Efforts of Mount Kenya University
towards Cancer Control in Kenya
The theme for 2022 World Cancer Day is “Close
the Care Gap”. The theme is a rallying call to world governments to
prioritise access to comprehensive cancer by all citizens regardless of income
status.
This calls for
capital investments in facility development and enabling off all citizens to
access the services offered, regardless of their levels of income.
The disparity in access to cancer care, ranging from
screening, diagnosis, treatment, follow up/palliative care and psychosocial
support is disproportionately against low income settings, in both High Income
(HICs) and Low & Middle Income Countries (LMICs).
While the incidence of cancer in Sub-Saharan Africa
(SSA) is lower than that in HICs, there is a more likelihood of dying from
cancer in this region. For instance, over one third of deaths associated to
cervical cancer occur in SSA.
It is projected that SSA will bear the heaviest burden
of cancer as the occurrence of cancer in the region continues to increase. This
calls for urgent measures to ensure timely access to good quality care of
cancer in the region.
It is estimated that there were 19.3 million people
were diagnosed with cancer worldwide in 2020. Within the same year, 10 people
are estimated to have died from cancer. In Kenya, about 42,116 people were
diagnosed with cancer while 27,092 died from cancer related illnesses in 2020.
Breast cancer was the most frequently diagnosed
cancer, accounting for 16.1% of all cancer cases reported in Kenya , followed
by cervical, prostate, oesophageal and colorectum cancer as the top five most
commonly diagnosed cancers in the Kenyan population.
The above mentioned figures are based on two cancer
registries, Nairobi Cancer Registry records cancer occurring among Nairobi
residents and Eldoret Cancer Registry that records cancer occurring among
residents surrounding Eldoret town, namely Nandi, Uasin Gishu and Elgeyo
Marakwet.
Thus the data reported does not represent the exact
cancer situation in the county. There could be many more people diagnosed with
cancer that were not included in the reported data.
This presents a limitation in closing the care gap. Without knowing the near exact number of
people to care for, planning for such care remains difficult.
To reduce the gap in planning for cancer care, MKU
researchers, led by Dr Francis Makokha have partnered with Kiambu and Machakos
Counties to develop population based cancer registries.
The Machakos cancer registry was completed and handed
over to the county’s department of health in 2021. Additionally, this research
team worked with AIC Kijabe Hospital to establish a hospital based cancer
registry.
The registry was handed over to the hospital in
November 2021 and plans are under way to assist update it, and hopes to
complete and handover the Kiambu county cancer registry in the next few months.
It is envisaged that these registries will guide in
prioritising planning for cancer care, prevention and psychosocial support programmes
to reduce the burden of cancer in these counties.
As indicated above, breast cancer was the most
commonly diagnosed cancer in Kenya. Breast cancer is a collection of different
types of diseases that present differently in different patents. It can be
inherited if one inherits mutations in certain genes referred to as Breast
Cancer gene 1 or 2 (BRCA 1, BRCA2).
However, hereditary breast cancer represents only a
very small percent of breast cancer cases diagnosed. Breast cancer diagnosed in
most patients is of unknown.
However, in all breast cancer patients (like all other
cancer cases), there are changes in DNA (mutations) of certain genes that drive
the disease.
Knowledge of the patterns of these changes, referred
to as mutational signature is important in understanding the nature of breast
cancer. It also guides development of drugs to treat breast cancer.
Additionally, it may guide the choice of treatment,
including drugs needed for targeted treatments, what is commonly referred to as
precision/personalised medicine.
MKU Researchers, led by Dr Francis Makokha have
partnered with faculty from other institutions including Aga Khan University
Hospital (Nairobi), AIC Kijabe Hospital in a study titled “Genomic approaches
for understanding breast cancer among Kenya patients” study the genetic changes
among breast cancer patients in Kenya.
This study was funded by a grant from The National
Research Fund (NRF) Kenya. Building on this initial study are other studies
focusing on liquid biopsy using circulating cell-free DNA and gene expression
patterns.
The study has
also attracted partnerships with international partners including University of
Edinburgh from the United Kingdom and International Agency for Research on
Cancer (IARC) among others, who are working with the MKU team to understand the
genetic changes causing breast cancer in Kenya.
Currently, preliminary data from this study is being
analysed and the results will be shared with the public through peer reviewed
journals, media and other stakeholder engagement forums in the course of this
year.
Thus the team hopes to improve breast cancer treatment
outcomes by based treatment on the genetic nature of the patient, as is the
case of personalised medicine.
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