Using awareness days for data- and equity-driven responses to cancer prevention and control in Uganda

“Early detection saves lives.” In reflecting on this message, one key thing comes to mind – access, and, more so, equity in access. How can the Ugandan living deep in a rural area of this country benefit from this message? Where is the starting point to act, particularly given all the existing barriers to information access? The disparities in access to information and to cancer services leave a majority of Ugandans based outside of the Kampala with limited, if not completely absent, access.

Uganda’s cancer burden

Let’s step back and reflect deeper. What is the burden of cancer in Uganda? We have estimates from the International Agency for Research on Cancer Globocan report, which presents figures forecast from the Kampala Cancer Registry (KCR), a credible, population-based cancer registry considered one of the most established in the region, to give a national picture in terms of new cases, number of deaths, as well as prevalence over time.

Globocan data indicates an increase in new cancer cases, number of deaths and prevalence in Uganda since 2012. Uganda currently registers up to 32,617 new cancer cases and a cancer mortality of 21,829 each year, with similar impact for men and women. The five top cancer are cervical cancer, Kaposi Sarcoma, breast cancer, prostate cancer, and Non-Hodgkin Lymphoma. Today, Uganda has registered 56,238 prevalent cancer cases over the last five years.

That’s a lot of facts and figures. What does it mean for Ugandans? Here are a couple of critical observations:

• Most alarmingly, cervical cancer incidence and mortality has almost doubled in the last five years. There is something about cervical cancer that we need to demystify. Cervical cancer is perhaps the most preventable cancer and there is now a global call to eliminate it entirely. This can be done through vaccination of Human Papillomavirus (HPV) for young girls and regular screening of all women aged 25 years and above, particularly for women living with HIV/AIDS.
• Kaposi Sarcoma, which is an HIV/AIDS-linked cancer and currently the second leading cancer in both sexes and the leading among men, has become more common than in 2012. This raises new questions for the cancer community in terms of how we can integrate cancer care with other diseases, with emphasis on care provided at the primary healthcare level.

Raising cancer control awareness and action on World Cancer Day

As part of our awareness and advocacy efforts, each year Uganda joins the rest of the world, in a collaboration with the Ministry of Health and Uganda Cancer Institute, to commemorate World Cancer Day, which takes place every 4th of February. This year’s global theme is “I am and I will,” which is an empowering call to action, urging personal commitment and representing the power of individual action. For Uganda Cancer Society, the aim was to bring together Uganda’s stakeholders and the general population through an inclusive process to advocate for cancer control and raise awareness on cancer, while recognising progress made so far and the role we each can play in building on this progress.

What we learn from “I am and I will” is that all of us can contribute to improving cancer outcomes in our country. For example, you can say I am a man above 40 years and I will go screen for prostate cancer. I am a parent and I will take my child for HPV vaccination to prevent her from getting cancer in the future. I am a woman above 25 years old and I will go screen for cervical cancer. I am a community leader and I will spread the right message about cancer, fight stigma and mobilise my community for vaccination. Each and every one of us can do something, including you.

For Uganda Cancer Society, this year, we committed our World Cancer Day pledge to take action toward equity in access of cancer care for all through a united push for the drafting of a national cancer control plan. It is in this spirit that we joined the Treatment for All global advocacy campaign led by UICC, which calls for national responses to improve data for public health use, access to early detection and diagnosis, timely and accurate treatment, and supportive and palliative care.

We know that there is fragmentation in the way services are being delivered in Uganda. There is, therefore, a need to create supportive legal frameworks for cancer control as we try and ensure that ‘Treatment for All’ is achieved. For this, Uganda needs to define the strategic direction it will take as a country in the fight against cancer, driven by a costed, evidence-based national cancer control plan, with support across government and civil society actors, and with representation of patients. This plan can allow for progress on the staggering findings presented above, with targeted solutions to eliminate cervical cancer and push for integrated care for people living with HIV, amongst other necessary interventions that support, not only cancer patients but the health of our population, today and in the future.

We believe that everyone has a role to play in cancer control, and the presence of a cancer control plan and programme will give better guidance as the direction required to fight cancer nationally. We, therefore, call upon the Government of Uganda to adopt a national cancer control plan in order to improve patient outcomes with cost-effective, timely and quality treatment and care.