implemented. The Framework Convention on Tobacco
Control10 needs ratification. HIV infection control efforts
have led to a reduction in incidence of some HIV-associated
tumours such as Kaposi sarcoma.11 However, there is a need
for more awareness about prevention of Hepatitis B.
Vaccination against the liver cancer-causing virus is included
in the pentavalent vaccine for children and coverage was
more than 80% in 2010. As for prevention of cervical cancer,
Zimbabwe now has funding from the Global Alliance for
Vaccines and Immunisation (GAVI) to carry out HPV vaccine
pilot projects on young girls in two selected, high
immunization coverage districts, commencing in 2014. These
demonstration projects will guide the national
implementation of HPV vaccination. On-going bilharzia
control to prevent bladder cancer, focusing on school
children in endemic areas commenced in 2013. It is also
critical that any anti-cancer programmes and interventions
integrate control of chronic infections and noncommunicable diseases within primary care. This would
optimize cost-effective usage of the available limited
resources.
Early detection
Early detection comprises both screening in asymptomatic
but at-risk populations and early diagnosis in symptomatic
populations. The problem is that in Zimbabwe the majority of
patients, even with potentially curable cancers, present at an
advanced stage.9 Early clinical diagnosis can only be
implemented through increased public and health workers'
awareness of cancer symptoms and signs and of available
cancer programmes. The work force needs to be adequate,
empowered, well trained in primary care and able to
promptly recognize and refer people with suspected signs
and symptoms for early diagnosis and treatment. Equally,
health services need to be equipped with the necessary
infrastructure to support diagnosis and treatment. Lack of
access to early detection services and general lack of
awareness currently leads to late presentation which is costly
to manage and leads to poorer outcomes.
Priorities to improve early detection of cancers in
Zimbabwe include formal assessment of the reasons for
delays in early detection, scaling up of provision of early
detection services at all levels accompanied by a sound
referral system, i.e. referral centres need to have the capacity
to take up the referred cases. Additionally, access to cancer
screening services should be improved through increased
availability of cost-effective screening services. Screening by
Visual Inspection with Acetic Acid and Cervicography (VIAC)
has been introduced at tertiary and some secondary centres.
This has been selected as the screening method for
Zimbabwe because it places less demand on the limited
numbers of available pathologists, provides immediate
results, the simplicity of the procedure and the potential for
immediate treatment of lesions and its cost-effectiveness for
both the woman and the health system. Plans are on-going to
make VIAC available for primary care and all other levels.
Diagnosis and treatment
Diagnosis is the first step in cancer management. Once the
diagnosis is confirmed, staging to evaluate the extent of
disease is essential. Treatment will obviously depend on the
type of cancer, the tissue of origin and stage of the disease.
The aims of treatment will also vary according to the
circumstances, from cure, to prolonging useful life and
improving the quality of life.2
The diagnostic infrastructure in Zimbabwe is limited. Early
diagnostic facilities are available mainly in the two largest
cities: Harare and Bulawayo. However, a critical shortage of
diagnostic facilities in public institutions leads to diagnostic
delays of up to three or more weeks.
The three major modalities of cancer treatment namely
surgery, radiotherapy and chemotherapy are both costly and
inadequate in the country, in terms of personnel, medicines
and equipment. Tumours which are detected early can be
managed surgically but shortage of oncology-trained
surgeons compromises care. Multidisciplinary teams are
essential but currently a lack of trained specialists such as
paediatric oncologists, haematologists and oncology nurses
compromises this. Priority should be given to coordinate the
fragmentary existing paediatric surgical and oncology
services to improve care given to children with cancer.
Facilities at the existing radiotherapy centres have recently
been upgraded but are still inadequate for the population.
Affordable and accessible chemotherapy and palliative care
medicines should be available in public institutions.
REGIONAL INITIATIVES
128 CANCER CONTROL 2014
Early detection comprises both
screening in asymptomatic but at-risk
populations and early diagnosis in
symptomatic populations