The Burden of Cancer

Three years ago, I lost my mother to what was described as renal cell carcinoma or the cancer of the kidneys.  Four years prior to her demise, she had complained of low back pain.  We got her into one of the best hospitals in the city to have her checked. 

Clinicians concluded that she had some degenerative disease along her spinal cord.  We were satisfied with the prognosis.  She was put on pain killers and was made to exercise her back-side daily.  Four years down the road, the pain was getting worse to the extent that she could not stand.

A simple scan revealed she had cancer but we had lost time.  How could we have missed this very simple test four years earlier?   How did the experts miss this simple test in the first place?  What was the basis of their conclusions?  These were the questions that ran through my mind as we began to fight a hopeless war on cancer. 

TRIAL AND ERROR

Clinicians by nature start their investigations by trial and error.  This is why most pain killer adverts warn, maumivu yakizidi muone daktari (if the pain persists, see a doctor).  I should have asked questions on how these clinicians arrived at their initial conclusions four years earlier.

Global Cancer facts and figures from the International Agency for Research on Cancer (IARC), show that “there were 12.7 million new cancer cases in 2008 worldwide, of which 5.6 million occurred in economically developed countries and 7.1 million in economically developing countries. The corresponding estimates for total cancer deaths in 2008 were 7.6 million (about 21,000 cancer deaths a day), 2.8 million in economically developed countries and 4.8 million in economically developing countries.

By 2030, the global burden is expected to grow to 21.4 million new cancer cases and 13.2 million cancer deaths simply due to the growth and aging of the population, as well as reductions in childhood mortality and deaths from infectious diseases in developing countries”.

IARC estimates that future burden could be much larger than given above due to the adoption of western lifestyles, such as smoking, poor diet, physical inactivity, and reproductive factors, in economically developing countries. Cancers related to these factors, such as lung, breast, and colorectal cancers, are increasing in economically transitioning countries. Rates of cancers common in Western countries will continue to rise in developing countries if preventive measures are not widely applied.

The American Cancer Society contends that “more than half of all cancer cases and deaths worldwide are potentially preventable. Tobacco use, heavy use of alcohol, and obesity can be most effectively prevented through a combination of education and social policies that encourage healthy behaviors and discourage unhealthy practices”.

In Kenya, cancer ranks third as a cause of death after infectious and cardiovascular diseases.  Data availability that is key to fight against the disease is scanty and mainly hospital based.  The true burden of cancer in Kenya is unclear.  In 2005 an attempt to compile the data shows that approximately 18,000 deaths were as a result of cancer and most of them under the age of 70.  The government in 2012 enacted a cancer law to help ease the burden of the affected families.

CONTAMINATION OF GROUND WATER

Leading types of cancer in Kenya among the women are cancers of the cervix and breast while with men, cancers of prostrate, esophagus, neck and head are more common.  In children, the commonest cancers are blood cancers (leukemia) and lymphomas.  Cancers of the digestive tract such as stomach, liver, colon and rectum are on the rise.

Although we can deduce the causes of cancer from this write up, it is not enough.  We need more research to establish local causes and solutions.  Our academics ranging from social scientists to environmental scientists to engineers to hard core scientists are virtually sleeping on the job.  There is simply not enough curiosity to establish the use of Nairobi River to irrigate vegetables that end up on our dinner table.  There is no research on contamination of ground water through over-utilization of land (mainly due to excessive subdivisions).  We simply do not attempt to look into causes of many of our problems.

There is need for statistics on current cancer incidence, mortality, and survival statistics and information on cancer symptoms, risk factors, early detection, and treatment.  With statistics, we can then devise informed methods of dealing with the cancer problem.  More importantly, we must get into the culture of checkups through partnerships with equipment suppliers spread throughout the country.  This will help create the necessary critical mass for lowering the cost significantly for the poor to afford. 

Even as we know that early diagnosis of most cancers is key to successful treatment, most Kenyans give priority to their vehicle checkups to their own life.  Our doctors too need a lesson.  In most parts of the world, when a patient sees a doctor, there are basic standard operating procedures commonly referred to as SOPs.  Twice as many people are dying in developing countries as they are in developed economies.  Just as we have adopted western type of lifestyle, we must begin to closely watch our health in the same way it is done in developed economies.