, we now have time to develop chronic illnesses, while we haven't yet gotten rid of malaria or tuberculosis."
Much has been achieved on the cancer front in the last 10 years. Most African countries have adopted national plans to fight it, and numerous radiotherapy centers have been built. In 2022 and 2023 alone, 11 sprang up, notably in sub-Saharan Africa – Benin is due to open its own in 2024 – and 39 of the continent's 54 countries are now equipped, according to data from the international register of radiotherapy centers. But money is still lacking to ensure comprehensive patient care and a quality care pathway remains the privilege of an urbanized middle class.
The continent, which bears a quarter of the world's cancer deaths, invests only 1% of total healthcare spending in the fight, according to the 2019 report published by the University of Washington's Institute for Health Metrics and Evaluation. Just 2% of multilateral and bilateral aid, a mainstay of emerging healthcare systems, benefits non-communicable diseases, including cancers, according to an analysis carried out the same year by the British Medical Journal. Finally, Africa has two to four times fewer oncologists than recommended by the International Atomic Energy Agency.
In the field, therefore, patients are often diagnosed too late, and access to care remains complicated and expensive, even when governments provide partial coverage. For example, Senegal, which declared in 2019 that chemotherapy for breast and cervical cancer would be completely free of charge, can still only subsidize half the cost of treatment for other cancers.
As a result, patients still have to pay for numerous "ancillary" diagnostic or follow-up costs, such as mammograms or analyses, as well as extensive travel. Outside North Africa, South Africa and Kenya, where radiotherapy centers are well equipped, patients often have to travel dozens or even hundreds of kilometers to be treated in the nearest capital or major city.
"Most families go into debt to treat their loved ones," explained Hélène Kane, an anthropologist at the Université de Rouen who is heading up a special dossier on cancers in the Sahel for the social science journal L'Ouest Saharien, due out in early 2024. "Worse still, they often have to interrupt treatment for lack of funds. You manage to pay for the first treatment, sell your possessions for the second, go into debt for the third, and give up on the fourth."
A growing number of patient support organizations and national cancer leagues, often founded by recovered patients, provide financial support, accompaniment and even accommodation through mutual aid networks. But here too, resources are limited.
Prevention, which is far less costly for governments, remains crucial. Vaccination, when possible, notably against human papillomaviruses (HPV, highly contagious, responsible for cervical cancer, as well as anal, penile, oral and throat cancers) and hepatitis B and C (liver), is being expanded on the continent. According to WHO data, more than 21 African countries have achieved 70% coverage against HPV.
As for screening, while it needs to be strengthened to combat the disease more effectively and at a lower cost to health systems when it is carried out early, "it poses a real ethical problem for doctors, who are unable to provide their patients with full care," said Kane, who has worked in Mauritania for over 10 years. "It's a real source of suffering for them. This raises the question of palliative care, which is virtually non-existent in sub-Saharan Africa. But no matter how far we get in the fight against this disease, and no matter what resources we have, we have to face up to it, because this 'epidemic,' which has long remained invisible, is really taking place."
Translation of an original article published in French on lemonde.fr; the publisher may only be liable for the French version.