Download Cancer is a disease that is becoming more prevalent throughout the

Date : June, 01 , 2010 Publication : Life Page Number: 22-23
Cancer in
South Africa
Cancer is a disease that is becoming more prevalent throughout the world,
but it is a killer that can be beaten. Gillian Warren-Brown explores how
cancer is affecting ordinary South Africans
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Date : June, 01 „ 2010 Publication : Life Page Number: 22-23
6 6 There are about 150 different cancers and
not every cancer is a death sentence. In fact,
about a third of all cancers are potentially
curable if diagnosed early enough 5 J
cancer is a death sentence. In tact, about
a third of al cancers ore potenhaly curable
il diagnosed earty enough, according to
Mogdalene Seguin. Head of Advocacy at the
Cancer Association of South Africa (CANSA).
What's surprising, yet abo inspiring, is that
* ) percent of al cancers ere preventable.
HOW COMMON IS CANCER?
According to the latest avatabie National
Cancer Registry [NCR} statistics (2000-2001).
one in sa men and one in eight women rt
South Africa w i get cancer. Nobody wants
to be a statistic, espeoafy not that 'one' in six
or eight, but knowing how common cancer
is helps raise awareness about a cfcease that
con often be prevented. This knowledge also
helps the hearth system and care facities in
planning to meet demands for cancer services.
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e a l know someone
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or, unfortunately,
someone who has discovered that he or she
has the disease when it's too kite to treat.
Fortunately. '** this day and age, there are
irony survivors.
Dr Gary McMchoet. an oncologist at the
west Rand Oncology Centre based at Lite
Ftora Cinic in Roooepoort. says there are
about 150 different cancers and not every
\
In al of Africa, the incidence of cancer is
increasing, reflecting the increasing Hespon of
our poputations. urbanisation and the adoption of a Western Hestyle.
Seguin says that according to the most
recent statistics avatable from the NCR,
between 80 000 and 100 000 South Africans
ore atognosed with cancer every year. But
these figures are nearly a decode old.
The NCR. which reSes on funding support
from the National Health Laboratory Service
and the Department of Hearth, colates
and analyses cancer cases dkjgnosed in
pathology laboratories. However, it hasn't
been able to gather accuratefiguressince
2001 because patient confidentioJty laws
prevent private laboratories from dbclosing
thetfilormationto the NCR. This is about to
change though, m December lost year, the
health department pubfahed lor comment
new regulations developed in terms of the
National Health Act that w i make cancer a
registrable disease. A Deportment of Health
spokesperson has confirmed that everything
is on track for these regulations to be implemented later this year which w i mean that
pubic and private tabs can pass on ther data
to the NCR. However, it could take the urit
up to five years to oddress the backlog and
provide refabte data.
According to CANSA, a planned population-based registry is even more vital,
especiafy when decisions ore mode relating
to awareness, education and early detection.
ON THE INCREASE
Cancer is one of the major kJers in the
developed and developing world. inc*jding
South Africa. Globaly, 11 mflon new cases
of cancer are diagnosed and seven m*on
people die from the disease each yeor.
A report pubfahed in The Lancet lost year.
entitled 'The burden of noncommunicable
ofceoses in South Africa', says the country's
health situation is characterised by a 'quadruple burden' of dfeease - communicable.
nofKommunicable. perinatal and maternal,
and injury-felated disorders.
A large proportion of South Africa's heatth
resources hove, understondabty, gone
towards HIV 4. Aids and tuberculosis (Tfj). But,
the report warns: 'The burgeoning morbiotty
and mortofty from HIV & Aids and tuberculosis has probably suppressed theriseof
rwrvcomrnunicabte diseases. Once the
accelerated rc*out of highly active cntretrovial therapy takes effect, deaths from HIV &
Aids and TB should fot leoding to arisein He
expectancy accompanied by an increasing
burden of norvcommunicabte diseases.'
Cancer is one of these.
Whietomepeoplefr/ingwith HIV & Aids
may gel cancer in the future due to their
prolonged survival age. recent research
suggests that increasing cancer rates in
Africa may be a drect result of the Htv &
Aids pandemic. Dr Zainob Mohamed. a
radiotherapy oncologist at Groote Schuur
Hospital in Cape Town, says there has been
an increase in HIV & Aids related cancers such
as lymphoma and Kaposi's Sarcoma, A large
proportion of the cervical concer patients
treated at the hospitot are also HIV positive.
'This has reached a plateau due to better
management of HIV in the community, as wel
as wider use of antiretrovral drugs.' she says.
Accorclng to the World health Cfgarfaation.
lifestyle factors play a role in the growing incidence of cancer. These inckxle high smoking
rates, poor nutrition (which destabises the
immune system) and a Hestyterichin fatty
foods andtttleexercise.
Even chldren are at risk. Avatabie data
indicates that about 800 chBdren are
diognosed with cancer every year in South
Africa, but CANSA says the octualfigureis
likely to be more than double this. It says over
80 percent of cases are diagnosed very late
un
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Date : June, 01 , 2010 Publication : Life Page Number: 22-23
(sloge 3 or 4). but with eorty detection and
treatment, the chances of a chid recovering
are good.
