Editorial: Childhood Cancer in sub-Saharan Africa
Measurement of incidence rates of childhood cancer in Africa is difficult. The study ‘Cancer of Childhood in sub Saharan Africa’ [Stefan C, Bray F, Ferlay J, Parkin DM and Liu B (2017) Cancer of Childhood in sub-Saharan Africa ecancer11(755)] brings together results from 16 population-based registries which, as members of the African Cancer Registry Network (AFCRN), have been evaluated as achieving adequate coverage of their target population. The cancers are classified according to the third revision of the International Classification of Childhood Cancer (ICCC-3) and recorded rates in Africa are compared with those in childhood populations in the UK, France, and the USA.
It is clear that, in many centres, lack of adequate diagnostic and treatment facilities, leads to under-diagnosis (and enumeration) of leukaemias and brain cancers. However, for several childhood cancers, incidence rates in Africa are higher than those in high income countries. This applies to infection-related cancers such as Kaposi sarcoma, Burkitt lymphoma, Hodgkin lymphoma and hepatocellular carcinoma, and also to two common embryonal cancers—retinoblastoma and nephroblastoma. These (and other) observations are unlikely to be artefact, and are of considerable interest when considering possible aetiological factors, including ethnic differences in risk (and hence genetic/familial antecedents).
The data reported are the most extensive so far available on the incidence of cancer in sub Saharan Africa, and clearly indicate the need for more resources to be devoted to cancer registration, especially in the childhood age range, as part of an overall programme to improve the availability of diagnosis and treatment of this group of cancers, many of which have—potentially—an excellent prognosis.
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The African Cancer Registry Network (AFCRN) was formally inaugurated on 1st March, 2012, and succeeded and expanded the activities of the East African Cancer Registry Network (EARN), which had been established in January 2011, thanks to a grant from the Doris Duke Charitable Foundation (USA).
AFCRN is a project of the Cancer Registry Programme of the International Network for Cancer Treatment and Research (INCTR). It is supported financially through The (INCTR) Challenge Fund, a registered UK charity (charity number 1079181) that raises funds for INCTR projects. The Challenge Fund in turn receives donations designated to support cancer registry activities in low and middle income countries.
AFCRN aims to improve the effectiveness of cancer surveillance in sub Saharan Africa by providing expert evaluation of current problems and technical support to remedy identified barriers, with long-term goals of strengthening health systems and creating research platforms for the identification of problems, priorities, and targets for intervention. Support to AFCRN is a recognition of the increasing burden of non-communicable diseases, and especially cancer, in the continent, and the need for adequate surveillance as a fundamental part of any rational programme for cancer control.
Since September 2012, the International Agency for Research on Cancer (IARC), in the framework of its Global Initiative for Cancer Registry Development in Low- and Middle-Income Countries (GICR), has partnered with AFCRN to provide a network Regional Hub for cancer registration in Sub-Saharan Africa.
The role of a regional hub is in:
- providing technical and scientific support to countries;
- delivering tailored training in population-based cancer registration and use of data;
- advocating the cause of cancer registration in the region and facilitating setting up associations and networks of cancer registries; and
- coordinating international research projects and disseminating findings
The role of INCTR is provision of a secretariat and coordinating centre for the Network, which assists in implementing the Programme of Activities.