Strengthening care and research for women's cancers in Sub-Saharan Africa

Abstract

Until recently, medical care in sub-Saharan Africa (SSA) has addressed the immediate demands of Human Immunodeficiency Virus (HIV), Tuberculosis, Malaria and Maternal–Child Health. Though these challenges remain, the region has had a degree of success in these efforts, and sufficient urbanization and economic development that an epidemiologic transformation, in which people live long enough to develop cancer and other non-communicable diseases, is well underway in SSA (Binagwaho, 2012).

The care of patients with cancer is one of the great challenges and achievements of modern society. It requires specific, coordinated multidisciplinary care from highly trained specialists, extensive infrastructure and a detailed and nuanced understanding of both the individual patient and the population at hand. In high-income countries (HICs), the care of patients with cancer is costly and highly resource intense, and often based on a specific molecular or genetic defect.

The treatment of cancer in the resource-limited context of SSA, therefore, presents a tremendous challenge. A simple transposition of protocols and technologies from HICs would be impractical and inhumane; resources would rapidly be depleted and many patients would remain without care. Other models have been developed that better match their setting, and this is as it should be. The challenges of biology, resources and human capacity found in SSA are such that effective solutions should be and, in fact, can only be developed in SSA. For this reason it is imperative that multifaceted research be developed in step with clinical cancer care in SSA (Varmus & Trimble, 2011). Here we review some of those challenges and opportunities.

The reader should note that the region of SSA is a huge and vastly diverse one, containing multiple sub-regions, 47 countries and approximately one billion people. To discuss cancer care and research in SSA is to broadly generalize as much as it might be to discuss cancer care in other WHO designated regions. Despite this significant limitation, however, we believe that some common challenges exist across the region, and that by exploring them we may be ready to more effectively address them.