Dr Emmanuel Kandusi

Today is World Cancer Day. It aims to save millions of preventable deaths each year by raising awareness and education about cancer. Correspondent GERALD KITABU interviewed Dr. Emmanuel Kandusi, a survivor of prostate cancer and national coordinator and founder of Tanzania 50 Plus Campaign on the situation of cancer in the country. Excerpts:

QUESTION: Today is World Cancer Day; being one of the victims once afflicted by the disease, what does the day mean to you?

ANSWER: World Cancer Day is a chance to raise our collective voices in the name of improving general knowledge around cancer and dismissing misconceptions about the disease. It aims at saving millions of preventable deaths each year by raising awareness and education about cancer, and pressing governments and individuals across the world to take action against the disease. Communities will increase there knowledge on what cancer is, the risk factors associated with the disease, the need for testing and the value of early detection. They will also learn the availability of treatment and that in most cancers such as breast, cervical and prostate cancer, the earlier it is discovered the better chance of cure. This year’s world Cancer Day will focus on Target number five of the World Cancer Declaration: Dispel damaging myths and misconceptions about cancer, under the tagline “Cancer - Did you know?” 

Q: What is cancer?

A: In short, cancer is caused by both external factors and internal factors. External factors are such as tobacco, infectious organisms, chemicals, and radiation where as the internal factors include inherited mutations, hormones, immune conditions, and mutations that occur from metabolism. The term “cancer” refers to a condition in which the regulation of cell growth is lost and cells grow uncontrollably.  Most cells in the body are constantly dividing, maturing and then dying in a tightly controlled process.  Unlike normal cells, the growth of cancer cells is no longer well-regulated.  Instead of dying as they should, cancer cells outlive normal cells and continue to form new, abnormal cells. There are about 200 kinds of cancer.

Q: What are the risk factors?

A: There are several factors which increase the risk of developing cancer. People should avoid tobacco consumption in all forms. Tobacco remains to be the most important avoidable cancer risk. It accounts for 75% of all cancers. In the 20th century, approximately 100 million people died world-wide from tobacco-associated diseases. We need to abide on healthy lifestyle and natural diet. Avoid red meat and high-fat dairy products. Frequent consumption of fruit and vegetables and physical activity can make a difference. Avoid obesity and get involved in physical exercise. Chronic infections from hepatitis B (HBV), hepatitis C virus (HCV) and some types of Human Papillomavirus (HPV) are leading risk factors for cancer in low- and middle-income countries. Cervical cancer, which is caused by HPV, is a leading cause of cancer death among women in low-income countries. Vaccination is the answer to HPV.

Q: You have been advocating for early detection. What is the value of it?

A: Thank you once again, actually cancer can be reduced and controlled by implementing evidence-based strategies for cancer prevention, early detection of cancer and management of patients with cancer. There are two components of early detection efforts – testing and screening. The examples of testing and screening methodology include visual inspection with acetic acid (VIA) and Papanicolaou (PAP) smear test for cervical cancer; mammography screening for breast cancer; Prostate Specific Antigen (PSA) and Digital Rectal Examination (DRE) harbinger tests for prostate cancer. Many cancers, particularly prostate cancer, cervical and breast cancers have a high chance of cure if detected early and treated adequately. The public should be encouraged to develop a culture of undertaking medical check-up including tumour marker tests at least once per year. Parents should be watchful of your children. If you notice any lump in any part of the child’s body, that should be reported immediately to your nearest oncologist for check up. Many swelling can start while the child does not feel any pain, when tested, some end up being cancer tumours.

Q: What is the cancer situation in Tanzania at the moment?

A: We don’t have an adequate cancer registry in Tanzania. In its report of 2009, Ocean Road Cancer Institute (ORCI) revealed that new cancer cases were 2,807 in 2006, 3,138, in 2007 and 3,480 in 2008. It’s estimated that about 100 out of 100,000 persons are cancer patients. It’s estimated that country wide there 50,000 new cancer cases per year.

Q: If that is the case, are the hospitals in the country equipped well with facilities to fight against the disease?

