Cancer is a generic term for a large group of diseases that can affect any part of the body. One defining feature of cancer is the rapid creation of abnormal cells that grow beyond their usual boundaries, and which can then invade adjoining parts of the body and spread to other organs. This process is referred to as metastasis. Metastases are the major cause of death from cancer.
Lung, prostate, colorectal, stomach, and liver cancer are the most common types of cancer in men, while breast, colorectal, lung, uterine cervix, and stomach cancer are the most common among women.
Tobacco use, alcohol use, unhealthy diet and physical inactivity are the main cancer risk factors worldwide. Some chronic infections are risk factors for cancer and have major relevance in low- and middle-income countries. Cancer-causing viral infections such as Hepatitis B (HBV), hepatitis C virus (HCV) and some types of Human Papilloma Virus (HPV) are responsible for up to 20% of cancer deaths in low- and middle-income countries.
Cancer arises from one single cell. The transformation from a normal cell into a tumour cell is a multistage process, typically a progression from a pre-cancerous lesion to malignant tumours. These changes are the result of the interaction between a person's genetic factors and 3 categories of external agents, including:
  • physical carcinogens, such as ultraviolet and ionizing radiation;
  • chemical carcinogens, such as asbestos, components of tobacco smoke, aflatoxin (a food contaminant) and arsenic (a drinking water contaminant); and
  • biological carcinogens, such as infections from certain viruses, bacteria or parasites.
Ageing is another fundamental factor for the development of cancer. The incidence of cancer rises dramatically with age, most likely due to a build up of risks for specific cancers that increase with age. The overall risk accumulation is combined with the tendency for cellular repair mechanisms to be less effective as a person grows older.

Early detection

Cancer mortality can be reduced if cases are detected and treated early. There are 2 components of early detection efforts: 1.Early diagnosis The awareness of early signs and symptoms in order to get them diagnosed and treated at early stage. Early diagnosis is particularly relevant when there are no effective screening methods or – as in many low-resource settings– no screening and treatment interventions implemented. In absence of any early detection or screening and treatment intervention, patients are diagnosed at very late stages when curative treatment is no longer an option. 2.Screening Screening aims to identify individuals with abnormalities suggestive of a specific cancer or pre-cancer and refer them promptly for treatment or when feasible for diagnosis and treatment. Examples of screening methods are:
  • visual inspection with acetic acid (VIA) for cervical cancer in low-resource settings;
  • HPV testing for cervical cancer;
  • PAP cytology test for cervical cancer in middle- and high-income settings;
  • mammography screening for breast cancer in high-income settings.

Treatment

A correct cancer diagnosis is essential for adequate and effective treatment because every cancer type requires a specific treatment regimen which encompasses one or more modalities such as surgery, and/or radiotherapy, and/or chemotherapy. The primary goal is to cure cancer or to considerably prolong life. Improving the patient's quality of life is also an important goal. It can be achieved by supportive or palliative care and psychological support.

Palliative care

Palliative care is treatment to relieve, rather than cure, symptoms caused by cancer. Palliative care can help people live more comfortably. It is particularly needed in places with a high proportion of patients in advanced stages where there is little chance of cure. Relief from physical, psychosocial and spiritual problems can be achieved in over 90% of advanced cancer patients through palliative care.
Breast cancer is the top cancer in women worldwide and is increasing particularly in developing countries where the majority of cases are diagnosed in late stages.
Several risk factors for breast cancer have been well documented.
  • A familial history of breast cancer increases the risk by a factor of two or three. Some mutations result in a very high risk for breast cancer. However, these mutations are rare and account for a small portion of the total breast cancer burden.
  • Reproductive factors associated with prolonged exposure to endogenous estrogens, such as early menarche, late menopause, late age at first childbirth are among the most important risk factors for breast cancer. Exogenous hormones also exert a higher risk for breast cancer. Oral contraceptive and hormone replacement therapy users are at higher risk than non-users.
  • Diet, alcohol use, overweight and obesity, physical inactivity, infections, environmental pollution, occupational carcinogens, and radiation.
Comprehensive cancer control involves prevention, early detection, diagnosis and treatment, rehabilitation and palliative care.

Prevention

Control of specific modifiable breast cancer risk factors as well as effective integrated prevention of non-communicable diseases which promotes healthy diet, physical activity and control of alcohol intake, overweight and obesity, could eventually have an impact in reducing the incidence of breast cancer in the long term.

