- KNH cancer patients are getting younger by day and most come in when the disease has advanced, reducing their chances of surviving five years after diagnosis.
- An obese generation, eating poor diets low in fibre, and sedentary lifestyles may be partly to blame, but experts say doing local research instead of relying on Western studies where patients’ genetic composition differs from Africans will help the continent understand cancer better.
Stomach, colon, rectum, breast, and cervical cancers were typically considered diseases of the old, with most cases diagnosed in Kenyans over 50 years.
But oncologists at Kenyatta National Hospital (KNH), which treats a majority of cancer patients in Kenya, are recording a worrying trend — the patients are getting younger by day and most come in when the disease has advanced, reducing their chances of surviving five years after diagnosis.
In research conducted for five years by Dr Mohamed Maalim, a physician, and a team of oncologists, 413 patients with stomach cancer, which is also known as gastric cancer were reviewed.
Most of the patients were in their 50s.
“This is one or two decades younger than patients in Asia and Europe,” said Dr Maalim at the Kenya International Cancer Conference held two weeks ago.
“About 30 per cent of the patients were less than 50 years, which is a new trend as a previous study had shown no patients below that age,” he said.
Stomach cancer cases in Kenya are growing. With an estimated 2,127 new cases and 2,068 deaths every year, Kenya has the highest numbers in Africa.
“Gastric cancer is occurring in younger patients, and they are mainly diagnosed with aggressive disease that has spread to nearby tissues,” said Dr Maalim.
To blame is the inadequate screening tests like endoscopies, which can identify and treat lesions before cancer develops, low awareness, and few gastroenterologists.
Stomach cancer starts with persistent abdominal pain and vomiting. Others lose weight. Anaemia was present in over 60 per cent of the patients reviewed. H pylori infection is also a major cause of stomach cancer.
These symptoms could signal any disease and patients are misdiagnosed with digestive illnesses as cancer progresses if endoscopy services and specialists are not available. “Stage 3 and stage 4 cancers amounted to over 70 per cent of the patients in the study,” adds Dr Maalim, making the treatment expensive and the disease less curable.
From the research, the younger patients below 40 had a worse survival rate, and the disease had metastasised to other body organs.
The pattern is quite similar to colon and rectum cancer.
Dr Andrew Odhiambo, an oncologist, also says colon and rectal cancer is increasingly affecting younger patients in Kenya.
In research that he studied 357 colorectum patients at KNH, more than 40 per cent were aged below 50 and most were men. This is a fairly young age compared to patients in the West.
“The younger patients tend to have aggressive disease. About 38 per cent of the patients were diagnosed when the disease had progressed. The size of the tumour and if the disease has spread significantly affects survival and cost of treatment,” said Dr Odhiambo, who was the chair of the cancer conference that brought together experts from Africa to chart a new path for management of the disease on the continent.
The records that he reviewed over five years showed that the patients had blood in their stool, abdominal pain, changes in bowel movement, and the intestines were obstructed.
Colon cancer is more common in men with about 1,400 Kenyans getting it every year and 900 diagnosed with rectum cancer, according to the World Health Organisation’s Globocan data.
An obese generation, eating poor diets low in fibre, and sedentary lifestyles may be partly to blame, but experts say doing local research instead of relying on Western studies where patients’ genetic composition differs from Africans will help the continent understand cancer better.
Africans have also been underrepresented in cancer drugs clinical trials.
“We need to understand why this is happening in young people so that we can prevent it,” said Dr Odhiambo. “For instance, from the surgery reports, we found that most of the disease had affected the left side of the patients’ colon and rectum but the right-sided disease may be undiagnosed,” he said.
Colon and rectum cancers begin with persistent constipation, cramps, bloating, unexplained weight loss, blood in the stool, and fatigue. But because of low awareness, the signs are overlooked as people think they are too young to get cancer.
Also, doctors do not consider checking for certain types of cancer in patients who are in their 20s and 30s.
Eunice Mwende was diagnosed with breast cancer at 23. Before that, many clinicians had brushed off her fears of having a breast lump.
“The first time I went to the hospital, a nurse told me she couldn’t feel the lump yet I could. I went on with life until one day I saw that my breast looked bigger and the lump was visible from the skin,” she says.
“It took me seven months, going to four different clinics and one big hospital to get a diagnosis.”
Cancer ruled out
Ms Mwende, now 27, says the problem in diagnosing young adults is that nothing in the cancer checklist ticks off.
“I was asked if cancer runs in my family. I said no. Was I obese? No. I was weighing 37 kilogrammes then, which is underweight. Was I over 40 years? No. So the doctors ruled out cancer,” she says.
She also did not suspect because she believed breast cancer affects older women in the 50s.
“Young men and women know little or nothing about breast cancer yet there is a lot of data and research about the disease and its risks. For instance, why aren’t girls made aware early that some hormonal contraceptives increase the risk of breast cancer or about genetic testing for those with a family history?” says Ms Mwende.
“After cancer, I started reading a lot. I’ve read that diet also comes to play. But who has ever told young people about eating foods high in antioxidants such as berries? I wish I knew about these.”
How doctors deal with younger patients also poses another challenge.
“When a doctor offers no counselling or doesn’t recommend a support group you’ll never realise you’re not alone. Or if she blatantly tells you that you have one year to live, does she expect you to go on with treatment? Most times young people do not have medical insurance, so one wonders, why make her family struggle fundraising and she’s dying soon?” she says.
At the time of the diagnosis, Ms Mwende was told the breast cancer was at stage zero.
That was in 2016. The disease was still within the milk ducts. She did a lumpectomy, a surgeon cutting a small breast tissue, but months later a test showed more cancerous lumps and she opted for the total removal of her right breast.
Last December, at a time that she thought all was behind her, she found a new lump under the scar.
“The doctor thought it was a non-cancerous cyst until I noticed swollen lymph nodes in the neck. A PET scan showed new cancer cells in the same side of the mastectomy site, and it had spread to my lungs,” she says.
Traditionally, stage zero ductal carcinoma in situ, a type of breast cancer that is most common in Kenyan patients, was treated with mastectomy, which is the total excision of the breast.
But with advances in surgery, surgeons have been conserving the breast guided by technology which marks the cancerous areas. Yet these traditional treatments, in some cases, seem ineffective to wipe out the cancerous cells.
“My doctor was shocked, she couldn’t understand how a stage zero cancer jumped to stage 4 yet I had done mastectomy and I was taking Tamoxifen drugs [which reduce the risk of early-stage breast cancer coming back after surgery and other treatments]. But the prognosis is good. I have no pain at all. Scans show the chemotherapy treatment is working, the tumours have shrunk,” says Ms Mwende.