Cancer is a growing public health burden in South Africa with cases projected to rise from about 62,000 in 2019 to 121,000 in 2030, yet obstacles hindering early treatment and access to cutting-edge drugs are causing needless deaths, warns a new report.
Public sector patients are not only diagnosed late, often resulting in treatment failure, poor quality of life, and death, says the World Cancer Day 2024 equity report by the Union for International Cancer Control (UICC), but factors such as gender and education levels often result in prejudices when accessing cancer treatment.
The report, marking World Cancer Day on Sunday, revealed black South Africans experience greater barriers than whites as 70% of cancer specialists in the public sector are white and often not understood by their patients due to language barriers.
Only five provinces offer cancer care, meaning many who develop cancer are screened late. Not only are they subjected to expensive transport and accommodation costs getting to cities for treatment, but once there oncology drugs are often not available due to costs.
Ann Steyn, president of Reach for Recovery International (RRI) — an umbrella body for cancer organisations — and a past UICC board member, said the “healthcare system in the country shows significant disparities, despite a progressive constitution that recognises human rights”.
Steyn said diagnostic and radiation equipment was often in short supply, especially in public hospitals not linked to academic institutions.
Despite some cancer drugs being on the essential medicines list — a register of minimum medicine needs for every healthcare system — oncology medicines were often unavailable.
The report noted there were challenges with diagnostic and radiation equipment in provinces “compounded by poor maintenance, lack of funds and lack of trained staff”.
“With 84% of the nearly 60-million population accessing public health care, there are enormous challenges to overcome,” said Steyn.
“Entrenched barriers such as gender and racial equity exacerbate the situation. Only 20% of healthcare professionals are in the public sector, with 70% of them being white males treating a majority of patients that are people of colour. This can often create challenges for diagnosis and treatment if there is not mutual language understanding or cultural background consideration.”
Those in the private sector are not without problems either. The report notes that only 10% can access high-cost cancer medicines as treatment guidelines differ between health insurance schemes. This means many medical aid members have heavy out-of-pocket expenses obtaining treatment, or face the task of looking for a substitute treatment.
With cancer incidence and mortality set to rise, gender and racial equity must be addressed with increased urgency as integral to improving cancer outcomes.
The report said introducing early screening programmes would not only ensure timely treatment of cancer, irrespective of patients’ ability to pay, but heavily regulating carcinogenic products such as tobacco, alcohol and ultra-processed foods and beverages could go a long way towards managing the disease.
This could be enforced through increasing taxes, labelling and imposing product warnings.
“To close the cancer care gap is an ambitious task, but there are actions we can take to make progress, in particular by establishing proper referral pathways for leading cancers, implementing a robust cervical cancer elimination strategy, and drafting standardised treatment protocols,” said Steyn.
UICC CEO Cary Adams said: “Where you live, how much money you make, your age, your health, your gender, who you love or the colour of your skin shouldn’t dictate whether you have access to cancer care.”
Meanwhile the World Health Organisation (WHO) cancer agency, the International Agency for Research on Cancer (AIRC), which has just released the latest cancer estimates of the global burden of cancer, has revealed there will be 35-million new cancer cases by 2050, a 77% increase from the estimated 20-million cases in 2022.
About 9.7-million people died of cancer in 2022. About one in five people develop cancer in their lifetime.
The global survey showed only 39% of participating countries covered the basics of cancer management as part of their financed core health services. Only 28% of countries covered care for people needing palliative care and pain relief.
Lung cancer was the most common cancer with 2.5-million new cases worldwide, accounting for 12.4% of the total new cases. It was also the leading cause of cancer deaths, resulting in 1.8-million deaths. Breast cancer ranked second with 2.3-million cases or 11.6%, followed by colorectal cancer (1.9-million cases, 9.6%).
Prostate cancer ranked fourth with 1.5-million new cases, or 7.3%, while stomach cancer ranked fifth with just more than a million cases, or 5%.
Colorectal cancer was the second leading cause of deaths, resulting in about 900,000 deaths (9.3%) worldwide. Liver cancer ranked third with 760,000 deaths — 7.8%.
The survey blamed the rapidly growing global cancer burden on “population ageing and growth, as well as changes to people’s exposure to risk factors, which are associated with socioeconomic development”.
It revealed that tobacco, alcohol and obesity are key factors behind the increasing incidences of cancer, with air pollution still a key driver of environmental risk factors.
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