Cancer in SA ‘will double if left unchecked’
Lifestyle choices, HIV complications, poor care are all to blame
When Zoe Strachan was diagnosed with cervical cancer in 2017, at the age of 47, she was taken by surprise.
“When I heard the news, I said: ‘What is this, God?’ I was relatively healthy and active ... I was taking part in a fitness competition. I was also so young. Cancer was the last thing on my mind.”
After a hysterectomy and gruelling chemotherapy, she was retrenched.
When the cancer returned, she had to rely on public health care, known for its challenges, but she described it as “phenomenal, as they saved my life without it costing an arm and a leg”.
She is now in remission for the third time. The mother from Fourways, Johannesburg, is one of many South Africans affected by the growing burden of cancer, which a new modelling study presented at the World Cancer Congress in Geneva this week says is expected to almost double by 2030.
Produced by actuarial consultancy firm Percept and the University of Cape Town (UCT), the study shows common cancers such as breast, cervical, prostate, lung, blood and paediatric are “increasing for all ages” from about 62,000 cases in 2019 to a projected 121,000 in 2030.
The Union for International Cancer Control (UICC) warned that if new cancer cases were left unchecked, cancer deaths in lower-and middle-income countries would rise to about 4-million by 2040. In 2020, more than 3.5-million new cancer cases were diagnosed in such countries.
The researchers in the South African study, Emma Finestone and Jodi Wishnia, said while an ageing population in South Africa was driving up new cases, the high prevalence of HIV and risk factors such as smoking, harmful alcohol use, unhealthy diets and sedentary lifestyles also contributed.
They noted that sex-specific cancers such as breast, cervical and prostate would have the highest incidence. Breast cancer was expected to move from 19,860 new cases in 2019 to 29,593 by 2030.
Cervical cancer, which kills about 6,000 women in SA each year, was expected to increase from 8,149 in 2019 to 18,000 by 2030. Prostate cancer was expected to jump from 17,554 in 2019 to 42,181 in 2030.
The incidence of non-Hodgkins lymphoma was expected to rise from 3,180 cases in 2019 to 8,661. Lung cancer has a relatively high incidence in women and men, mostly above the age of 50.
Researchers said it was not surprising that many cancer cases were detected in the public health system, but “given the higher case-finding rate in the private sector, the incidence rate [there] was expected to be higher than that of the public sector overall”.
Those with HIV were at greatest risk of cervical cancer due to the link between HIV and the cancer-causing human papillomavirus (HPV).
Lymphoma was also prominent, with 30%-40% of cases of cervical cancer and lymphoma expected to be among people living with HIV, and 20% of new Hodgkin lymphoma cases occurring in this group.
Given the limited health budget and shortage of cancer treatment and palliative care services in the public sector, “this is only going to become more pressing in the coming years and as such cancer, along with all non-communicable diseases, should be a key area that the NHI [national health insurance] considers when doing its planning”, warned Finestone.
The resignation of breast cancer specialist surgeon Professor Carol-Ann Benn from Helen Joseph Hospital in Johannesburg, as reported this week by Spotlight, has raised concerns over the loss of public health sector expertise in Gauteng. Breast Health Foundation volunteers withdrew their services from the facility in solidarity, citing “barriers to the provision of quality patient care and a lack of support from senior management”. Lauren Pretorius, CEO of Campaigning for Cancer, said cancer was underreported as the national cancer registry “is pathology-based and many South Africans don’t even manage to get to screening or diagnostic services”.
Those seeking cancer services not only juggled transport costs and time off work, but “once they make it to a primary health clinic they are potentially faced with a primary health-care worker who is not adequately trained in identifying the signs and symptoms of cancer, a lack of working diagnostic equipment and, again, the cost of transport to another hospital.
“If they get a diagnosis they are often sent to a tertiary treatment facility far from their home that has limited access to innovative treatments or equipment that is not working,” Pretorius said.
Zodwa Zithole, head of advocacy at the Cancer Association of South Africa (Cansa), said that while South Africa had impressive cancer policies, they were not implemented effectively.
“The increasing burden of cancer internationally and in South Africa is worrying. Many patients are diagnosed with advanced cancer because of poor screening or access. Our government is not making cancer and noncommunicable diseases a priority.”
Zithole said Cansa was inundated by state patients discharged with poor pain management. Private sector patients faced struggles, mostly related to out-of-pocket payments.
Researchers say it’s not too late to act, estimating that 30%-50% of cancers could be avoided by reducing exposure to risk factors.
“It is never too late to intervene, even if one doesn’t avert the cancer entirely. To pick it up at an earlier stage has far improved health outcomes in most cases,” said Finestone.