Early detection

Although some risk reduction might be achieved with prevention, these strategies cannot eliminate the majority of breast cancers that develop in low- and middle-income countries. There are two early detection methods:
  1. Early diagnosis - Awareness of early signs and symptoms in symptomatic populations in order to facilitate diagnosis and early treatment remains an important early detection strategy, particularly in low- and middle-income countries where the diseases is diagnosed in late stages and resources are very limited.
  2. Screening - This is the systematic application of a screening test in a presumably asymptomatic population. It aims to identify individuals with an abnormality suggestive of cancer. A screening programme is a far more complex undertaking that an early diagnosis programme.
    • Mammography screening - Mammography screening is the only screening method that has proven to be effective. Mammography screening is very complex and resource intensive.
    • Breast self-examination (BSE) - The practice of BSE has been seen to empower women, taking responsibility for their own health. Therefore, BSE is recommended for raising awareness among women at risk.
There are several ways to treat breast cancer, depending on its type and stage.
  1. Treatments that are more likely to be useful for earlier stage (less advanced) cancers:
    • Surgery
    • Radiation therapy
  2. The use of drugs that can reach cancer cells anywhere in the body:
    • oChemotherapy
    • Hormone therapy
    • Targeted therapy
A combination of more than one type of treatment is common.
Cervical cancer is the second most common cancer in women living in less developed region. In developing countries, limited access to effective screening means that the disease is often not identified until it is further advanced and symptoms develop. In addition, prospects for treatment of such late-stage disease may be poor, resulting in a higher rate of death from cervical cancer in these countries.
Nearly all cases of cervical cancer can be attributable to HPV infection. HPV is mainly transmitted through sexual contact and most people are infected with HPV shortly after the onset of sexual activity.
HPV infections usually clear up without any intervention within a few months after acquisition, and about 90% clear within 2 years. A small proportion of infections with certain types of HPV can persist and progress to cancer. It takes 15 to 20 years for cervical cancer to develop in women with normal immune systems. It can take only 5 to 10 years in women with weakened immune systems, such as those with untreated HIV infection.
Symptoms of cervical cancer tend to appear only after the cancer has reached an advanced stage and may include:
  • irregular, intermenstrual (between periods) or abnormal vaginal bleeding after sexual intercourse;
  • back, leg or pelvic pain;
  • fatigue, weight loss, loss of appetite;
  • vaginal discomfort or odorous discharge; and
  • a single swollen leg.
More severe symptoms may arise at advanced stages.
  • Early first sexual intercourse
  • Multiple sexual partners
  • Tobacco use
  • vaginal discomfort or odorous discharge; and
  • Immune suppression (for example, HIV-infected individuals are at higher risk of HPV infection and are infected by a broader range of HPV types)
Cervical cancer screening is testing for pre-cancer and cancer among women who have no symptoms and may feel perfectly healthy. When screening detects pre-cancerous lesions, these can easily be treated and cancer avoided. Screening can also detect cancer at an early stage and treatment has a high potential for cure. There are 3 different types of screening tests are currently available:
  • conventional (Pap) test and liquid-based cytology (LBC)
  • visual inspection with Acetic Acid (VIA)
  • HPV testing for high-risk HPV types.
Because pre-cancerous lesions take many years to develop, screening is recommended for every woman from aged 30 to 49 at least once in a lifetime and ideally more frequently.
There are currently 2 vaccines which protect against both HPV 16 and 18, which are known to cause at least 70% of cervical cancers. The vaccines may also have some cross-protection against other less common HPV types which cause cervical cancer. Both vaccines work best if administered prior to exposure to HPV. Therefore, it is preferable to administer them before first sexual activity. The vaccines cannot treat HPV infection or HPV-associated disease such as cancer. HPV vaccination does not replace cervical cancer screening.
Common types of treatments for cervical cancer include:
  • Surgery
  • Radiation therapy
  • Chemotherapy (chemo)
  • Targeted-therapy
  • For the earliest stages of cervical cancer, either surgery or radiation combined with chemo may be used. For later stages, radiation combined with chemo is usually the main treatment. Chemo (by itself) is often used to treat advanced cervical cancer.
Prostate cancer is the second most common cancer in men and is the fifth leading cause of death from cancer in men, with the number of deaths from prostate cancer larger in less developed than in more developed regions. Mortality rates are generally high in predominantly black populations such as Sub-Saharan Africa. http://globocan.iarc.fr/old/FactSheets/cancers/prostate-new.asp
Several risk factors for breast cancer have been well documented.
  • Age: the chances of having prostate cancer increases rapidly after age 50.
  • Family History/ Genes: Prostate cancer seems to run in some families. A small number of cases of prostate cancer can be linked to several inherited genes that raise a risk of developing this cancer.
