Tuesday, November 28, 2023

The rising burden of cancer in Botswana

Although cancer is not among the top causes of death in Botswana, a report published by the Lancet medical journal says Botswana has the third largest proportion of women with cervical cancer living with HIV in the SADC region.

“Eswatini had the largest proportion of women with cervical cancer living with HIV 75%, followed by Lesotho 69.3%, Botswana 66.5%, South Africa 63.4%, and Zimbabwe 52.2%. By contrast, this proportion was less than 5% in 122 countries globally. In absolute terms, most women with cervical cancer living with HIV were from South Africa 8220 cases, followed by Tanzania 2610 cases, Mozambique 2150 cases,….and Malawi 1790 cases,” states the report.

The World Health Organisation (WHO) Global Strategy to Accelerate the Elimination of Cervical Cancer has three targets to be met by every country by 2030. These include 90% of girls fully vaccinated with the human papillomavirus (HPV) vaccine by 15 years of age; 70% of women screened using a high-performance test by age 35 and again by 45; 90% of women identified with cervical disease receive treatment (90% of women with pre-cancer treated and 90% of women with invasive cancer managed). Successful implementation of all three could reduce more than 40% of new cases.

Research conducted in Botswana shows that cancer screening is not common in the public sector of Botswana. Research which has been conducted previously shows low rates of mammography screening, probably because mammography is not readily available and thus is not part of routine screening. Furthermore, prostate cancer screening is also not routine. Similarly, colon cancer screening is not commonly performed, due to the fact that the incidence of colon cancer in Botswana is low compared with higher-income countries.

The Asco Post which reports clinical cancer research, policy news, patient care, clinical practice issues, and thoughtful commentary by leaders in the field of clinical oncology states “the incidence of cancer is expected to rise from 1,953 in 2018 to 3,760 in 2040, whereas mortality is expected to increase form 1,064 in 2018 to 2,284 in 2040”.Statistics show that over 80 percent of women in Botswana seek medical assistance when the cancer is at an advanced stage and cannot be cured. Public health officials say there is need for the ministry of health to do community outreach programs to educate women about mammograms. Mammography is the process of using low-energy X-rays to examine the human breast for diagnosis and screening. The goal of mammography is the early detection of breast cancer, typically through detection of characteristic masses or microcalcifications.

Over the years, the ministry of health has been advising women to adopt a healthy lifestyle, healthy eating, good hygiene, exercise, and regular screening for cancer which can delay the onset of fully fledged conditions. The global burden of cancer is substantial. WHO predicts that morbidity and mortality due to cervical cancer will increase by more than 20 percent by 2025 in women under the age of 65 years in Botswana if current trends remain.


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