Doctor Works to Reduce Cancer Burden in Africa

Newswise — In 2010, cancer will be the single leading cause of death worldwide, overtaking chronic illnesses such as heart disease and stroke. Already cancer causes more deaths than HIV/AIDS, tuberculosis and malaria combined. Almost three-quarters of new cases will occur in developing countries, with more than a million cases in sub-Saharan Africa by 2020, according to World Health Organization projections.

Scot Remick, M.D., director of the Mary Babb Randolph Cancer Center at West Virginia University, is leading U.S. efforts to help prepare for the growing cancer burden in Third World nations. He heads the International Working Group of the National Cancer Institute's AIDS Malignancy Consortium, which has been instrumental in training doctors and building clinical trials for AIDS-related diseases in Uganda and Kenya.

"Most people don't realize that by 2010 cancer will be the single greatest cause of mortality worldwide," said Remick after returning from the May-June meeting of the American Society of Clinical Oncology, where he chaired an education session on the topic. "Anywhere from 15 to 20 percent of cancers are due to transmissible causes, and healthcare professionals in the industrialized world are likely to underestimate the role of infectious agents " even though they constitute a significant burden."

Transmissible causes include viruses such as Epstein-Barr virus, human immunodeficiency virus (HIV), Hepatitis B and Hepatitis C viruses, and the human papillomavirus. Viruses may hit the developing world particularly hard, but rising rates of obesity and tobacco use are a factor, too. "You're beginning to see Western influences on lifestyle, and this is creating impact on the cancer rate," Remick said.

Remick and an international team of researchers have just published results of the first clinical trial of its type in Africa " a low-dose chemotherapy regimen for people with AIDS-related non-Hodgkin's lymphoma. The trial showed dramatic results " a 6 percent mortality rate, compared with an expected 20 percent to 66 percent rate in the Kenyan and Ugandan populations studied.

The research team chose a low-dose chemotherapy regimen because it's vital that cancer therapies in sub-Saharan Africa be less myelotoxic " or damaging to bone marrow " than conventional treatment plans. Money, means and blood products may not exist in resource-challenged countries to counteract chemotherapy's potentially destructive effects on bone marrow.

Remick, senior researcher on the study published in the current issue of the Journal of Clinical Oncology, said the clinical trial represents a dozen years of work. Partners in the project are Case Western Reserve University in Ohio, Ohio State University, the Uganda Cancer Institute and Kenyatta National Hospital as well as medical schools in Uganda and Kenya.

The AIDS Malignancy Consortium will be promoting measures such as vaccination and other strategies aimed at preventing cancer as well as screening programs to encourage early diagnosis. Development of more low-dose chemotherapy trials is also on the agenda.

"The hope is that, as things will evolve, our efforts will be less about awareness and advocacy and more about action," Remick said.