New insights into cancer epidemiology and survival in sub-Saharan Africa
Authors: Jennifer Ann Geel, Yusuf Mayet
Journal: The Lancet Global Health (2024)

Despite scarcity of data, it is widely recognised that adults with cancer in sub-Saharan Africa have poor outcomes, attributable to multiple factors.1Ngwa W Addai BW Adewole I et al.Cancer in sub-Saharan Africa: a Lancet Oncology Commission.Lancet Oncol. 2022; 23: e251-e312Summary Full Text Full Text PDF PubMed Google Scholar The study by W Yvonne Joko-Fru and colleagues2Joko-Fru WY Bardot A Bukirwa P et al.Cancer survival in sub-Saharan Africa (SURVCAN-3): a population-based study.Lancet Glob Health. 2024; 12: e947-e959Google Scholar published in The Lancet Global Health, is an important addition to the sparse literature on cancer epidemiology and outcomes in sub-Saharan Africa. By collating updated population-level survival data for 18 cancer types from more sub-Saharan Africa countries than previously reported, including both cancers with high incidence and rare cancers, this study advances the understanding of cancer survival in the region. The data highlight the substantial disparities within sub-Saharan Africa and emphasise the poor outcomes of adult cancers using standardised survival estimation methods to facilitate comparisons across populations over time. Variability in survival outcomes was observed across cancer types with a relatively good prognosis (eg, 3-year age-standardised net survival for breast cancer ranged from 31·3% in Kampala [Uganda] to 94·1% in Namibia) and for cancers with a poor prognosis (3-year age-standardised net survival for liver cancer ranged from 0·4% in Abidjan [Cote d'Ivoire] to 18·3% in Addis Ababa [Ethiopia]). The legacy of colonisation in sub-Saharan Africa has had a lasting impact on health-care infrastructure in the region. Originally designed to serve a minority of the population, these health-care systems continue to perpetuate economic and health disparities. Post-colonial challenges such as political instability, corruption, and an over-reliance on foreign aid have hindered the development of sustainable, locally relevant health-care solutions.3Tilley H Medicine, empires, and ethics in colonial Africa.AMA J Ethics. 2016; 18: 743-753Crossref PubMed Scopus (48) Google Scholar Despite the clear value of the robust dataset comprising population-based registry data presented by Joko-Fru and colleagues,2Joko-Fru WY Bardot A Bukirwa P et al.Cancer survival in sub-Saharan Africa (SURVCAN-3): a population-based study.Lancet Glob Health. 2024; 12: e947-e959Google Scholar the barriers faced by most African countries in funding such registries1Ngwa W Addai BW Adewole I et al.Cancer in sub-Saharan Africa: a Lancet Oncology Commission.Lancet Oncol. 2022; 23: e251-e312Summary Full Text Full Text PDF PubMed Google Scholar must be acknowledged and options to include and improve facility-based registry data should be explored. The amalgamation of substantial patient cohorts yields invaluable insights; however, it is imperative to acknowledge the potential loss of subtleties inherent in this process. For example, although certain countries might have higher survival rates, such nuances might become obscured within the broader statistical aggregates. Limited access to quality health care, delayed presentation to health-care facilities, and advanced disease at presentation contribute to poor outcomes for adults with cancer.1Ngwa W Addai BW Adewole I et al.Cancer in sub-Saharan Africa: a Lancet Oncology Commission.Lancet Oncol. 2022; 23: e251-e312Summary Full Text Full Text PDF PubMed Google Scholar The introduction of standard-of-care treatments and targeted therapies that have benefited high-income countries has been slow in sub-Saharan Africa, further exacerbating survival disparities.4Sharma K Mayer T Li S et al.Advancing oncology drug therapies for sub-Saharan Africa.PLoS Glob Public Health. 