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Screening Programmes as the Answer to Reducing THE BURDEN OF CANCER

Updated: Mar 2, 2023



Screening programs involve testing asymptomatic individuals with an accurate screening test to identify those likely to have the disease of interest and to further investigate them to confirm or exclude the disease. The purpose of screening is to advance the time of diagnosis so that prognosis can be improved by earlier intervention. A consequence of earlier diagnosis is that it increases the apparent incidence of cancer in a screened population and extends the average time from diagnosis to death.

 

Cancer screening can also be used to prevent cancer deaths and improve quality of life by finding cancers early and effectively treating them. The components of an effective screening programme include: patient education, record keeping, information sharing, human and financial/material resources as well as political will. Challenges with one or more of these components make the screening programmes ineffective. Screening programmes are effective at spreading awareness and thus educating people about a given ailment. Estimates of absolute benefit of screening in the United Kingdom have varied from one breast cancer death avoided for 2000 women invited to screening to 1 avoided for about 100 women screened, about a 20-fold difference.

 

Most cancer deaths in Africa are attributed to delays in screening and treatment, lack of cancer awareness, inaccessibility and unaffordability of care, as well as poor healthcare systems that lack trained personnel. Most African countries are overburdened by competing healthcare priorities such as communicable diseases that limit attention to cancer prevention. Common female cancers in Africa are breast and cervical cancer while prostate cancer is the most common among African males. Other common cancers are liver, colorectal, and non-Hodgkin’s lymphoma (Busolo & Woodgate, 2015). Cervical and breast cancer screening are among the most popular cancer screening programmes available. Cancer of the cervix is the most common (as reported) form of cancer (malignancy) amongst South African (SA) black women (incidence of over 40 per 100000) but fourth in white women. It is estimated that approximately one in every 29 women in their lifetime may develop this form of cancer. Deaths due to cervical cancer in SA have been seen to outnumber maternal deaths (Hoque, Hoque, & Kader, 2008).



In South Africa 10 702 women are diagnosed with cervical cancer, and over half (5 870) die from the disease (Bruni et al., 2021). Cancer patients have highlighted that their quality of life has been compromised (Zeng et al., 2011). Cervical cancer patients tend to experience, the psychological and emotional distress of managing a fatal illness. Over half (57.5%) of cervical cancer patients report anxiety and depression (Maree & Holtslander, 2020). Cervical Cancer patients often feel like they are a burden to their families and worry about the future of their families once they pass away (Coovadia et al., 2009). Such experiences are not unique to cervical cancer patients but are also experienced by patients with other cancers. Patient educations as well as information sharing in the cancer screening programme are useful in addressing the psychological and emotional distress that accompanies a cancer diagnosis.

 

As has been the case in the UK, effective screening programmes can reduce the deaths experienced as a result of cancer in Africa. However, challenges to the efficient implementation of screening progammes have to be addressed particularly within the African context where public hospitals are often crowded, deficient in human resources and have long waiting periods that delay screening, diagnosis and treatment (Busolo & Woodgate, 2015).Effective screening progammes not only reduce deaths from cancer through early detection but they also improve the quality of life of patients through empowering them with information. The benefits of screening programmes are undeniable however the challenges in African countries are persistent. Effective screening programmes require resources that most if not all African countries simply do not have as such, international funding is required.

 

Reference

  1. Busolo, D. S., & Woodgate, R. L. (2015). Cancer prevention in Africa: a review of the literature. Global health promotion, 22(2), 31-39.

  2. Coovadia, H., Jewkes, R., Barron, P., Sanders, D.& McIntyre, D. (2009). The health and health system of South Africa: Historical roots of current public health challenges. Lancet, 374 (9692). 817-834.

  3. Hoque, M., Hoque, E., & Kader, S. B. (2008). Evaluation of cervical cancer screening program at a rural community of South Africa. East Afr J Public Health, 5(2), 111-6.

  4. Maree, J. E., & Holtslander, L. (2020). The Experiences of Women Living with Cervical Cancer in Africa: A Meta synthesis of Qualitative Studies. Cancer nursing.

  5. Marmot, M. G., Altman, D. G., Cameron, D. A., Dewar, J. A., Thompson, S. G., & Wilcox, M. (2013). The benefits and harms of breast cancer screening: an independent review. British journal of cancer, 108(11), 2205-2240.

  6. Sankaranarayanan, R. (2014). Screening for cancer in low-and middle-income countries. Annals of global health, 80(5), 412-417.

  7. Zeng, Y. C., Li, D., & Loke, A. Y. (2011). Life after cervical cancer: quality of life among Chinese women. Nursing & health sciences, 13(3), 296-302.


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