Expanding Programs to Reduce Unnecessary Cancer Mortality in Africa
By: Tony Boova, MPH, Medical and Scientific Affairs/Beckman Coulter Life Sciences
Maja Diemel, B.S., ENG, Selling and Marketing – Strategic/Beckman Coulter Life Sciences
Cancer Crisis in Africa
Cancer is serious wherever a patient resides, but in some parts of the world, even highly treatable cancers are fatal much of the time.1 There are several reasons for the divide, but in some regions in east Africa, lack of diagnosis may be the main culprit. Pilot programs are being implemented to address the problem, but more work still needs to be done, both to understand the differences in risk across the globe and to roll out effective, affordable solutions.
Cancer in Africa represents about 70% of the global burden.2 Part of this is due to the high prevalence of infection-based cancers—for instance, HIV itself is a risk factor for cancer,3 since it compromises the immune system, and being on antiretroviral therapy over the long-term can make a person additionally susceptible to certain blood cancers, including leukemia and lymphoma. But it’s not all HIV/AIDS-related. One common, but highly treatable form of lymphoma, called Burkitt’s lymphoma,4 is essentially a repercussion of malaria and Epstein-Barr virus5—and while it’s fatal in only 10% of the cases in the U.S., because of the discrepancy in diagnosis, the survival rate is just 30%6 in certain parts of Africa.
And discrepancies exist in other, non-infection-related cancers in the developing vs. developed world. For instance, a particularly severe form of blood cancer, acute myeloid leukemia (AML), is much more common in Africa and researchers are working hard to understand why.7 The lack of diagnostic infrastructure exacerbates the situation, making timely and accurate diagnosis nearly impossible in many resource-poor areas.
The Gaps in Cancer Control in Western Kenya
In Western Kenya, the gaps in cancer control are evident and multifaceted. Public health labs in the region lack the infrastructure to screen for cancer effectively. This is particularly problematic for blood cancers, where specialized diagnostics are crucial. Most patients cannot afford to travel abroad for care, and the scarcity of hematological experts—only one or two specialists for millions of people—compounds the issue.
Training staff to run diagnostic labs is another significant hurdle. It requires less training than hematologists or oncologists, yet remains challenging due to limited funding. Much of the available health funding is directed toward combating infectious diseases like HIV and malaria, leaving cancer care under-resourced.
For the cancers that are not only easy, but also inexpensive, to treat—e.g., Burkitt’s lymphoma—the situation is especially heart-breaking and sorely needs to change.
To try to address some of these issues, several organizations (Fred Hutchinson Cancer Institute, Children’s Hospital of the University of Washington, Uganda Ministry of Health, Uganda Cancer Institute, AMPATH Laboratories at Moi Teaching and Referral Hospital, Beckman Coulter Life Sciences CARES Initiative, and Burkitt’s Lymphoma Fund for Africa) have partnered together to launch a pilot program in Uganda and Kenya. The program aims to demonstrate the feasibility of using flow cytometry for diagnosing blood cancers.
Flow cytometry offers improved accuracy over previously used morphology (cell examination under a microscope) and reduces the need for highly trained professionals.
Patient outcomes and future aspirations
The pilot program has made considerable progress, testing over 1,000 patients between Uganda and Kenya, despite delays caused by the COVID-19 pandemic. The initiative has leveraged the existing, robust flow cytometry infrastructure used for HIV diagnosis and monitoring. By centralizing blood collection and utilizing cold chain-independent reagents, as well as preformulated components, there’s less room for error, and minimal waste of expensive reagents.
Though the primary goal of the initiative is to expand testing capability into the two countries and develop a model that others can follow, there are also larger aims. Getting treatment to patients locally after diagnosis is critical. In the case of Burkitt’s lymphoma, the survival rate without treatment and supportive care is low.4 Centers like the Uganda Cancer Institute have been very successful in this area, but more are needed.
Another aim is to understand the disease patterns of blood cancers, and the discrepancies that exist between regions. There may also be a benefit in transferring diagnostics out closer to patients—in other words, to decentralize the highly-centralized system and move to a regional or district level. This would mean faster turnaround times and better care for patients. Finally, the data gathered from the Beckman Coulter Life Sciences Global Health Initiative could eventually influence policy changes and lead to more effective testing strategies incorporated into WHO guidelines.
A close parallel to all this work is education on a local level. Increasing awareness about cancer symptoms and treatment options can encourage more people to seek care early, potentially saving countless lives. The Beckman Coulter Life Sciences Global Health Initiative pilot program may begin to help address these issues, but more work will be needed to inform residents of available options.
Despite ongoing challenges—deploying technical support for the instruments as needed and keeping the labs stocked with reagents—the researchers are optimistic about the Beckman Coulter Life Sciences Global Health Initiative potential value. They hope that through continued efforts and additional collaborations, the disparity in cancer outcomes between the U.S. and Africa will significantly decrease in the coming years.
References:
- Shad et al. (2013) PAEDIATRIC ONCOLOGY IN ETHIOPIA: AN INCTR-USA AND GEORGETOWN UNIVERSITY HOSPITAL TWINNING INITIATIVE WITH TIKUR ANBESSA SPECIALIZED HOSPITAL. Cancer Control 2013; 108-112
- World Health Organization. (2020). Assessing national capacity for the prevention and control of noncommunicable diseases: report of the 2019 global survey. World Health Organization.
- Palella FJ Jr, Baker RK, Moorman AC, Chmiel JS, Wood KC, Brooks JT, Holmberg SD; HIV Outpatient Study Investigators. Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study. J Acquir Immune Defic Syndr. 2006 Sep;43(1):27-34. doi: 10.1097/01.qai.0000233310.90484.16. PMID: 16878047.
- Molyneux, E., Scanlan, T., Chagaluka, G. and Renner, L. (2017), Haematological cancers in African children: progress and challenges. Br J Haematol, 177: 971-978. https://doi.org/10.1111/bjh.14617
- Rowe M, Fitzsimmons L, Bell AI. Epstein-Barr virus and Burkitt lymphoma. Chin J Cancer. 2014 Dec;33(12):609-19. doi: 10.5732/cjc.014.10190. Epub 2014 Nov 21. PMID: 25418195; PMCID: PMC4308657.
- World Health Organization. (2021). CureAll framework: WHO global initiative for childhood cancer: increasing access, advancing quality, saving lives. World Health Organization. https://apps.who.int/iris/handle/10665/347370
- Williams Christopher KO, Foroni Letitzia, Luzzatto Lucio, Saliu Idris, Levine Arthur, Greaves Mel F (2014) Childhood leukaemia and lymphoma: African experience supports a role for environmental factors in leukaemogenesis ecancer 8 478