The fight against cancer in the subSaharan Africa, a business of all ... and the university! La lutte contre le cancer en Afrique subsaharienne, une affaire de tous…. et de l’université !

Abstract

English version
Some will allude to signs of time that ... wake up: cancers occupy scientific publications, the media and our daily lives.
The Nobel Prize in Medicine and Physiology, awarded last October, to an American, James Allison, and a Japanese, Tasuku Honjo, come to devote the discovery of "treatment of cancer by inhibition of negative immune regulation." Their work on cancer immunotherapy thus opens a promising avenue in the management of this appalling pathology.
The fight against cancer is celebrated every February 4th; for 2019 and the next two years, the World Organization for the fight against Cancer, the Union for International Cancer Control (UICC), has chosen the theme "I am and I will". I am, I am ... aware of the reality of cancer, I am concerned, and I will, I will ... inform myself, get involved, raise awareness, communicate, ... about cancer. A theme resolutely in action and which meets a global desire for an all-out mobilization.
The reality of cancer goes beyond borders and represents an obvious public health problem in our different countries. And this global scourge spares no one because of its age, sex, race, religion, state of wealth or poverty.
Worldwide, there is a steady increase in the prevalence of all types of cancers. And its corollary, a mortality related to cancer that continues to increase. The number of new cancer cases worldwide has increased from 14 million in 2012 to 18.1 million in 2018, and the number of deaths from 8.2 million to 9.6 million (1). In the West, cancer, the leading cause of death, is responsible for more than half of all deaths, even though it is declining (2).
The African continent is not spared. It is estimated that nearly 12.4% of the 804 million people in the African Region will develop cancer before they reach 75 years of age (3). The risk increases with age, and 90% of cancer cases will occur after the age of 40. According to a study by the Alliance of African and Mediterranean Francophone Cancer Leagues (ALIAM), cancer mortality is proportionally higher in Africa than elsewhere in the world. Cancers already account for between 10% and 20% of pathologies on the African continent. "(4) If current trends persist, cancer morbidity in Africa could double, from 1,055,172 new cancer cases in 2018 to 2,123,245 new cases by 2040 (5).
In the majority of African countries, the main problems faced by cancer patients are poverty, late diagnosis or misdiagnosis of cancer, and lack of medical coverage. Thus, the detection of advanced cancer and the impossibility of having access to diagnosis and treatment are common problems (5). In 2017, only 26% of low-income countries reported having pathology services generally provided by the public sector. Less than 30% of low-income countries reported having treatment services, while the proportion for high-income countries exceeded 90% (6).
In the Democratic Republic of the Congo (DRC), cancer kills more than tuberculosis, AIDS and malaria combined! Its prevalence is rising steadily as in the rest of the world (data unpublished). In 2008, nearly 44% of deaths recorded in hospitals in the DRC were due to cancer according to the Ministry of Health.
Among the factors favoring cancer are cited dietary habits, lifestyle changes. In fact, cancer stems from the combination of several factors, some of which are preventable such as tobacco, alcohol abuse, abuse of fat, lack of exercise, non-consumption vegetables and fruit, environmental pollution, exposure to infections such as AIDS, hepatitis B and C, human papillomavirus that exposes to cancer of the cervix and anus and Helicobacter pylori. The most common cancers in humans affect the lungs, prostate, colon; and, in the woman, the breasts, the lungs, the colon, the uterus. For digestive cancers, in the DRC, the rise seems regular for cancers of the liver, stomach, large intestine, rectum (3).
One study showed that regular physical activity, a diet rich in fruits and vegetables and low in fat, reduced the risk of colorectal cancer by nearly 75% (7). Controlling risk factors can reduce cancer mortality by 25% (8-9). Two-thirds of the cancers are treatable, provided they are screened and diagnosed at an early stage, and treated appropriately.
We must therefore work on a national awareness of the reality of cancer; the commitment of the Ministry of Public Health in this fight is unavoidable. The WHO Regional Director for Africa said in 2016: "Governments and development partners have a shared responsibility to raise awareness to dispel prejudices and misconceptions about cancer and to promote change in health, lifestyles and behaviors related to risk factors for this disease.
In many sub-Saharan Africa countries including the DRC, the incomprehensible absence of a national cancer registry, statistics and an official cancer control program is an anomaly that must be corrected without delay (10). There is indeed a need to organize treatment in oncology; this presupposes, among other things, the training of health professionals in the management of cancer; a development of structures adapted to care; the organization of information campaigns aimed at the general public; mobilization of financial resources; accessibility to anticancer drugs, as I dream, of the HIV antiretroviral model.
The role of the university seems obvious. And the “I am and I will “theme is timely, as cancer is a growing cost in our country in terms of human lives; it is urgent to organize its care.
Version française
Certains feront allusion à des signes de temps qui…réveillent : les cancers occupent les publications scientifiques, les médias et notre quotidien.
Le prix Nobel de la médecine et Physiologie, décerné, en octobre dernier, à un Américain, James Allison, et un Japonais, Tasuku Honjo, viennent consacrer la découverte du « traitement du cancer par inhibition de la régulation immunitaire négative ». Leurs travaux sur l’Immunothérapie dans le cancer ouvrent ainsi une voie prometteuse dans la prise en charge de cette pathologie effroyable.
La lutte contre le cancer est célébrée tous les 4 février ; pour 2019 et les 2 années à venir. L’organisation mondiale de lutte contre le cancer, l’UICC (Union for International cancer control), a retenu comme thème : « I am and I will ». I am, Je suis… conscient de la réalité du cancer, je suis concerné,… et I will, Je vais…m’informer, m’impliquer, sensibiliser, communiquer,…sur le cancer. Un thème résolument dans l’action et qui rencontre une volonté mondiale d’une mobilisation tous azimuts.
La réalité du cancer dépasse en effet, les frontières et représente un évident problème de santé publique dans nos différents pays. Et ce fléau mondial n’épargne personne du fait de son âge, de son sexe, de sa race, de sa religion, de son état de richesse ou de pauvreté.
Dans le monde entier, il est constaté une augmentation régulière de la prévalence des cancers toutes spécialités confondues. Et son corollaire, une mortalité liée au cancer qui ne cesse d’augmenter. Le nombre de nouveaux cas de cancer dans le monde est passé de 14 millions en 2012 à 18,1 millions en 2018, et le nombre de décès de 8,2 millions à 9,6 millions (1). En occident, le cancer, première cause de mortalité, est responsable de plus de la moitié des décès, même si celle-ci y est en baisse (2). Le rôle de l’université paraît ainsi évident. Et Le thème I am and I will arrive à propos, tant le cancer représente, dans les pays d’ASS, un coût de plus en plus important en termes de vies humaines ; Il devient urgent d’organiser sa prise en charge.