In 2012, more than 8 million people died from cancer and 14 million new cases were diagnosed – with well over half the cases and two-thirds of the deaths occurring in low- and middle-income countries (LMICs). By 2030, the global burden is expected to grow to 21.7 million new cancer cases and 13 million cancer deaths. And the burden will be concentrated even more in LMICs, where scarce resources and critical shortages of trained health professionals often prevent patients from accessing the care they need. An estimated 1.9 million to 3 million cancer deaths could be avoided each year in LMICs with effective prevention and treatment.
Every year on February 4 we recognize World Cancer Day to highlight the on-going fight against cancer. World Cancer Day aims to reduce the number of preventable deaths each year by raising cancer awareness among the general public and pressing governments to take further actions to strengthen cancer prevention, control, and treatment.
This year’s theme is I can. We can, highlighting the fact that reducing the global burden of cancer depends on the work and dedication of many, including healthcare providers to prevent and treat cancer. Today, cancer is one of the leading causes of death in sub-Saharan Africa, and cervical cancer, which is almost entirely preventable, ranks as the leading cause of cancer and cancer deaths for African women. East Africa has the highest cervical cancer incidence and mortality rates in the world. Incidence of cervical cancer in the region is 42.7 per 100,000 women, and mortality rates in East African countries range as high as 54 deaths per 100,000 women in Tanzania and 76 per 100,000 in Malawi. In North America, there are less than 7 new cases and 3 deaths per 100,000 women each year. The high incidence and mortality in Africa result in part from a shortage of more than 800,000 health care professionals in the region, which severely limits prevention and treatment of the disease.
Dr. Caroline Damian is one Tanzanian health care provider who is part of the fight. She has seen first-hand the impact that high rates of cervical cancer can have on a community. She also understands that fighting the disease will require the work of many. Today, she is helping to meet that need, by training additional health care providers to prevent and treat cervical cancer.
Dr. Damian wanted to be a doctor from a young age. As a child, Caroline was frequently sick and spent significant time in the local hospital. It was then that she developed an interest in becoming a health care provider. After receiving her Master’s of Medicine in Obstetrics and Gynecology, she went to work for the Medical Women’s Association of Tanzania (MEWATA) as a Program Manager. There she managed a cervical cancer initiative that focused on raising community awareness, increasing training for health care providers, and organizing cervical cancer screening campaigns. The campaigns reached more than ten thousand women across three regions in Tanzania. But as Dr. Damian observes, “Screening is not a part of the routine and has not been integrated into primary care.” While Tanzania has made great strides in recent years by training health professionals in the simple techniques to screen and treat cervical pre-cancer and provide screening through mass campaigns, most women at risk have not yet been tested. And as the country looks to increase access to screening services they can encounter other challenges, as Dr. Damian states, “then there is the issue of training providers, the capacity of the facilities to conduct services…”
After working for MEWATA, Dr. Damian returned Muhimbili National Hospital as a faculty member and clinical OB/GYN lead for the entire region. There she saw that the cervical cancer unit was only seeing a few patients despite the high rates of cervical cancer in the region. As a result, Dr. Damian and her colleagues in Dodoma Region, are working to increase access to life-saving screening and treatment for women, “We are creating awareness in the region so we get more women screened for cervical cancer”
One focus of this work involves increasing the number of health providers trained in a simple technique to prevent cervical cancer. Along with GHSP Nurse Educator, Elisa Vandervort, Dr. Damian conducted a cervical cancer screening refresher course for hospital staff. Together with their local colleagues, they are planning mass screening and treatment activities for women in the surrounding community. This team is also collaborating with the University of Dodoma and the Tanzanian Ministry of Health to train health professional students in cervical cancer prevention.
In Dodoma Region, Dr. Damian and her colleagues are fighting back against cervical cancer in Tanzania. We anticipate that her determination to share knowledge and skills to prevent cervical cancer will have a lasting impact on the number of diagnoses and deaths from this preventable disease.