Cancer Control in Sub-Saharan Africa: Investment Needed

David J. Kerr, CBE, MD, DSc


December 08, 2022

This transcript has been edited for clarity.

I'm David Kerr, professor of cancer medicine at University of Oxford. I've just come back from Ghana. It was my great honor to work with my friends and colleagues, Professor Beatrice Wiafe, Professor Will Ngwa, and Professor David Collingridge, to launch The Lancet Oncology Commission on Cancer in Sub-Saharan Africa.

I think this is a fantastic piece of work. It involved more than 50 senior colleagues, drawn predominantly from across Africa, but with support from the global cancer community. Representing 24 different sub-Saharan African countries, we've worked together for over a year to produce the report, which we launched in Accra and under the auspices of the First Lady of Ghana and former President John Kufuor.

It was a fantastic event. It was well attended, both in person and online, and it's generated much interest. It was an opportunity for us to capture the experience of my brothers and sisters in positions of power across Africa to be able to condense this into a report, providing a snapshot and a look back as to how cancer control predominantly isn't working in sub-Saharan Africa, but with some very clear actions as to how we should move forward.

Of course, we make recommendations around cancer registries, we hope with support from IARC. Unless we have the data giving us a clear idea of what's happening within different countries and different regions, how can we plan cancer services? We would like to have what I call precision national cancer planning, in that we adapt each cancer plan. We may have a broad template, but we must adapt it to the situation faced by individual countries.

We're looking for sustainable funding and that's why we need government joined up with health, education, the finance minister, policing, and transport. We need a joined-up governmental approach to see what we can do. Of course, we want to improve the quality of cancer care, but with a focus on prevention.

When I was a very young fellow in Glasgow visiting with my friend Twalib Ngoma in a cancer center in Tanzania, 80%-90% of patients were presenting with stage IV disease. That's similar still, 30 years later. Whether those patients were treated in Oxford, Dar es Salaam, or Harvard, the outcomes would be broadly similar because we would be beaten often by the burden of disease.

For pediatric oncology, we made a special case. There are some great African leaders. My friend, Lorna Renner, from Ghana, is an outstanding pediatric oncologist who has a great commitment and has made great advances in the field, but there are far too few of her. Let's cure the curable — think of it that way.

Early detection requires lateral thinking about how we screen, using available workforces, working with traditional healers — so-called witch doctors — making them part of the solution rather than a problem. Many African patients still believe that cancer — in many African dialects, there is no word for cancer — may be caused by witchcraft. They spend too much time with traditional healers, allowing the cancer to advance well beyond the point of curability.

We need to look at infrastructure, staff, training, kit, and equipment, and that would be included in the national cancer plan. We need to do something about flight of talent. I work within our National Health Service, and we are well served by African nurses, doctors, and healthcare professionals. We need to find a system of incentives that allows these excellent medical professionals to practice within their own countries and to deliver care in that way.

In terms of innovation and research, we know that our African colleagues are keen to contribute to global knowledge. With support with North-North, North-South, and South-South academic partnerships, we think that we should be able to build alliances and networks that would allow us to do that, particularly in the field of implementation medicine, something which I've talked many times before. I think telehealth or telemedicine is another rapidly advancing field that we should embrace.

I'd be grateful if you'd look at the report. Please comment on it. Solutions, help, support, and any ideas that you have would be gratefully received.

The other thing that I have posted in addition to this video is a new discipline that I have invented called dancing diplomacy. Everywhere I went in Africa, I was invited to celebrate what we were doing in dance.

Therefore, for good amusement, we posted a video of me attending a fantastic event with breast cancer survivors in Kumasi in the North of Ghana. You'll see that I've got rhythm and that I can move. Please, don't call it dad dancing. Call it dancing diplomacy.

Thanks for listening. Please, make comments — not on the dancing, but on the Lancet Oncology report. Hope to speak to you soon. Goodbye and thank you.

David J. Kerr, CBE, MD, DSc, is a professor of cancer medicine at the University of Oxford. He is recognized internationally for his work in the research and treatment of colorectal cancer and has founded three university spin-out companies: COBRA Therapeutics, Celleron Therapeutics, and Oxford Cancer Biomarkers. In 2002, he was appointed Commander of the British Empire by Queen Elizabeth II.

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