Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Jun;23(6):e251-e312.
doi: 10.1016/S1470-2045(21)00720-8. Epub 2022 May 9.

Cancer in sub-Saharan Africa: a Lancet Oncology Commission

Wilfred Ngwa  1 , Beatrice W Addai  2 , Isaac Adewole  3 , Victoria Ainsworth  4 , James Alaro  5 , Olusegun I Alatise  6 , Zipporah Ali  7 , Benjamin O Anderson  8 , Rose Anorlu  9 , Stephen Avery  10 , Prebo Barango  11 , Noella Bih  12 , Christopher M Booth  13 , Otis W Brawley  14 , Jean-Marie Dangou  11 , Lynette Denny  15 , Jennifer Dent  16 , Shekinah N C Elmore  17 , Ahmed Elzawawy  18 , Diane Gashumba  19 , Jennifer Geel  20 , Katy Graef  16 , Sumit Gupta  21 , Serigne-Magueye Gueye  22 , Nazik Hammad  23 , Laila Hessissen  24 , Andre M Ilbawi  25 , Joyce Kambugu  26 , Zisis Kozlakidis  27 , Simon Manga  28 , Lize Maree  29 , Sulma I Mohammed  30 , Susan Msadabwe  31 , Miriam Mutebi  32 , Annet Nakaganda  33 , Ntokozo Ndlovu  34 , Kingsley Ndoh  35 , Jerry Ndumbalo  36 , Mamsau Ngoma  36 , Twalib Ngoma  37 , Christian Ntizimira  38 , Timothy R Rebbeck  39 , Lorna Renner  40 , Anya Romanoff  41 , Fidel Rubagumya  42 , Shahin Sayed  43 , Shivani Sud  17 , Hannah Simonds  44 , Richard Sullivan  45 , William Swanson  46 , Verna Vanderpuye  47 , Boateng Wiafe  48 , David Kerr  49
Affiliations
Review

Cancer in sub-Saharan Africa: a Lancet Oncology Commission

Wilfred Ngwa et al. Lancet Oncol. 2022 Jun.

Abstract

In sub-Saharan Africa (SSA), urgent action is needed to curb a growing crisis in cancer incidence and mortality. Without rapid interventions, data estimates show a major increase in cancer mortality from 520 348 in 2020 to about 1 million deaths per year by 2030. Here, we detail the state of cancer in SSA, recommend key actions on the basis of analysis, and highlight case studies and successful models that can be emulated, adapted, or improved across the region to reduce the growing cancer crises. Recommended actions begin with the need to develop or update national cancer control plans in each country. Plans must include childhood cancer plans, managing comorbidities such as HIV and malnutrition, a reliable and predictable supply of medication, and the provision of psychosocial, supportive, and palliative care. Plans should also engage traditional, complementary, and alternative medical practices employed by more than 80% of SSA populations and pathways to reduce missed diagnoses and late referrals. More substantial investment is needed in developing cancer registries and cancer diagnostics for core cancer tests. We show that investments in, and increased adoption of, some approaches used during the COVID-19 pandemic, such as hypofractionated radiotherapy and telehealth, can substantially increase access to cancer care in Africa, accelerate cancer prevention and control efforts, increase survival, and save billions of US dollars over the next decade. The involvement of African First Ladies in cancer prevention efforts represents one practical approach that should be amplified across SSA. Moreover, investments in workforce training are crucial to prevent millions of avoidable deaths by 2030. We present a framework that can be used to strategically plan cancer research enhancement in SSA, with investments in research that can produce a return on investment and help drive policy and effective collaborations. Expansion of universal health coverage to incorporate cancer into essential benefits packages is also vital. Implementation of the recommended actions in this Commission will be crucial for reducing the growing cancer crises in SSA and achieving political commitments to the UN Sustainable Development Goals to reduce premature mortality from non-communicable diseases by a third by 2030.