A: I don’t think so! Many hospitals are ill-equipped and some don’t have facilities at all. For example, in response to hospital staff grievances on lack of radiotherapy treatment at the Ocean Road Cancer Institute institute, a situation causing a lot of untimely deaths to cancer patients, Prof. Twalib Ngoma, the Executive Director of the institute, made clarifications on the situation. He said that, “While the Institute needed eight radiotherapy equipments to serve 40,000 patients, the institute has only one operating treating only 4,000 per year leaving 36,000”.

Go to government regional and district hospitals where most people go for medical treatment as much as in most of the hospitals up-country you can’t find a mammography, a Prostate Specific Antigen screening gadget not to say a CT scan, PET scan, Magnetic Resonance Imaging (MRI) and many other modern types of equipment. That is the same with medical specialist. Most of medical specialists are in urban settings mostly Dar es Salaam. Cancer specialists such as urologist, radiation oncologist and medical oncologist are limited in number. Costs for some of the screening are unaffordable. Cancer medicine is also expensive and most cannot be procured in the country. The government with collaboration of medical entrepreneurs need to take deliberate action to arrest this situation.

However, one time Minister of Health and Social Welfare (MoHSW) Prof. David Homeli Mwakyusa was quoted saying that, “only 10 percent of patients suffering from various types of cancer have been registering in the hospitals for medical check-up and treatment. The remaining 90 percent have not made any effort to attend medical check-up….but from general observations it seems the disease is affecting many people” and he added,   “prostate cancer causes many deaths in the country because of lack of sensitization to the sufferer”.

Furthermore, in a Channel Ten Television interview, Prof. Ngoma attested to the fact that 100 cancer patients die in Tanzania per day. These must be from the 10 percent registering in hospitals for medical attention. No much is known on morbidity and mortality of the remaining 90 percent.

Q: Looking at it in a wider perspective, what is the situation of cancer compared to other diseases?

A: The situation is shocking! You can imagine that cancer kills more people each year than HIV/AIDS, Malaria and Tuberculosis-TB combined. It is estimated that by 2020 cancer is expected to kill more than 12 million people a year. More than 75 percent of new cancer deaths will be in the developing world to which Tanzania is a part. More than 70 percent of cancers in developing countries are diagnosed too late for cure and 40 percent of all cancer deaths can be prevented. If we have to arrest the cancer prevalence in our country, deliberate action needs to be taken now, the actions should include educating the public on the disease. People need to know the risk factors, warning signs, the value of early detection and that in most cancers such as breast, cervical and prostate cancer the earlier it is discovered the better chance of cure. Knowledge on what cancer is will liberate people’s minds from rumour, false and misinformation, and will demythologize and get rid of syncretism associated with cancer. That is the kernel of Target 5 of the World Cancer Declaration: Dispel damaging myths and misconceptions about cancer. From a global level, we will be focusing our messaging on the four myths and I will add the fifth from a local situation. Myth 1: Cancer is just a health issue. Truth: Cancer is not just a health issue. It has wide-reaching social, economic, development, and human rights implications. Myth 2: Cancer is a disease of the wealthy, elderly and developed countries. Truth: Cancer does not discriminate. It is a global epidemic, affecting all ages, with low- and middle-income countries bearing a disproportionate burden. Myth 3: Cancer is a death sentence. Truth: Many cancers that were once considered a death sentence can now be cured and for many more people their cancer can now be treated effectively. Myth 4: Cancer is my fate. Truth: With the right strategies, more than one in every three cancers can be prevented and Myth 5: I have been bewitched. Truth: Cancer is a condition in which the regulation of cells growth is lost and cells grow uncontrollably.

Q: So, what is your advice?

A: If we have to beat and demythologize the myths associated with the disease, there is an urgency to come up with community outreach initiatives to educate the public by addressing cancer concerns effectively. That engagement should be multi-sectoral, holistic, whole-of-government and a whole-of-society. No one should be left behind. High level of morbidity and mortality in the world is highly due to ignorance of the disease amongst communities. As it is written, “My people are destroyed for lack of knowledge” (Hos. 4.6).  The informed society will translate the arrest of the disease. “Knowledge is the best defence against cancer”. On the other hand, the government should take deliberate efforts to pioneer and support community outreach initiatives morally and financially and at the same time invest heavily on training oncologists at all level such as surgeons, nurses, experts in all level etc., modernizing cancer treating facilities such as using big science and big technology and modernizing palliative care services. Together we can beat cancer.