By Herbert Mutugwi
Harare (New Ziana) – Being diagnosed with cancer in Zimbabwe is generally viewed as a death penalty.
Many people do not survive the effects of this debilitating, non-communicable disease.
The southern African nation has around 15 million people whose behaviour change is usually due to witnessing real -life cases.
Change to this perception has been slow due to lack of information on cancer, how to avoid contracting the disease and treatment options. Even more, few survivors have been coming forward to tell their stories.
But the Cancer Association of Zimbabwe (CAZ) has been hard at work to change the death penalty perception and appears to be winning the fight against myths and misconceptions surrounding cancer.
Cancer is a leading cause of death worldwide, accounting for nearly 10 million deaths in 2020, or nearly one in six deaths. The most common cancers are breast, lung, colon and rectum and prostate cancers.
Around one-third of deaths from cancer are due to tobacco use, high body mass index, alcohol consumption, low fruit and vegetable intake, and lack of physical activity. Cancer-causing infections, such as human papillomavirus (HPV) and hepatitis, are responsible for approximately 30 percent of cancer cases in low-and lower-middle-income countries.
Cancer is a generic term for a large group of diseases that can affect any part of the body. Other terms used are malignant tumours and neoplasms. One defining feature of cancer is the rapid creation of abnormal cells that grow beyond their usual boundaries, and which can then invade adjoining parts of the body and spread to other organs; the latter process is referred to as metastasis. Widespread metastases are the primary cause of death from cancer.
The most common in 2020, in terms of new cases of cancer, were: breast (2.26 million cases); lung (2.21 million cases); colon and rectum (1.93 million cases); prostate (1.41 million cases); skin (non-melanoma) (1.20 million cases); and stomach (1.09 million cases).
In terms of deaths, cancer types were ranked as follows in 2020: lung (1.80 million deaths); colon and rectum (916 000 deaths); liver (830 000 deaths); stomach (769 000 deaths); and breast (685 000 deaths).
Each year, approximately 400 000 children develop cancer. The most common cancers vary between countries. Cervical cancer is the most common in 23 countries.
Cancer arises from the transformation of normal cells into tumour cells in a multi-stage process that generally progresses from a pre-cancerous lesion to a malignant tumour. These changes are the result of the interaction between a person’s genetic factors and three categories of external agents, including: physical carcinogens, such as ultraviolet and ionizing radiation; chemical carcinogens, such as asbestos, components of tobacco smoke, alcohol, aflatoxin (a food contaminant), and arsenic (a drinking water contaminant); and biological carcinogens, such as infections from certain viruses, bacteria, or parasites.
The World Health Organisation (WHO), through its cancer research agency, the International Agency for Research on Cancer (IARC), maintains a classification of cancer-causing agents.
“It’s unfortunate that people are not aware and are scared of the disease but as CAZ we have come across a lot of people who were living with cancer but have been successfully treated and cured,” says CAZ’s Lovemore Makurirofa.
“Some of them are now cancer survivors and have notched 20 years and above after the disease, so it’s a disease that can be managed but needs to be detected and treated early.
“The challenge in Zimbabwe is that more than 80 percent of the cancers are detected at stage three and four. That in itself means that the chances of curing the disease become very low, so we encourage people to access screening and treatment as early as possible so that the prognosis is better and the chances of treating the diseases become higher.”
According to the Zimbabwe Cancer Registry Report, Zimbabwe on average reports over 7 500 cancer cases annually, with the latest published report for 2018 that was published last year placing the country’s cancer burden at 7 841 cases.
A 63-year-old cancer survivor in Harare said she lived a long time with cancer in denial mode. A hairdresser and mother of five, she survived breast cancer in 2016.
For her, the biggest challenge was accepting to undergo chemotherapy, and loss of income during the seven months of treatment which rendered her unable to work and pay for her children’s school fees and general upkeep of the family in a harsh economic environment.
And after conquering the disease, she found that most of her clients had migrated elsewhere and found alternative hairdressers.
Makurirofa said CAZ had noted a significant change in attitude among Zimbabweans towards the disease, thanks to its vigorous awareness programmes designed to help dispel the myths and misconceptions around the condition.
Until recently, research and public health interventions in Zimbabwe largely focused on the so-called big three diseases – tuberculosis, HIV/AIDS and malaria – and on maternal and child mortality. Yet, recent epidemiological research from the WHO showed the high cost of neglecting non-communicable diseases in developing countries. The young, old, malnourished and poor are disproportionately impacted.
“We are seeing that these programs have an impact in the general population. People are becoming more aware of cancer as evidenced by them seeking cancer treatment. We are also seeing a lot of people being aware of the risk factors of cancer and trying to change their lifestyles so that they can prevent cancer which is one of the effective ways that Zimbabwe should focus on because, as a developing country, we would not be able to cope with the burden of rapid increase in cancer cases,” he said.
One such intervention saw over 1 200 men take up the annual prostate cancer screening promotion CAZ offers at its Harare offices every June which is men’s month. During the month-long promotion, prostate cancer screening was offered at half the price of the procedure’s cost recovery charge of US$10.
“We saw a total of 1 211 men coming to the cancer centre in Harare to access the screening and this is a very good response especially compared to the previous years when we had challenges with COVID-19 and we could not run this promotion effectively,” said Makurirofa, who expressed hope that some partner organizations would help CAZ devolve it countrywide.
“It is very important for men to be screening because prostate cancer is the number one cancer among males in Zimbabwe and the cases are increasing. As a result, we recommend that males be screened at least once in a year especially using the Prostate Specific Antigen PSA test that we do at the CAZ.”
CAZ acknowledges that screening is very expensive to the majority of people while the culture of being screened without any signs and symptom is uncommon among Zimbabweans. Because of the prevalence of infections, most Zimbabweans believe that the only reason to visit a clinic is when one experiences a sign or symptom of a certain disease or condition.
“By running this promotion, we are trying to change that mindset so that people have a habit of going for check-ups even if they are healthy, are not sick or suffering from any form of disease,” said Makurirofa.
Similar promotions are held for other common cancers such as cervical cancer screening every May and breast cancer in October for women.
“We are happy that more organizations are now helping in the fight against cancer in the country,” he said.
“Some organizations who have for a long time being doing HIV/AIDS programming are incorporating cervical cancer programmes and other cancers which is a sign that the nation is progressing in a positive direction as far as cancer is concerned.”
Besides cancer screening at its main offices in Harare, CAZ, as a psycho-social support institution for cancer patients, carries out outreaches for the benefit of people outside the capital, advocacy, free counselling to patients and their families and medication to vulnerable patients when it is in stock.
The long journey towards winning the fight against cancer in Zimbabwe is paying dividends. Mindsets are slowly changing, raising hopes that the disease will eventually be curtailed in the country.
“Cancer may soon lose its death tag grip among the population,” said Makumbirofa.