2023; 3e0001653 Crossref Google Scholar In the 21st century, survival rates in sub-Saharan Africa remain markedly lower than those documented in high-resource settings in the 20th century before the introduction of many modalities that are now considered standard of care.5Siegel RL Miller KD Wagle NS Jemal A Cancer statistics, 2023.CA Cancer J Clin. 2023; 73: 17-48Crossref PubMed Scopus (4945) Google Scholar Although continued advocacy for targeted cancer therapies is crucial, there is also a pressing need for funders and policy makers to address the broader socioeconomic factors affecting health, which fall outside the direct scope of clinicians and epidemiologists. Malignancies such as cervical, colorectal, and triple-negative breast cancers might be more aggressive in people of African ancestry and the high prevalence of HIV in sub-Saharan Africa complicates cancer prognosis and management.6Ntekim A Cervical cancer in human immunodeficiency virus (HIV) positive patients.https://www.intechopen.com/chapters/48491Date: 2016Date accessed: April 19, 2024Google Scholar, 7Alfa-Wali M Tait D Allen-Mersh T et al.Colorectal cancer in HIV positive individuals: the immunological effects of treatment.Eur J Cancer. 2011; 47: 2403-2407Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar, 8Reddy P Ebrahim S Singh B Ramklass S Buccimazza I Breast cancer and HIV: a South African perspective and a critical review of the literature.S Afr J Surg. 2017; 55: 10-15PubMed Google Scholar The interaction between HIV and cancer is a crucial area for future research, particularly to understand its impact on treatment responses and survival rates in sub-Saharan Africa. Although quality cancer care is provided by the government and other funders in some countries in sub-Saharan Africa, out-of-pocket costs remain prohibitive in many others, making access difficult for the majority of people with cancer.1Ngwa W Addai BW Adewole I et al.Cancer in sub-Saharan Africa: a Lancet Oncology Commission.Lancet Oncol. 2022; 23: e251-e312Summary Full Text Full Text PDF PubMed Google Scholar The availability of up-to-date, comprehensive data on cancer survival in sub-Saharan Africa provides a vital knowledge base for advocacy efforts to improve access to quality cancer care in the region. The study by Joko-Fru and colleagues highlights crucial opportunities to improve outcomes for people with cancer in sub-Saharan Africa, calling for concerted action among policy makers, health-care providers, and the global health movement to address the issue of cancer survival in sub-Saharan Africa. Investments in appropriate prevention and screening, earlier diagnoses, rapid referrals, increased capacity of referral centres to accept patients, sustainable supply of chemotherapy, and targeted therapies are considered essential to improved survival.9Neugut AI El-Sadr WM Ruff P The looming threat: cancer in sub-Saharan Africa.Oncologist. 2021; 26: e2099-e2101Crossref Scopus (2) Google Scholar Efforts are being made to increase multiple diagnostic capabilities to assist with therapeutic decision making, and enhance survival outcomes.10Orem J Building MODERN CANCER CARE SERVICES IN Sub-Saharan Africa based on a clinical-research care model.Am Soc Clin Oncol Educ Book. 2022; 42: 423-428Crossref Google Scholar Determining the impact of current prevention and early detection programmes on cancer survival, and methods to optimise them, would be beneficial. Enumerations of causes of high mortality are not enough: proposed solutions must follow. High-level approaches must incorporate registry data, improved referral pathways, accurate and timely diagnosis, and locally relevant treatment options administered by strong multidisciplinary teams.9Neugut AI El-Sadr WM Ruff P The looming threat: cancer in sub-Saharan Africa.Oncologist. 2021; 26: e2099-e2101Crossref Scopus (2) Google Scholar This study provides an important baseline for monitoring progress in regional cancer control initiatives, emphasising the need for data-driven advocacy. The findings of the study should be considered as a call for action to improve health-care outcomes through policy interventions targeting the entire cancer control continuum through local leadership and ownership, and reducing socioeconomic disparities and the resulting health inequities, which result in enduring health inequities. JAG is Secretary General of SIOP Africa. YM declares no competing interests. Cancer survival in sub-Saharan Africa (SURVCAN-3): a population-based studyFor cancers for which population-level prevention strategies exist, and with relatively poor prognosis, these estimates highlight the urgent need to upscale population-level prevention activities in sub-Saharan Africa. These data are vital for providing the knowledge base for advocacy to improve access to prevention, diagnosis, and care for patients with cancers in sub-Saharan Africa. Full-Text PDF Open Access