CERVICAL CANCER: EARLY DETECTION, DIAGNOSIS & TREATMENT in LRS

By Dr D. A. Kombe, MD, Mmed

(Rad/onc)

2nd East Africa WE CAN Breast & Cacx Advocacy, Education and Outreach

Summit September 11-13 ,2014

NEW ORCI

OLD ORCI

INTRODUCTION

• ANNUAL CANCER INCIDENCE IN TZ (Glob can 2012): – 40,000 new cancer cases

• In Tz there is a well-established patient referral system from health centers to referral hospitals;

however no proper guideline for cancer patients’ referral.

• It is the policy of our government to treat cancer patients for free (once diagnosed).

TANZANIAN HEALTH SYSTEM …

• Health promotion & education, cancer advocacy, prevention and early detection/screening are not yet a priority for funding in our health system!!!

Reasons:The Government is overwhelmed with a burden of both communicable and non- communicable diseases; therefore, a bigger portion is allocated mainly to treatments!

EARLY DETECTION

• For reasons mentioned above, prevention and early detection/screening are still an up-hill battle. This is done in few places mainly by ORCI and international NGOs – eg: ICAP, JHIPIEGO, IMA world, PSI, MST UMATI and probably a few national NGOs such as MEWATA.

However, currently there has been recognition and therefore efforts are now being directed towards this goal.

PRECISE DIAGNOSIS OF CANCER

• Oncologists (medical & radiation) are aware of the crucial need and closer collaboration with surgeons and pathologists for precise diagnosis and staging of cancer patients when planning subsequent management... THIS IS PARAMOUNT!!!

• Lack of such collaboration leads to poor decisions of treatment planning on the side of the oncologist! And, this further compromises the ability to offer optimal treatment to the patient.

• We have a good team –tumour board for this

DIAGNOSIS: CURRENT STATUS

• Few/non pathologists in some referral centers.

• Pathology services available are slow & often lack proper reporting.

• It has been observed in general, that prompt

referral is a major problem for most of cases.

TREATMENT OF CANCER IN TZ: CURRENT STATUS

• Like most countries in Africa, Tz is among the low resource countries.

• Even with this fact, the policy of our government policy is to treat cancer patients for free.

CURRENT STATUS...

• So far ONLY ONE Treatment center for ˃ 45million population .

- Two cobalt-60 machines (one is down) working round the clock including w/ends…

- Two HDR machines which are currently not operating (mechanical problem which need to fix).

- Never enough chemotherapy drugs. Demand & supply always is out of proportion!

CHALLENGES

• Serious lack of financial and material/equipment resources.

• Rapidly increasing cancer burden: Number of new cases doubling every 3 years (With no resource to accommodate them)!

• Late Presentation: Approx. 75% of cases present with FIGO III- IV stage.

• Serious lack of awareness of cancer symptoms and signs in majority of these women!

Recommendation

• Whilst efforts of addressing cancer awareness advocacy & screening are taking toll, more and more patients are coming requiring treatment. Currently bookings at ORCI are approaching January 2015!!!

• Therefore then, parallel with the above, there is a great need to advocate for and improve tertiary care as well. The latter can not be over- emphasized.

Indeed, WE CAN