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Cancer burden

According to World Health Organization (WHO) projections,

the majority of people with cancer worldwide live in

developing countries. These countries are facing a growing

double burden of both infectious and non-communicable

diseases such as cancer.2 This is causing enormous pressure

on already overstretched health systems. The African region,

in particular, is facing a major public health challenge due to

the rising burden of cancer.2

Zimbabwe, a low-income developing country in southern

Africa, has a population of 12.75 million, with a life

expectancy of 54 years.3 The gross domestic product was US$

10.8 billion in 2012.

4 It is currently recovering from an

economic crisis that peaked in 2008. However, the country

has realized some encouraging successes, among which is the

decline in HIV prevalence from 18% in 2004 to 15% in 2011.5

This was achieved through a coordinated, multidisciplinary

approach. Success in HIV control in Zimbabwe brings hope

for the fight against cancer. Yet another positive attribute is

the high literacy rate of >90%: amongst the highest in Africa.6

In Zimbabwe, cancer is a major cause of morbidity and

mortality with over 5,000 new diagnoses and over 1,500

cancer deaths per year.7 Most cancers are infection-related.

The other major risk factors include unhealthy lifestyles,

nutritional and environmental factors. Figures 1 and 2 show

cancer incidence and mortality data from the Zimbabwe

National Cancer Registry.8

The most common cancers are cervical cancer and Kaposi

sarcoma; these are also the leading causes of cancer

mortality (Figures 1 and 2). In children, the most common

cancers are Kaposi sarcoma, Wilm's tumour, retinoblastoma,

soft and connective tissue tumours and tumours of the

central nervous system.7 Analysis of data from the National

Cancer Registry showed that 60% of cancers were HIVassociated.8

Unfortunately, in Zimbabwe, like other resourcelimited countries, the majority of cancers present at an

advanced stage. Low survival rates are therefore mainly a

consequence of limited access to early detection and

treatment.9

Current status of cancer management in Zimbabwe

Access to screening, early detection, diagnostic and palliative

care services is limited due to resource constraints. Another

problem is that most diagnostic, treatment and palliative care

services are centralized, so limiting access for many patients.

Cancer treatment is currently only available at two

PRIORITIES FOR CANCER

PREVENTION AND CONTROL

IN ZIMBABWE

ANNA MARY NYAKABAU, PARIRENYATWA HOSPITAL, ZIMBABWE

Zimbabwe is among the top 22 countries in the world in terms of the burden of HIV.1 Many of

the cancer cases in the country are related to HIV infection and therefore the country is facing

a huge cancer challenge. Priority areas include prevention, early detection, care and support.

The focus should be on high-impact, low-cost interventions such as vaccination against

Human Papilloma virus (HPV) and cervical cancer screening using visual inspection of the

cervix. These are the most appropriate measures for resource-constrained countries such as

Zimbabwe. Furthermore, as most cancers present at an advanced stage, scaling up early

detection is a priority. Equally important, is making treatment and care available and

accessible to all patients, as opposed to the current situation whereby services are mainly

centralized. This article highlights the priorities for national cancer prevention, control and

care in Zimbabwe.

REGIONAL INITIATIVES

126 CANCER CONTROL 2014

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