Lung cancer remains a major public health problem in Africa, with substantial socioeconomic and disease burdens. It is the ninth most common cancer worldwide, making up 11.4% of all new cases of cancer. Its burden and management in Africa, particularly Nigeria and the West African subregion, present peculiar challenges.

Prevalence and Incidence

Lung cancer contributes about 1.4% of all new cancer patients in Nigeria, ranking as the 14th newly diagnosed cancer. This is significantly lower compared to countries like the United States and the United Kingdom, where lung cancer is the third most common malignancy. Late presentation of the disease, minimal diagnostic facilities, and poor accessibility to treatment are among the key reasons that cause high mortality rates in the West African subregion.

Challenges in Diagnosis and Treatment

One of the greatest challenges to the management of lung cancer in Africa remains underdiagnosis. The lack of a specific lung cancer registry with inexact data from other cancer registries hinders effective intervention and treatment planning. Patients usually present in the advanced stage of disease, and curative treatment becomes impossible. For example, in a Nigerian study, more than 90% of lung cancer patients presented with the disease in an advanced stage. These limitations in therapy are compounded by the lack of surgical facilities and high costs for newer, more effective drugs. However, radiotherapy is rarely available and forms an integral part of lung cancer management; only a few functional units exist in the country. Misdiagnosis by the healthcare workers of lung cancer as pulmonary tuberculosis also complicates accurate reporting and case management.

Risk Factors

Several genetic and environmental risk factors are associated with lung cancer in Africa. Tobacco smoking is identified as one of the major risk factors, despite the disparity in the odds ratios for the regions. Recent studies in Nigeria estimate that the odds of smoking induced lung cancer are lower than in North and South Africa, although another variable factor of occupational exposures is asbestos and industrial pollutants-roles generally are much lower compared to that of tobacco. Other identified significant risk factors include environmental factors predisposing to indoor air pollution related to the usage of coal in cooking as well as outdoor pollution related to the emission of industrial pollutants. This risk is, however, relatively less as compared to that with tobacco smoking. Infection-associated predispositions, such as HIV, have also been implicated in lung cancer development, and evidence from Nigeria failed to show any significant association.

Recommendations for Improvement

In order to address the current inadequacies in lung cancer management in Africa, the following is proposed:

• Lung Cancer Registries: There is a compelling need for an effective, well-coordinated registry for lung cancer in Nigeria and indeed the whole of the West African subregion to collect proper data for proper intervention planning.

• Up-gradation in diagnostic facilities: Increasing access to diagnostic facilities and training of healthcare workers to recognize the initial signs and symptoms of the disease can help in its early detection and treatment.

• Commitment of the Government towards Health: Governments in West Africa need to allocate their resources to 15% of the GDP for increased health care infrastructure and access, in accordance with the agreed WHO/Abuja Declaration.

• Public Awareness Campaigns: In addition, public awareness campaigns that increase knowledge on the risk factors and early warning signs of lung cancer in a population can help encourage early presentation and diagnosis.

• Research on Local Risk Factors: Local studies on risk factors, especially among younger populations, are likely to offer specific preventive measures tailored to a region.

• Universal Health Insurance: This will greatly cushion the patients financially and provide easier access to basic treatments for lung cancer.

If these challenges are addressed and the aforestated measures are implemented, lung cancer management in Africa will change by a great proportion, thus lowering the disease burden and bettering patient outcomes.

Source: Journal of the Pan-African Thoracic Society

Review Article Management of lung cancer in Africa: Underdiagnosis and poor access to treatment – A close look at Nigeria and West African Sub-region 

Kelechi E. Okonta1 , Peter C. Echieh2 , Umar Abubakar3 , Lateef A. Baiyewu4 , Onyekwelu C. Nzewi5