Addressing Kenya’s growing cancer burden

Kenya definitely has a growing cancer problem. We have about 47.000 new cases and 33.000 deaths annually. These are huge numbers for a country with a population of almost 50 million people. Maybe we also have better diagnostic pathways and people are becoming more aware of cancer. They will probably have a biopsy for a lesion, whereas in the past they would just have died and we didn't know what they died of. But the absolute numbers that the Global Cancer Observatory extrapolated from our registries are definitely much higher than five years ago. I am actually suspecting that there are many more unreported cases.

How do you explain this new trend?

There are multiple explanations. For example our changing lifestyles. People have moved away from Ugali, pumpkin leaves and other traditional foods to a more Western kind of diet. They are also physically less active.

The other big risk factor is infectious agents contributing to cancer such as the human papillomavirus (HPV) responsible for more than 90 per cent of the cervical cancer burden. In certain areas of Kenya, people are also exposed to Schistosoma, the leading cause of bladder cancer.

Tobacco, alcohol and industrial pollution are also major issues. Our rivers are increasingly polluted and in certain industries employees have to work without protective gear exposing them to benzene and other petrochemicals.

Lifestyle and environmental factors are certainly the drivers towards more cancer cases. This also explains why cancer in Kenya, like in many other countries in Sub-Saharan Africa, appears in a relatively young population. This is detrimental to our economy. Young women and young men who are supposed to be productive or contribute to the economy get cancer. To afford treatment they often sell the family land and lose their jobs.  While Kenya’s National Insurance Fund coverage has come as a big boost, it is by far not enough to address the issue. A cancer diagnosis still leads to catastrophic spending.

Has there been any progress in the national fight against cancer?

The story is not all dark and gloom. First, there are committed, passionate professional individuals and organisations determined to do something about it. Secondly, there is the political will to do something. Maybe the resources have not yet followed, but at least there is the political will. So that is another big plus. And thirdly, the country is one of the few that has legislation around cancer. We have a National Cancer Control and Prevention Act, a law passed by parliament to give direction on how cancer should be managed. We also have a National Cancer Control Plan which sets forth various priorities in the key strategic areas like prevention and screening, treatment and diagnostic palliative care and survivorship, as well as pathology and registries and monitoring and evaluation.

But obviously this is the big picture of the national priorities. But for the individual person who has cancer, who lost their job and who does not know how to afford treatment and how to bring up three little kids, the situation remains extremely difficult.

How is KENCO planning the way forward?

For KENCO access to treatment is certainly a top priority. We are advocating for a better oncology package within the National Hospital Insurance Fund. Overall, we align our priorities with the national strategic plans so that we are in tandem with what needs to be done. We are supporting a more structured approach to cancer control. It should be informed by evidence, by resources, by long term sustainability and not by emotions.

If you show up and say, I have a billion shillings and would like to build a cancer centre because I love Kenya, we will tell you, these are the things you need to do. We need to make sure the plans are within the national strategy in terms of infrastructure, human resources and equipment.

Kenyan media are covering the cancer burden extensively. How are you nourishing the interest?

Our members and other civil society organisations have done a great job in keeping the cancer control agenda alive in the public domain, trying to look for media slots and media interviews, and pushing for cancer stories in the mainstream media.

The coverage started with a deliberate decision by KENCO to train media journalists.

We invited about sixty radio-TV, print and online journalists to a one-day workshop and offered them to help address any challenges they have when reporting on cancer.

We gave them a brief of how cancer services are organised, who the Kenyan experts are and how to approach them. The journalists very much appreciated that.

Very sadly, a number of our politicians recently lost their lives to cancer. But it also helped draw the attention of the country to the plight of this disease and the need for action.

KENCO, fortunately, has very good and constructive working relations both with the government and with other agencies. Whenever we have any official engagements, we make sure that the media are also at the table.