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