Downstaging cancer in rural Africa

Cancer is usually diagnosed late in rural Africa leading to incurability and abbreviated survival. Many curable cancers present on the body surface, often recognizable early by laymen as suspicious, justifying professional referral. Cancer diagnoses in two randomly chosen Tanzanian villages were compared after conventional dispensary self-referral vs. proactive visits in the home. Village navigators organized trips for professional consultation. In the control village 21% were self-referred, 20% of them were sent on as suspicious, 78% had cancer (8% in men) 0.9% of the village population. In the intervention village 99% were screened, 14% were referred for professional opinion, 93% had cancer (32% in men) 1.6% (p-<-0.01 compared with control village). In the second and third years similar activity yielded 0.5% cancer annually in the control village for a 3 year total of 1.86% whereas interventional villagers had 1.4% and 0.6% cancer for a 3 year total of 3.56% (p-<-0·001). Downstaging was recognized in the second and third years of intervention from 23 to 51 to 74% Stages I and II (p-<-0.001) but in the control village Stages I and II changed from 11% to 22% to 37% (p-=-NS). The greatest downstaging occurred in breast and cervix cancers. What's new? High cancer mortality in Africa is associated with an array of factors, including deficiencies in public education and health resources, which are likely to persist for decades to come. In the interest of effecting cancer control quickly and by economically practicable means, the authors of the present investigation in Tanzania compared routine self-referral against proactive visitation by health aides trained in the identification of suspected lesions. Significant improvement toward earlier cancer diagnosis was observed in the village where proactive visitation was implemented. Proactive referral could significantly improve the effectiveness of therapy, leading to reductions in cancer mortality in Africa.