Social and other factors associated with the late diagnosis and treatment of cancer in Africa

The late presentation of cancer patients for diagnosis and treatment is one of the major problems confronting effective management of cancer in almost all the developing countries, particularly in Africa. It is recognized that the cancer patient presenting early as we commonly see in the developed countries usually conveys a totally different clinical picture from his counterpart in the developing countries. A typical patient in Africa with a tumour in the head and neck region, for example, usually presents with a huge tumour mass originating from the primary site, with secondary unilateral or bilateral neck nodes. These nodes are often very large and sometimes fungate with infected and malodorous ulcers. He is usually very ill-looking, anaemic, and malnourished. This picture of advanced disease is also true for other sites such as the cervix or breast. Patients with advanced breast cancer have been seen with the anterior chest wall on both sides destroyed by tumour, often with necrotic, infected and foul-smelling ulcers and sometimes with maggots. Soft-tissue tumours, bone tumours and tumours in other sites are usually seen towards the end of their natural course. They present as huge masses often outgrowing their blood supplies. This picture is hardly ever encountered in the developed countries where the majority of the patients presented early for diagnosis and treatment. The occasional late case when seen may be regarded as being too advanced and not suitable for treatment. This study which attempts to quantify the severity of the problem in an African country showed that 92% of the cancer patients presented with late stages 3 and 4 disease. The various factors responsible for the late presentation of cancer patients for diagnosis and treatment are assessed with reference to the experience from Nigeria, one of the largest countries in Africa with a population of 120 million people. Suggestions are offered towards improving this unacceptable situation and ensuring earlier diagnosis and treatment of cancer in Africa. (author). 8 refs, 2 tabs