Efforts of MKU 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. This is 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. The team 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.
