4 February 2017

Tanzania: The Cancer Burden That Dar Carries

Dar es Salaam — A new database shows that Dar es Salaam carries the biggest burden of cancer compared to any other region in the country. At least 5,529 cancer cases were recorded at the Dar es Salaam-based Ocean Road Cancer Institute (ORCI) last year alone.

New data suggests that there has been a consistent, significant rise in the number of cases since 2013.

In 2015, Dar es Salaam recorded at least 5,244 cases, while in 2014 some 4,195 patients sought treatment at the institute. In 2013, at least 3,776 patients were attended to.

Geita has the least burden of cancer in the country, according to the new data.

But experts were quick to explain that the data may not "accurately" represent the reality of the cancer situation in Tanzania.

They have noted that because a significant number of cancer patients in Tanzania depend on the Dar es Salaam-based Institute, the region would obviously feature as the highly affected.

And The Citizen on Saturday has established that the ORCI does not have an established system to track and register cancer patients based on their exact places of origin. Usually, many people travel from upcountry for services at the major cancer diagnosis and treatment centre.

The ORCI data availed to The Citizen on Saturday ahead of today's commemorations of World Cancer Day, revealed that Dar es Salaam leads with 16.88 per cent of all the cancer cases diagnosed last year, followed by Mbeya (10.83 per cent), Morogoro (10.58) and Kilimanjaro (8.31 per cent).

The least affected regions are Geita (0.5 per cent), and three others, Kagera, Rukwa and Simiyu, with each carrying 0.76 per cent of the cancer burden in the country.

Cervical cancer ranks as the leading type in Tanzania, with 1,896 cases recorded last year alone. Cervical cancer also leads in deaths among women in sub-Saharan Africa, according to Seed, Global Health.

And East Africa suffers by far the highest mortality rate in the world at 27 cervical cancer deaths for every 100,000 women - nine times the rate in the United States. Other notorious type of cancers in Tanzania are Kaposi sarcoma and breast cancer.

Cancer experts who spoke to The Citizen on Saturday, say the low distribution in the least-affected regions does not necessarily mean that there are low risk factors. Rather, it could be largely attributed to people's failure to turn up for diagnosis and treatment, possibly due to the lack of diagnostic facilities, compounded by the poverty situation in those regions.

The higher figures seen in the "most-affected" regions, the experts say, could also be attributed to increased awareness about cancer and increased literacy levels.

Dr Crispin Kahesa, the ORCI Director of Cancer Preventive Services, said Dar es Salaam seemed to have the largest number of cancer patients partly because the city is home to the country's only specialised cancer centre - the ORCI, and the region has the largest population.

He said that most cancer patients diagnosed at the institute tend to say they come from Dar es Salaam; he, however, didn't downplay other risk factors for cancer, such as rapid urbanisation, people leading sedentary lifestyles, eating unhealthy foods, harmful use of alcohol and tobacco smoking.

"You see, a cancer patient may have originated from Rukwa Region but he/she gets a temporary residence in Dar es Salaam as he/she seeks treatment. During registration he or she will refer Dar es Salaam as his or her residence," said Dr Kahesa as he explained why the commercial capital appears to lead in cancer cases.

Regions closer to Dar es Salaam - Mbeya (10.8 per cent), Morogoro, (10.6 per cent) and Kilimanajaro (8.3 per cent) were also generally found to have higher percentages of cancer. According to Dr Kahesa, the closer the region is to the Dar, the greater the numbers of cancer diagnoses are likely because of the availability of diagnostic centres in the city.

"Even though cancer is more likely to be high in urban centres, due to unhealthy lifestyles and urbanisation, we still need to understand that people in those regions are more likely to seek medical care, are more aware of cancer and can easily report their problems early compared to those in rural settings," he said.

The Citizen on Saturday has learnt that until today, Tanzania has not carried out a population-based study that could give a true picture of the national cancer burden. The ORCI also needs a hi-tech cancer registry that could help give correct data on cancer. Dr Kahesa confirmed this to this reporter.

Cancer experts also fear that the burden of the disease could be bigger than it is currently estimated because most cancer cases in rural areas go undiagnosed due to lack of diagnostic tools in most upcountry hospitals and the shortage of cancer specialists.

An oncologist at Muhimbili National Hospital (MNH), Dr Heri Tungaraza, told The Citizen on Saturday that there is a growing number of private facilities across the country, which can now diagnose cancer, meaning that there are a number of cases that don't reach the ORCI.

"There are also patients who are diagnosed and treated early through surgery at zonal hospitals in Mwanza, Kilimanaro and Mbeya. There are also cases of cancer in children that the ORCI does not treat. Still, there are those patients who end up in private health facilities," said Dr Tungaraza when analysing the data.

The oncologist, who has worked at the ORCI in the past, suggested that a national survey on cancer was urgently needed in the effort to establish the exact burden of the disease.

"All stakeholders - from public and private institutions - need to come up with a well-established cancer registry. This would also give a clear map of the country on where and how to intervene on cancer," he noted.

Globally, 8.2 million people die each year from cancer, an estimated 13 percent of all deaths worldwide, says the World Health Organisation(WHO). There is an over 70 per cent increase in new cases of cancer expected over the next two decades, WHO warns. There are over 100 cancer types, each requiring unique diagnosis and treatment.


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