PubMed Disclaimer

Conflict of interest statement

Declaration of interests JD and KG received grants or contracts from Takeda Pharmaceutical, Johnson and Johnson, AstraZeneca, Cepheid, Merck, and Pfizer as funding for specific cancer projects. JG has served as previous chair of the South African National Advisory Committee on Cancer Control and Prevention, secretary general of the International Society of Paediatric Oncology Africa, and was part of the executive committee for the South African Children's Cancer Study Group. OWB received a P30 National Cancer Institute cancer grant to Johns Hopkins University and has had a leadership or fiduciary role paid or unpaid at Lyell Immunopharma, PDS Biotech, and Grail. OWB has stock or stock options with Lyell Immunopharma and PDS Biotech. AR received the Schneider-Lesser award as a junior faculty grant. TRR served as principal investigator on grants from the National Cancer Institute including: P20 CA233255, R01CA207365, and U01CA184374. These provided support to African cancer research activities, not directly related to the Commission. TRR received consulting fees from serving on 13 US cancer centre scientific advisory boards. None of these overlap in content with the Commission. All other authors declare no competing interests.

Figures

Figure 1:
Figure 1:
Cancer incidence and mortality over time (2020–40) by sub-Saharan Africa sub-region
Figure 2:
Figure 2:. Prevalence of tobacco use and obesity
(A) Prevalence of tobacco use in 2019 in selected African countries (adapted from Statista). (B) Prevalence of obesity by wealth quintiles in selected African countries (adapted from Agyemang and colleagues). The year represents the period the study was done.
Figure 3:
Figure 3:. Recommendations for scaling up of systemic therapy delivery in sub-Saharan Africa
ESMO=European Society for Medical Oncology.
Figure 4:
Figure 4:. Quality of cancer care in Africa framework capturing existing and proposed activities and initiatives
Adapted from the Institute of Medicine and the Lancet Global Health Commission. AORTIC=African Organisation for Research and Training In Cancer.
Figure 5:
Figure 5:. Palliative care course estimates for sub-Saharan Africa
(A) Estimated 2018 and anticipated 2030 number of 90-day morphine courses per country for cancer pain. (B) Estimated total number of palliative radiotherapy courses needed by country in 2018 and 2030 (information not available for Sudan).
Figure 6:
Figure 6:. Estimates of childhood cancers for children 0–14 years of age
(A) Incidence of paediatric cancers in different countries of sub-Saharan Africa, with Canada as a comparator. (B) Estimates of annual cases of childhood cancer in sub-Saharan Africa, by sub-region.
Figure 7:
Figure 7:
Paediatric oncology services in Africa
Figure 8:
Figure 8:
Determining priority cancer actions to enhance research in Africa
Figure 9:
Figure 9:. Incidence and mortality metrics for prioritising cancer needs
(A) Number of new cases in 2018 and the percentage increase in new cases by cancer site from 2018 to 2040. (B) Number of deaths in 2018 and the percentage increase in deaths by cancer site from 2018 to 2040. (C) Rate ratio of mortality to incidence in 2018 vs 2040. (D) Number of new cases in 2040 vs number of deaths in 2040. Data from Ferlay and colleagues, Bray and colleagues, and the Global Cancer Observatory. Red shading represents cancers that might be prioritised for research in sub-Saharan Africa, followed by the yellow and green shading. The blue dots represent cancer sites and those of greatest interest are labelled.
Figure 10:
Figure 10:. Pathways to enhanced cancer research and impact in Africa
Adapted from Rebbeck and colleagues.
Figure 11:
Figure 11:
Levels of care for cancer in sub-Saharan Africa
See this image and copyright information in PMC

Comment in

References

    1. WHO. WHO report on cancer: setting priorities, investing wisely, and providing care for all 2020. https://apps.who.int/iris/handle/10665/330745 (accessed Aug 23, 2021).
    1. Addai BW, Ngwa W. COVID-19 and cancer in Africa. Science 2021; 371: 25–27. - PubMed
    1. WHO. Second round of the national pulse survey on continuity of essential health services during the COVID-19 pandemic 2021. https://www.who.int/publications/i/item/WHO-2019-nCoV-EHS-continuity-sur... (accessed Aug 23, 2021).
    1. UN. Childhood cancer care in Africa hit hard by pandemic Aug 13, 2021. https://news.un.org/en/story/2021/08/1097752 (accessed Aug 23, 2021).
    1. Ferlay J, Colombet M, Soerjomataram I, et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer 2019; 144: 1941–53. - PubMed

Publication types