Correspondence Address:
M M Borodo
Department of Medicine, Bayero University, Aminu Kano Teaching Hospital, Kano
Nigeria

Full Text

Cancers continue to be a major cause of mortality, morbidity and disability-adjusted life years (DALYs), the world over. The regional variations occur not only by virtue of cancer type and presentation, risk factors and opportunity for prevention, control and treatment, but also by the availability of healthcare resources as well as the level of health education in the regions.

In 2000 alone, 5.3 million males and 4.7 million females worldwide developed cancers with a total of 6.2 million deaths. Currently 12% of global mortality is from cancers and 70% of the global cancer burden is found in low- to medium-income countries. Furthermore, based on the current trends of the risk factors and risk behaviours for cancers globally, which is expected to increase by 50% in the next decade, it is estimated that the incidence of cancers would rise to 15 million people by the year 2020.

In 2008 alone, based on a systematic analysis of DALYs on global burden of cancers, Soerjomataram and colleagues estimated that worldwide 168 million years of healthy life were lost due to cancers with an individual loosing, on average, 2 years of healthy life after cancer diagnosis. [1] The authors further noted that colorectal, lung, breast and prostate cancers were the main contributors to the total DALYS in most regions of the world, accounting for 18-50% of the total global burden for cancer. In sub-Saharan Africa and East Asia, an additional large burden from infection-related cancers (hepatocellular, gastric and cervical cancers) was estimated at 25% and 27%, respectively.

The world over, the management of cancers has been less than satisfying and very expensive, more so in resource poor regions, calling for reviewed strategies to address the problem. For example the relatively new drug treatment option for moderately advanced hepatocellular cancer, Sorafenib, is not only too expensive for patients use in resources poor countries but often the opportunity for its use where affordable, is squandered by late presentation of the cancers to hospital such that only symptomatic treatment can be offered to the teaming patients that present with this devastating cancer. This template of experience can generally, without exaggeration, be said to be true for cancers of the breast, cervix and prostate in the same countries.

Tackling the huge global burden of cancers requires a multi-prong approach including strategies for prevention, control and effective treatment premised on surveillance for early detection. However, this global template requires adaptation and prioritisation to address varying regional peculiarities.

When effectively applied, the current and ever expanding level of knowledge on the genetic, biological and molecular basis of the aetio-pathogenesis of cancers can effectively lead to treatment of one-third of world cancers but at prohibitive cost to even the resource rich nations of the world making sole reliance on this approach untenable. Cancer prevention and control programmes can, albeit, long-term, handle yet another one-third of the global cancer burden if diligently pursued but this requires personnel and adequate organisational health structure.

In resource poor countries, 25% of the cancer burden is due to preventable infections that can be effectively addressed by immunisation programmes for Hepatitis B (the cause of most cases of primary liver cell cancer) and human papilloma virus (developing countries are responsible for the current 80% global mortality of cancer of the cervix). Similarly the 100 million deaths resultant from tobacco-related illnesses including cancer of the lung in the 20 th century can be averted in the current century through effective preventive/control measures against tobacco smoking including further public restriction of smoking and imposition of higher taxes on the production and purchase of tobacco.

Finally in this edition, Yusuf and colleagues have reported a disproportionately high prevalence of 8% for malignant soft tissue sarcomas after review of the cancer register of a busy teaching hospital in Nigeria over a 10-year period with a total reported cancer burden of almost 3000 in the period. Also in this edition are two case reports of unusual presentations of cancers from the same region. One on gastric cancer by Tijjani and colleagues and the other on primary metastatic extra skeletal osteosarcoma by Ahmed and colleagues. Both cases illustrate additional diagnostic/management challenges imposed on the already suboptimal management of the high cancer burden in the region. As you go through these and the other articles in this edition, we wish you happy reading.

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