Cancer is a non-communicable disease, yet more women in South Africa are succumbing to breast cancer and cervical cancer than they are succumbing to HIV.
This was revealed by Noelene Kotschan, chief executive and founder of PinkDrive, a non-governmental organisation (NGO) focusing on cancer awareness and early detection to save lives.
She was speaking in light of World Cancer Day under the theme ‘United by Unique’ — a campaign, which focuses on a people-centred approach to cancer care.
The World Health Organization estimated that the number of new cancer cases was 20 million in 2022, with 9.7 million deaths globally.
According to the National Cancer Registry’s 2020 report, the top five cancers in South Africa are breast cancer at 23%, cervical cancer at 16%, prostate cancer at 22%, colorectal cancer at 4.5% in women and 6% in men, and lung at 4% in men.
The rising prevalence of cancer is driven by multiple factors, including an aging population, lifestyle changes, and environmental exposures.
Kotschan, whose PinkDrive’s objective is to try not to have South Africans succumb to a disease that if treated early can be cured, said the state needs to invest in the NGOs on the ground.
“We are not getting any funding from the Department of Health. Yet, what we are doing is what the government of the day should be doing for its citizens. By taking health screening — regardless of what that screening is — to where the people live is what’s going to make the difference and help alleviate the backlogs at the secondary or tertiary hospitals.
“And that is what the government wants to do from a National Health Insurance (NHI) perspective, but if they can’t get this right — how do they want to deliver on the NHI?
“Basically, we’ve been doing the NHI from inception. So, we are totally dependent on other international governments, other philanthropic organisations, corporate South Africa, and individuals in South Africa to help fund us so that we can deliver the services that the government should actually be delivering,” Kotschan said.
On Tuesday, Deputy Minister of the Department of Health Dr Joe Phaahla was joined by Gauteng MEC for Health and Wellness, Nomantu Nkomo-Ralehoko; Kotschan; leaders and representatives from other stakeholders during the World Cancer Day national event held at the Slovoville Clinic and Recreation Centre, in Soweto.
Phaahla said the department and other organisations like PinkDrive, have screening programmes that are available at their facilities for breast, cervical, lung and prostate cancers.
He added that despite the strides made in awareness and screening, South Africa continues to face significant challenges in the fight against cancer.
“Long travel distances to hospitals, inadequate infrastructure, and long queues at our health facilities caused by our underfunded health system further delay timely diagnoses and interventions. Late presentation at facilities, causing late-stage diagnosis, is another challenge and remains a significant issue in our country. By the time these patients are diagnosed, the cancer is often at an advanced stage, making treatment more difficult and thus reducing chances of survival,” Phaahla said.
He added that the National Department of Health funds provinces including Gauteng by means of a conditional grant, the National Tertiary Services Grant, to improve service delivery for all tertiary health care services since April 2002.
He emphasised the importance of expanding access to healthcare services, particularly in rural and underserved communities.
“The good news is that many cancers can be prevented through lifestyle changes. Quitting smoking, reducing alcohol intake, eating a balanced diet rich in fruits and vegetables, and staying physically active can significantly lower our risk of getting cancer. Maintaining a healthy weight is equally important, as obesity is linked to several types of cancer,” he said.
Role of nuclear medicine in treating cancer
Professor Mariza Vorster, head of Nuclear Medicine at the University of KwaZulu-Natal and at the Inkosi Albert Luthuli Central Hospital, said with regards to targeted alpha therapies as offered by Nuclear Medicine, South Africa is among the leaders globally.
“Ac-225-based targeted radionuclide therapy was first offered at Steve Biko Academic Hospital and then followed by Inkosi Albert Luthuli Central Hospital, joining only a handful of centres offering this type of therapy globally.”
However, she noted that the country still has a long way to go to provide adequate access to appropriate forms of treatment, sufficient infrastructure, and adequately trained staff and funding.
She added that the most robust evidence available regarding the use of targeted radionuclide therapy exists for the treatment of patients with thyroid cancer, prostate cancer, and neuroendocrine tumours.
“Usually we treat patients that have advanced stage, widespread cancer which has not responded to more traditional forms of therapy (such as chemo and radiation therapy). Such patients are typically referred by oncologists, urologists, endocrinologists, and pediatricians and start with an imaging investigation at our department.”
She said treatment is provided on an out-patient basis and consists of a slow intravenous injection over a few minutes. Patients are able to go home the same day and the next dose is usually given two months later.
In total, patients usually undergo four-six injections (with two-month intervals). Side effects are usually minimal with many patients reporting improvement in their quality of life with less pain and increased mobility.
The early and correct staging of cancer is crucial in assigning patients to the most appropriate form of treatment, she said.
KwaZulu-Natal has one nuclear medicine department (Albert Luthuli) in the public sector that is able to provide a PET/CT service and targeted radionuclide therapy, while Gauteng has five. KZN also receives patients from parts of the Eastern Cape.
She said in the private sector, funding for targeted radionuclide therapies is often not available through medical aids either, based on overly stringent requirements for expensive, multi-centre, and randomised trials.
The medicine used for radionuclide therapy, though imported, is given for free at public institutions, and due to limited funding, there is a waiting list for patients who need treatment.
Vorster said: “We have recently opened a cost centre via the University of KwaZulu-Natal, where interested parties may donate money towards obtaining radionuclide-based treatments for our cancer patients.”