  • Diet: Men who eat a lot of red meat or high-fat dairy products have a slightly higher chance of developing prostate cancer than those who eat more fruits and vegetables
  • Obesity
  • Lack of exercise
Symptoms are not always present with prostate cancer. When they are present, the most common symptoms include:
  • Urinary Problems
  • Erectile dysfunction
  • Blood in the urine or semen
  • Frequent pain in the lower back, hips, or upper thighs
Digital rectal exam (DRE) and blood tests are conducted to measure prostate-specific antigen (PSA) levels. If the results are not normal, one may also undergo a transrectal ultrasoundand transrectal biopsy.
Treatment options vary, depending, in part, on age, stage of the disease, and doctor’s recommendations. Treatment options may include:
  • Active surveillance
  • Surgery
  • Radiation therapy
  • Hormone therapy
  • Chemotherapy
http://www.prostate.com/patient/ProstateCancerTools/ProstateCancerFAQs.aspx
These reproductive cancers are the most common cancers in Kenya, with Breast Cancer affecting 34 per 100,000 of the population, Cervical Cancer affecting 25 per 100,000 of the population, and Prostate Cancer affecting 17 per 100,000 of the population. (Kenya Network of Cancer Organizations).
  • The National Cancer Control Strategy (2011-2016) defines the interventions to be used to ensure health rights of those at risk and those suffering from cancer.
  • The Cancer Prevention and Control Act (2012) establishes a Cancer Institute with a Board to oversee implementation of cancer prevention and control measures.
  • The National Guidelines for Cancer Control (2013) provide management options for selected cancers.
  • Due to their great contribution to the burden of disease, the reduction of breast, cervical and prostate cancer incidences and resulting mortality rates has been placed on the country's national agenda. This led to the development of National Guidelines for Prevention and Management of Cervical, Breast, and Prostate Cancers (2012).
  • The National Health Sector Strategic and Investment plan 2013-2017 defines the various partners in health sector as the State actors, non-state actors, external actors and clients.
Despite the conducive policy environment, some gaps still exist in the implementation of effective interventions partly due to lack of information and illiteracy. The Beth Mugo Cancer Foundation seeks to compliment what the government is doing as per the laid down policy.
There is lack of information about cancer among the public, in terms of the precautionary measures to be taken to ensure early detection or what lifestyle to adopt to avoid or reduce cancer risk. Cancer is also one of those taboo illnesses that result in stigma further negatively influencing seeking conventional management by poor rural grassroots women and men. As such, a significant proportion of the population may be unaware of the causes, prevention measures and treatment options for breast, cervical and prostate cancer, as well as how to access various services, thus making them more vulnerable to the effects of these diseases. Women in Kenya face even more obstacles in accessing education due to domestic expectations as well as retrogressive cultural practices such as forced early marriages and Female Genital Mutilation (FGM). Furthermore, due to female underrepresentation in decision-making, women encounter barriers in having their needs addressed and accessing vital information, especially in rural areas. The Beth Mugo Cancer Foundation strives to enhance targeted awareness creation while simultaneously enabling those empowered through the foundation to disseminate the knowledge to their families to others in wider society.
Although Kenya is one of the fastest growing economies in Africa, characterized by improved economic and fiscal policies, almost half of the country’s population lives below the poverty line. Women are especially more susceptible to the devastating effects of poverty due to socio-cultural discriminatory practices that limit their opportunities to generate income and achieve financial independence. As a result, quality health care for a significant number of people, especially in rural areas, is unaffordable. Evidently there is a need for alternative sources of funding for them to access costly specialized cancer services, which The Beth Mugo Cancer Foundation will seek out.
Over the years, the health sector in the country has concentrated on communicable diseases and made minimal investment into the management of critical chronic diseases such as cancer. As a result there are limited facilities that provide comprehensive cancer management in Kenya. Further, management of cancer is long term requiring expensive equipment and medicines. The only public institution, Kenyatta National Referral and Teaching Hospital, is not only inadequate in terms of infrastructure but also in terms of human capacity. Therefore, even in cases where costs can be met, patients may be unable to receive care merely due to insufficient facilities, equipment, and personnel. This leads to long waiting time for treatment such as radiotherapy with the cancer progressing to incurable stages. If capacitated, most regional referral hospitals can handle early cases to leave the national referral facilities to handle complicated cases. The Beth Mugo Cancer Foundation aims to contribute towards strong programs to enhance the health sector’s capacity for prevention and early detection of cancer, coupled with decentralized care, treatment and community mobilization.