New cancer cases almost doubled in a decade as deadly illness takes heavy toll

One in five Kenyans will develop cancer during their lifetime, reveals a NationNewsplex review of health data over the past decade.

The risk of getting cancer by age 75 is slightly higher for women (20 per cent) than men (17 per cent). It is also above the global average of 18 per cent, indicate figures from the International Agency for Research on Cancer (IARC) at the World Health Organization (WHO).

“The risk is higher in Kenya than many countries because of the two main cancers among women. In developed countries, cervical cancer is not a threat as it has been under control through well-established screening programmes, early detection and effective treatment. Other African countries equally have high incidences of these cancers but the rate is higher in Nairobi,” Ms Anne Korir, head of the National Cancer Registry at the Kenya Medical Research Institute.

Figures from the UN agency further reveal that one in seven Kenyans is likely to die of cancer by the time they are a septuagenarian. The chance of dying from cancer is highest for breast, cervical, oesophageal, prostate and stomach cancers.

One of every 11 deaths in Kenya is due to cancer. The disease is the third leading cause of death, exceeded only by pneumonia and malaria, according to figures from the Kenya National Bureau of Statistics (KNBS).

The most common cancers include breast cancer, with Kenyans having a five per cent chance of getting it, followed closely by cervical and prostate (3.7 per cent each), oesophageal (two per cent) and stomach (one per cent).

While much attention is accorded to the major cancers, including breast, cervical and prostrate, the Newsplex review of cancer data over the last decade reveals that deaths from oral (mouth), uterine and gall bladder cancers increased the most, even as their incidence remains relatively low. Estimated oral cancer deaths more than tripled in the 10 years to 2018 from 264 to 805. Tobacco use, heavy alcohol use, human papillomavirus (HPV), excessive sun exposure and weakened immune system are some of the risk factors for oral cancer.

Altogether, estimated cancer deaths increased almost by half in the 10 years to 2018, from 22,115 to 32,987, according to IARC. The national projections are based on data collected from the Eldoret and Nairobi cancer registries.

Cancer deaths are three times as many as road crashes, shows data from KNBS.

Concerning incidence trends, new cases of gall bladder cancer quadrupled from 100 in 2008 to 426 in 2018, the highest spike, according to estimates from the IARC. Genetics and the presence of the typhoid-causing salmonella bacteria are risk factors for gall bladder cancer.

Prostate cancer recorded the second highest jump in new cases, more than doubling (163 per cent) from 1,087 in 2008 to 2,864 last year, followed by nasopharynx (145 per cent) cancer, which affects the upper part of the throat just behind the nose. Breast cancer, despite being the most common cancer, was ranked fourth with a 125 per cent increase in new cases. Cervical cancer, the second most occurring, rounded off the top five on the rate of increase chart, rising by 114 per cent in 2018 from a decade ago.

“We have seen an increase in cancers that were rare 10 years ago, such as gall bladder, lung, ovarian, and brain tumours, as well as a drop in HIV-associated cancers such as Kaposi sarcoma and non-Hodgkin’s lymphoma,” says Ms Korir.

Obesity is a major risk factor for many cancers. WHO data indicates that the obesity prevalence among Kenyan adults is seven per cent while among young children and teens it stands at two percent, an increase from 0.5 per cent in 2000. The growing obesity rates, especially among children, does not bode well for the fight against cancer.

More women than men have cancer and die from the disease. In 2018, three in five new cancer cases (60 per cent) were diagnosed in women, an increase from 55 per cent a decade earlier.

The leading cancer in women is breast cancer, with an estimated 5,985 new cases or one in eight cancers diagnosed last year. It is followed by cervical cancer with 5,250 new cases.

“If we were able to bring these two cancers under control we would save so many women from dying. Our data is showing that age at diagnosis is much younger compared to developed countries, hence we are losing young women who are still highly productive in the society,” says Ms Korir.

Globally, Kenya’s cancer prevalence in women is only surpassed by those of North American countries, Australia and New Zealand with 28 per cent each, European countries (25) and Polynesian countries (21). But cancer survival rates are much higher in those countries because of access to early diagnosis and more advanced treatments. “The risk is higher in Kenya than many countries because of the two main cancers among women. In developed countries, cervical cancer is not a major threat as it has been under control through well-established screening programmes, early detection and effective treatment. Other African countries equally have high incidences of these cancers but the rate is higher in Nairobi,” says Ms Korir.

To curb cervical cancer, the Ministry of Health recently rolled out mass vaccination of 10-year-old girls against HPV.

Leukaemia, which accounted for four per cent of estimated new cancer cases in 2018 and ranks eighth overall, is the commonest cancer among children. One in six cases of cancer among children is leukaemia. This is according to data tabled before Parliament by the National Cancer Institute of Kenya.

According to the American Cancer Society, several studies have found a possible link between childhood leukaemia and household exposure to pesticides, either during pregnancy or early childhood. Non-Hodgkin’s lymphoma, which affects the immune system, is the second leading cancer among children. The lymphoma is difficult to diagnose until in the later stages. The third-most prevalent cancer in children is kidney, followed by brain and nervous system, and nasopharynx cancer.

The top 10 cancers that affected Kenyans back in 2008 remain the most prevalent. Breast, cervical and oesophageal cancers topped new cases a decade ago, the same as last year. Prostate cancer climbed the new cases list from position nine in 2008 (1,087 cases) to four (2,864 cases) last year. However, liver cancer dropped from the sixth spot a decade ago (1,294 cases) to rank at number 10 (1,346 cases) in 2018. Kaposi sarcoma, which is linked to HIV, dropped from number four (1,455 cases) to seven (1,782) owing to better HIV and AIDS treatment.

Ms Korir says that it is not easy to link the higher numbers to an actual increase in prevalence, as it could also mean that there is now better detection due to improved diagnostic facilities or the cancer registries are improving in record-keeping.

Oesophageal, cervical and breast cancers have held the top three positions among leading killer cancers since 2008. Last year, projected deaths as a result of oesophageal cancer were estimated to be 4,351, accounting for one in eight of all cancer deaths.

Cervical cancer recorded 3,286 deaths followed by breast cancer (2,553), according to the IARC.

Prostate cancer also climbed up the new deaths charts to position five in 2018 from nine a decade ago. The disease is rare in men younger than 40 but the chances of getting it rise greatly after age 50. Other risk factors include genetics, diet, smoking, sexually transmitted infections and exposure to chemicals.

Chances of survival for cancer patients hang on early diagnosis and the ability to afford effective treatment. Unfortunately, about four in five cancer cases are diagnosed for treatment at an advanced stage of the disease (stage 3 or 4), lowering the chances of survival, according to the Ministry of Health.

Additionally, about 38 million Kenyans are not under any form of medical cover that would cushion them from direct out-of-pocket payments. A majority of the insured are covered under the state-owned National Hospital Insurance Fund (NHIF), which has its limits. For instance, the cover handles 20 radiology sessions.

Cancer treatment is ranked the seventh healthcare benefit package in NHIF spending. Unaudited results of the 2017/18 financial year indicate that Sh1.37 billion was spent on cancer treatment, an 11 per cent rise from Sh1.23 billion in 2016/17.