Priorities for AfrOx

There are six fundamental areas of cancer control that form the cornerstones of any comprehensive cancer control programme and AfrOx will focus on these:

1. Cancer Intelligence Units 
Cancer registries are vital for defining the type and number of cancers experienced by a population, assessing changes in these patterns over time, assessing the impact of any interventions associated with cancer control programmes and forming a useful framework for cancer research. AfrOx intends to assist African Nations in setting up Cancer Intelligence Units through the guidance of the International Agency for Research on Cancer (IARC).

2. Early Diagnosis and Prevention
Liver cancer (predominantly HepatoCellular Carcinoma, HCC) is by far the main cause of male cancer deaths in sub-Saharan Africa. The two main risk factors for HCC, chronic infection by hepatitis viruses (mainly Hepatitis B, HBV) and exposure to the dietary carcinogen aflatoxin, are well established. Effective strategies are at hand to reduce their impact. A safe and efficient HBV vaccine has been available since the early 1980s. However, WHO’s records show that less than 7% of subjects in sub-Saharan Africa actually receive the HBV vaccination. In addition, simple behavioural methods to reduce aflatoxin exposure have been tested in the field, with significant improvements on individual contamination.
Cervical cancer is the most common cancer in women in sub-Saharan Africa. The vast majority of patients present with the disease far advanced and beyond the capacity of surgery or other treatment modalities. Human Papillomavirus (HPV) types 16 and 18 cause 70% of cervical cancer cases and two vaccines have been developed which guard against these HPV types. These vaccines provide us with the opportunity to eradicate 70% of all known cervical cancers within a generation, saving almost 200,000 lives per annum, the vast majority of whom live in the developing world.

3. Cure the Curable
Mortality to incidence ratios are much higher in Africa than in more affluent world regions and improved access to proven, cost-effective therapy, efficiently delivered would save many lives. Sustainable treatment programmes need to be built in the context of the available human resources, equipment and facilities. Ideally, each country should have at least one National Cancer Centre with access to surgery, radiation and chemotherapy. Radiation programmes might be built on models provided by the IAEA and their excellent Programme for Action on Cancer Treatment (www-naweb.iaea.org/pact/). AfrOx will focus initially on childhood cancer, collaborating with Professor Tim Eden of the International Society of Paediatric Oncology and the newly formed World Childhood Cancer Foundation.

4. Palliative Care
Palliative care must be a priority component of affordable and effective cancer care. It is an essential part of the continuum of care of all adult and childhood cancer patients. For terminal cancers, palliative care is essential.  Pain and symptom control, coupled with counseling and spiritual care, enables patients to die with dignity, preventing a painful and distressing death. Palliative care should be provided as early as possible after diagnosis since it provides pain and symptom control, as well as terminal care and bereavement support. It should also be introduced into health policies and be included in training at all levels. Finally, there is relatively little use of oral morphine in Africa, although it is a therapeutic mainstay in the developed world. A process of education, awareness raising with due attention paid to cultural sensitivity, will lead to its more widespread introduction. AfrOx will work with its partners to promote the introduction of palliative care in all African countries.

5. Training and Education
AfrOx also has an important role to play in facilitating the coordination, commissioning and development of various educational programmes. AfrOx will develop sustainable in-country training and education programmes on a cascade model, whereby African healthcare personnel are trained not only to deliver healthcare services but also to provide initial training to others within the locality. In addition, continuing/updating training will also be provided. Partnership with the UK National Health Service (NHS) will be crucial.

6. Tobacco Control   
In Africa, tobacco use is estimated to be related to only 10% of deaths (lung, throat, mouth, pancreas, bladder, stomach, liver and kidney cancers) but recent evidence suggests an increase in smoking in the region, especially among young people. With the decreasing markets for the tobacco industry in the developed world, the industry is seeking new markets, such as in sub-Saharan Africa, where they see enormous potential for growth. AfrOx will take two approaches: (1) seek a ban on tobacco advertising and (2) encourage governments to heavily tax cigarettes, which would increase government revenues and decrease the likelihood of people being able to afford cigarettes. In countries where farmers rely on growing tobacco for income, support needs to be provided to farmers to plant and distribute alternative crops.