A review was done on Childhood Cancer in Africa and published in Paediatric Blood & Cancer in April 2014, to describe the current status of childhood cancer treatment in Africa, as documented in publications, dedicated websites and information collected through surveys. It was hoped that the overview would influence health-care policies to facilitate access to cancer care for all children in Africa.
Cancer is an important non-communicable cause of death in children, and it is estimated that about 148,000 children living in low-income countries suffer from cancer, according to GLOBOCAN 2008. Virtually 80% of childhood cancers in the developed world can be cured, and according to this paper, treating children with cancer is cost-effective, even in low-income countries. According to Bhakta et al. the drug cost in Malawi, for the treatment of Burkitt’s lymphoma (BL), the most common Childhood Cancer in Africa, is less than US$50 per patient.
Paediatric Cancer Epidemiology and Cancer Registries
Unfortunately there is a dire lack of data concerning true cancer incidence in Africa due to the lack of cancer tumour registries which currently cover a mere 11% of the African population, although data collection is variable. Another problem is that even when there are registries, they tend to cover mostly the urban areas, whereas Africa has large predominantly rural populations in many areas.
In equatorial Africa, Burkitt’s lymphoma is the most commonly occurring cancer, with an incidence rate estimated at 40–100 per million per year in children under 15, whereas there is a low overall incidence of all childhood cancers in the southern and western parts of Africa. The high incidence of BL is commonly associated with Epstein–Barr virus (EBV) and holoendemic malaria.
According to a study of 21 centres in 19 sub-Saharan African countries, in which the distribution of childhood cancer in Africa between 1985 and 2011 was analysed, in Southern Africa: Kaposi Sarcoma (KS) was the most common paediatric malignancy in Mozambique (15.8%) and the second most common in Zambia (15.6%), with 12.4% in Malawi and in Eastern Africa: KS is the most common tumour in children in Uganda (22.0%) and two Kenyan centres reported mainly BL (25.1% and 37.1%, respectively).
Epidemiology data from western Kenya confirmed non-Hodgkin lymphoma (NHL) as being the most common childhood cancer in the region – in Western Africa, NHL was the most common in Ghana (53.6%), in the Ivory Coast (73.6%), and in Mali (32.7%).
Nephroblastoma remains one of the most common solid tumours in Africa, exceeding 10% of all paediatric cancers in many countries: Rwanda 26.0%; Ivory Coast 14.5%; Mali 17.6%; Congo 15.5%.
Of the 60 African countries that belong to the International Association of Cancer Registries, only 17 have national registries, whereas the remainder are regional or hospital-based. These registries include both children and adults with cancer, which calls into question the veracity of the data as they pertain to childhood cancer.
The South African Children’s Cancer Study Group (SACCSG) tumour registry, established in 1987, is the only existing dedicated National Paediatric Tumour Registry in Africa, and only minimal data has been published.
The most common childhood cancer in South Africa is Leukaemia (25.4% of all cancers), which is similar to rates in other countries. Brain tumours and leukaemia comprise almost 50% of childhood cancers in developed countries; brain tumours represent 13.4% of the total cancers diagnosed in children in South Africa. When two periods (1987–1997 and 1997–2007) were compared, it was found that the number of brain tumours had decreased by 50%, while epithelial tumours doubled, almost exclusively as a result of the rising incidence of Kaposi sarcoma.
A cancer report from rural South Africa documented childhood cancer as comprising 2.9% of all cancers; cancers with a genetic predisposition (retinoblastoma and nephroblastoma) comprised 35.6% of that. Acute Lymphoblastic Leukaemia (ALL) is the most common cancer in North Africa, followed by brain tumours (especially astrocytoma and neuroblastoma).
In 2010 IARC, in collaboration with Stellenbosch University, offered the first training course in Africa for the registration of childhood cancer, attended by 105 participants from 14 African countries. An African Cancer Registry Network (AFCRN) was established in 2011.
Diagnosis can be very challenging in Africa due to its lateness, the inadequacy of diagnostic facilities, and the lack of sophisticated imaging equipment and trained staff, especially pathologists.
The World Health Organisation (WHO) decided to include the Early Signs of Childhood Cancer in the Integrated Management of Childhood Illnesses (IMCI) programme in an effort to address the problem of late diagnosis. This is largely to assist Primary Care Clinicians to recognise Childhood Cancer, and to enable them to refer cases early to specialised treatment centres. A study from Cameroon reported the usefulness of abdominal sonar for the diagnosis of BL for staging.
Pathology infrastructure in Africa is highly variable, as regards both personnel and equipment. Slides or tissue blocks are often sent to pathology centres in other countries that have the requisite pathology expertise. Fine-needle aspiration biopsy (FNAB), which has a sensitivity of 96.5%, and a specificity of 97%, with a positive and negative predictive value of 99% and 90% respectively, with a diagnostic accuracy of 97% has been found to be a useful tool for diagnosing childhood cancer in low- and middle-income countries.
Source: Childhood Cancer in Africa
We will post Part 2 of Childhood Cancer in Africa tomorrow