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A new study found significant gaps and disparities in breast cancer control in 42 of the 47 countries in World Health Organization’s (WHO) Africa region.
The assessment by WHO highlighted critical shortage of healthcare workers essential for prevention, diagnosis and treatment and restricted access to specialised cancer facilities, impeding advancements towards the objectives of the Global Breast Cancer Initiative.
In 2022, breast cancer incidence rates within the region varied considerably, ranging from 61.87 per 100,000 in Algeria to as low as seven per 100,000 in Sierra Leone, according to the report by WHO.
Eritrea, Gambia, Mauritius, Mauritania and South Africa did not participate in this survey.
Breast cancer is the primary cause of cancer-related fatalities among women worldwide. In 2022, there were 2.3 million new cases and more than 666,000 deaths globally, with sub-Saharan Africa accounting for 146,130 cases and 71,662 deaths.
In the WHO African Region in 2022, breast cancer mortality rates varied, with Cameroon having the highest rate at 27.44 per 100,000 and Sierra Leone the lowest at 4.22 per 100,000.
The region is projected to see a 85.7 per cent rise in new cases and 89 per cent in deaths by 2040. An estimated 162,095 women could lose their lives to breast cancer by 2040 in sub-Saharan Africa if the situation is not brought under control immediately, the analysis showed.
The report focused on six critical areas — leadership, governance and financing, health workforce, health information systems and service delivery.
Many countries lack comprehensive cancer control programmes and consistent funding. Even where national strategic cancer control plan (NCCP) exist, their implementation is often weak due to lack of funding, the authors highlighted in the report.
As many as 24 of the responding countries lacked a NCCP. 18 out of 42 countries either had an NCCP in place or were in the process of developing or updating their cancer plan.
The United Nations health agency found that only five out of 47 countries in the region have regular breast cancer screening programmes. They are Algeria, Kenya, Mozambique, Rwanda and Seychelles.
Eleven countries (Algeria, Ethiopia, Kenya, Lesotho, Madagascar, Malawi, Mozambique Nigeria, Rwanda, Uganda and Zambia) have a costed and funded plan, while two (Ivory Coast and Chad) have not yet costed their plans, but allocate funds for cancer interventions.
The region suffers from a severe shortage of qualified oncology professionals. The number of oncologists is very low in many countries, with some reporting none. There is a wide gap in the availability of oncology nurses across the region, with Algeria reporting 634 oncology nurses, while some countries report zero.
A lack of specialised cancer centres and insufficient infrastructure for diagnostic services, such as pathology labs, makes the situation worse.
Only two countries in the region meet the global standard of one pathology lab per 100,000 people, the study found, and dedicated cancer care centres exist in 27 out of 42 countries.
The infrastructure for diagnostic services, including mammography and pathology, is insufficient and unevenly distributed. This hinders timely and accurate diagnosis that is key for timely breast cancer diagnosis.
The analysis shows that 37 out of 42 countries have chemotherapy services. Comoros, Equatorial Guinea, Guinea-Bissau, Sao Tome and Principe and South Sudan were found to have no access to chemotherapy for cancer patients.
Every responding country indicated that they have access to a variety of anti-cancer drugs for chemotherapy. Some countries, such as Benin, Burundi, Congo Republic, Democratic Republic of the Congo, Ethiopia, Guinea, Madagascar, Malawi, Niger and Sierra Leone, reported not having access to certain targeted therapies essential for the treatment of patients with HER2-positive breast cancer.
Some 24 out of 42 countries have functional population-based cancer registries, but only a few of these registries have high-quality and accurate data, according to the African Cancer Registry Network.
There is an urgent need for investment in leadership, governance and financing and fundamental steps to augment breast cancer care in the region, WHO noted. These elements will facilitate improvement in strategic planning, healthcare infrastructure, workforce training and most importantly, equitable access to essential services.
The UN health agency called for countries to develop and adequately fund comprehensive National Cancer Control Plans, providing a strategic framework for coordinated national efforts to combat breast cancer effectively.
