Secure the Future – South Africa – KwaZulu-Natal

Lead by the Bristol-Myers Squib Foundation, the SECURE THE FUTURE® initiative works with their partners in Africa to provide care and support for communities affected by HIV. 

Lung cancer is the most common cancer worldwide, and disproportionately affects developing countries where over 58% of cases occur. This however, is in sharp contrast with low incidence rates of lung cancers reported in Africa. This apparently “low burden” of lung cancers in the context of critical lack of accurate data, likely reflects enormous underestimations of the true burden, considering the high prevalence in the African setting of some major risk factors for lung cancer such as pulmonary tuberculosis and HIV infection.Indeed, most African countries lack nationwide or regional population-based cancer registries, and have no reliable source of mortality data.

South Africa (SA) has nine provinces with a total population of approximately 51 million. KwaZulu-Natal (KZN) is the second most populous province in South Africa (Census 2011) with 1 metropolis and 10 districts. According to the KZN Hospital Survey 2011, 39% of patients admitted in public hospitals are admitted for infectious diseases; 37.4% for non-communicable conditions; and 23.6% for injuries. In SA, all three-study sites will be located in two districts of KZN province, namely eThekwini Metro District and uMgungundlovu District. These sites are the only three provincial public department oncology centers.

According to the South African Cancer Registry (NCR) (2011), lung cancer is the second most common cancer in men and seventh most common in women. The most significant risk factor of lung cancer, smoking, is also very common in SA. A comprehensive South African National Health and Nutrition Examination Survey (SANHANES-1) (2013) found that 20.8% of the population reported a history of having smoked tobacco and 17.7% reported being exposed to environmental tobacco smoke (ETS) at home on a daily basis. According to SANHANES-1 (2013), ETS is significantly higher for males (20.4%) than females (15.4%). Introduction of strong tobacco control policies as well as health education programs for smoking prevention has declined (SANHANES-1, 2013). Furthermore, in most African settings, there is generally low cancer awareness, uncoordinated or absent screening services and late cancer diagnoses, when therapeutic solutions, where available, are less likely to be effective. Cultural beliefs in these settings also influence health seeking behavior and patients with warning signs and those with clinical signs suggestive of cancer or diagnosed with cancer resort to alternative medicine either preferentially, or in parallel with modern medicine.

All of these factors have contributed to the lack of a true burden estimation of lung cancer in this region, which this program seeks to address.

This initiative is part of a Multinational Lung Cancer Control Program (MLCCP) which aims to improve understanding of lung cancer pathways and access to early diagnostic services for lung cancer by addressing the barriers of cancer care through working with communities and the Ministries of Health in the identified regions with a potential for scale-up. The multinational study covers specific regions in Kenya, Tanzania, Swaziland and South Africa. 

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