ACCESS TO TREATMENT
AND CARE
People needrig cancer treatment, inckxling
chemotherapy andradiotherapy,con get
H via the private or stale healthcare systems.
Most medical aids cover cancers that are
classified as a prescribed minimum benefit
(PMB). These include cancers ot soSd organs
thar are defined as 'treatable', and a variety
ot cancers ot non-soSd organs, whether
'treatable' or not. tf the cancer b not a PMB.
you con get treatment, but the cost w i be
subject to benefits and limitations set by your
medical scheme.
CEO ot the South African Oncology
Consortium (SAOC). t> Martyn Schickertng.
says the SAOC is wortdng with the Department
of Heotth and Councl for Medical Schemes
to make cancer treatment more avoJabte
to oJ people at a cost-effective price, whie
moJntahing cfrtcal standards. According
to its website, the SAOC has developed 'a
"tiered" oncology treatment guidelne in
whfch chemotherapy and radiation therapy
options are toiored to meet the financial
constraints of the indrvidual patient's healthcare insurance benefits.'
three years ago. a group ofradiolion
oncologists started a managed-care initiative, the Independent Clnical Oncology
Network (CON), to provide treatment in the
private sector at ctscoontedratesto mecScal
aid members with low Benefit options that
onry alow them imrted access to cancer
services. They do not have any co-payments
- something that has become a regular
feature of cancer care, as mealcol aids try to
reduce costs by Smiting benefits.
The network uses private faclties across
the country, such as the We Uttte Company
of Mary Hospital in Pretoria, to provide clnrcal
care equivalent to the best avoiable r> the
1 fj Common cancers
Skin cancer is the most common
type of cancer in South Africa and
lung cancer is becoming increasingly
prevalent, particularly among women.
According to the 2000-2001 NCR report,
prostate cancer tops the list for men.
followed by lung, oesophagus, colorectal
and bladder cancer. In women, breast
and cervical cancer are most common,
followed by uterine, colorectal and
oesophageal cancer.
pubic sector. Costs are simiar to that of the
pubic sector, but the major difference is that
patients have immediate access to treatment with no wotting fcts.
'South Africa's private f«eotrhcare sector
has the copabity to offer the same treatments as any offered in first world countries,'
says Dr McMichael. 'The constraint is often
that medical aids ore paying less and we
as oncologists are caught in the middte
between the patient wonting the best treatment posstole and the medical aid wanting a
less expensive treatment.'
Dr Conrad Jacobs, one of the drectars
of GVT. a private oncology practice, adds
that cost constraints also hamper the
avaiablty of speciaised equipment f©
treat cancer. 'Eaupment r> expensive to
set up and maintain. For this reason the use
areas because a disparity in cancer resources
between provinces leads to 'meefcot
tourism'. For example, patients from the
Eastern and Northern Cape often travel to
the Western Cape lor treatment. On the other
hand, as some chemotherapy drugs are not
avaiable in the Western Cape, people may
go to KwaZulu-Natal for treatment.
Fortunately, most oncology treatment is
given on an outpatient basis. 'One of the
most distressing things is not being able to
treat patients who need to be hospitafised
immedotery because of a shortage of beds.'
says Dr Mohomed. 'If it's an emergency,
we try to get beds in other words. The main
problem with lack of beds is the delay
in giving chemotherapy to patients with
curable cancers who require in-patient
chemo. Delays can decrease the efficacy
• • The authorities need to make an effort
to retain professionals and make sure the
training of new oncologists is not compromised mm
of GommoknrTe and Tomotheropy is not
avaiable n South Africa, but we do have the
latest Inear accelerators aftowrig us to do 30,
IMRT fntensity-modukated radiotherapy) and
IGRT frmoge-guided radiotherapy),' he says.
The cost of setting up on oncology f acity is
highighted in a report by economics consultancy Econex which looked at the viabity
of implementing the proposed national
heotth insurance (NHI) system in South Africa.
One of the reports, entitled 'Cancer and
the NHI: Cost Constraints and Opportunities'
(pubSshed in February this year] incScates
that a ful new unit costs R45-60 mBon to set
up and more than R24 mtton annuaty to run
(at cost). The report says that in oddrlion to
a shortage of 'acfties (even in the private
sector), there's oho a shortage of oncologists.
Professor Justus Apffefttoedt. Associate
Professor of Surgery and Head of Surgical
Oncotogy Services at the University of
Stefenbosch. says the shortage of oncologists
is most acute In the pubic sector, which deals
with the majority of cancer patients. 'The
authorities need to make on effort to retain
professionals and make sure the trainng of
new oncologists is not compromised due to
staffing issues at some institutions.'
