Secure the Future – Swaziland

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. 

Cigarette smoking is the most important cause of lung cancer and overall, 6% of Swaziland’s population (Males: 11.7%; Females: 1.2%) smoke tobacco. However, among males aged 45-69 years of age, the proportion is considerably higher at 21%. Globally, Swaziland has the highest adult HIV prevalence of 26% with an incidence rate of tuberculosis (565 per 100,000/ year) and a TB/HIV co-infection rate of 73%. Due to similarities in symptoms, lung cancer is often misdiagnosed as TB leading to delayed diagnosis or missed identification of cases. Furthermore, occupational exposure to asbestos, silica, and radon gas are additional and relevant lung cancer risk factors particularly in the southern part of Africa where mining activity is common. Asbestos mines in neighboring South Africa have employed thousands of Swazis since the 1920s from labor-sending communities and an asbestos mine operated in the northern region of the country from 1939 to 1991 also employing thousands of locals.

Independent of asbestos exposure, the history of being a current or ex-mine-worker is associated with TB which in turn increases the risk of lung cancer. Given the presence and confluence of these risk factors (tobacco use, HIV, TB, HIV/TB co-infection, mining history), the Swaziland  National Cancer Registry is keen to investigate the burden of lung cancer in the country. According to the Swaziland 2016 Annual Vital Statistics Report, cancers rank 6th overall and 2nd among non-communicable diseases as the main causes of death. However, both the incidence and prevalence of cancers in Swaziland, especially lung cancer, are poorly understood. Only 56 incidence cases of lung cancer were identified during a retrospective national review of medical records covering January 1, 2014 to December 31, 2015 lagging behind other common cancers. The factors contributing to this situation are not well understood but are thought to be multifactorial including lack of awareness of lung cancer symptoms in communities and non-oncology clinicians, misdiagnoses of lung cancer with TB, referral of suspected lung cancer cases to South Africa, lack of autopsy reports, and underreporting to population-based registries. However, the Ministry of Health recognize the threat of lung cancer to the population and are taking deliberate measures to address this challenge including the undertaking of this proposed project.

The goal of this project is to strengthen the capacity of the Swaziland National Cancer Registry initiative on lung cancer surveillance and to assist the Swaziland Ministry of Health to address barriers to care and improve early diagnostic services aimed at supporting evidence-based cancer registry coordination and establishing the epidemiologic burden of lung cancer to improve lung cancer surveillance.

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