Prof. Apff etstoedt says surgical treatment
in pubic sector hospitals is generaty of a high
standard, but when it comes to cancer treatment - particularty radiotherapy - the huge
volume of people means patients may have
to wait. The backlog is exacerbated in some
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of treatment and the possibility of cure.'
ri the midst of these chaienges. the
oncology department at Groote Schuur does
its Pest to be patient -frienaty and. due to a
recent foceift made posstole by donations,
also looks bright and attractive,
CANCER MANAGEMENT
What n e e d s to b e done?
Groote Schuur's radiation oncology unit
treated close to 3 000 new patients last
yeon a 95 percent increase on 2008, Dr
Mohamed says, 'Of these, a large number
of patients have advanced cancers.
Many patients present late because they
couldn't afford to come to hospital. Most
lock education about cancer so they don't
seek meoScoJ help immediately, or they try
alternative care first."
'Education is key to cancer prevention,'
says Dr McMichael. This includes getting
people to have screening tests, such as
pap smears (for cervical cancer) and
mammograms (for breast cancer). Seguin
agrees, saying that awareness, education,
screening, treatment, research and palliative care are al part of effective cancer
control. One of the challenges is a lack of
resources for prevention, treatment and
pafliative care.
CANSA has a special programme coJed
Tough Living with Cancer to help support
chMren with cancer and their famSes. It also
runs prevention programmes to promote
Date : June, 01 , 2010 Publication : Life Page Number: 22­23
hecihy Kestyles among school chWren.
Regarding envronmental cancer­causing
ogents (carcinogens). Seguin befeves
legislation to protect people needs to be
considered. For example, banning Lindane,
a substance which occurs in certain chl­
dren's head Ice shampoos. CANSA asked
the government lo ban polycarbonate
baby bottles containing Bophenol A. but
the heotth deportment responded that 'the
information at hond seems to be insutftcient
to ban the use ot SPA in baby bottles and
sipper cups'.
CANSA's head ot research. Or Carl
Albrecht. says that whie the Deportment
of Health spends obout R4 btfon a year on
cancer, there 6 irtte 'hofctic networking*
beiween the department, academic. NGOs.
industry, professions, the pubic and patients,
'we need something Ike the National
Cancer Institute (NCI) in the US to co­ordi­
nate a cancer control programme and to
unite o l the role players.' says Or Atxecht.
In the meantime. CANSA and the Medical
Research Counci (MRC) are working through
a joint platform coled the Cancer Resecrch
Initiative of South Africa (CARtSA), which is
beginning to perform a meaningful function
as a fledging NCI. he odds,
Dr AJbrecht's wish 1st is for government to
use a percentage of the R8 b*on tobocco
tax to fight cancer and fund the roll­out of
the anti­HPV vaccine, as wen as for a South
African NCI 'o be formed and for all the
organisationsfightingthe disease in South
Africa to function as a hofatic network.
What is being done?
One ot the most preventableriskfactors
tor cancer is tobocco use. Dr McMichael
says in addition to kjng cancer, smoking
increases theriskof developing stomach
ond pancreas cancer, as wel QS other types.
He cites South Africa's tobacco control
legislation, regarded as among the most
advanced in the world, as a success in terms
of cancer prevention efforts. But there ore still
about seven mfton smokers in South Africa.
'It's a concern that the number of young
people and women smokers is sta on the
increase,' he says.
A joint campaign between the
Department of Health ond partner organi­
sations, inducing CANSA, implementing
the Hepatitis B vaccine in the expanded
programme of immunisation is also helping
to prevent cancer ­ in this case, of the iver.
A DOH spokesperson odds that the depart­
ment is in the process of addressing other
issues surrounding the treatment of cancer
too, elaborating, 'Doctors are being trained
to use colposcopy mochines. which are used
to diagnose cervical obnormalties after an
abnormal pop smear, ond referral systems
are being reviewed.'
m a bid to decrease the incidence of
humon popioma virus (HPV), which can
lead to cervical cancer, the Medicines
Control Counci has registered two HPV
vaccines. 'If they become accessible. tney'B
alleviate the burden of this type of cancer.'
soys Seguin. Or Albrecht adds. 'CARISA is
initiating a m*on rand project aimed at
decreasing the incidence of cervical cancer
through HPV vocdnation and early detec­
tion, especialy in girts of school­going oge.'
CANSA olocates over R4 m*on a year for
cancer research in South Africa, the results
of which 'influence its watchdog ond health
education services', says Seguin. CANSA is
also involved in a number of projects aimed
at reducing the impact of environmental
carcinogens. In oddition to tobacco, these
include industrial polution, smoke from open
fires, contaminated water and trans fats in
food (recent legislation requres that trans fat
content should be less thon two percent).
Ultimately, the most effective action to
avoid getting cancer comes from you...
realising 'it could be me' will motivate
you to adapt your lifestyle so that it needn't
be you. □
0
For oncology services at Life Healthcare
hospitals, entail Janet Young at Janelyoung©
lrfeheaTOTcare.co.za or fax 086­500­7535.
CANSA: 011 ­616­7662; www.cansa.org.za
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