Infection-related cancers worry medics

Infections like malaria, HIV, Hepatitis B, Human Papilloma Virus (HPV) and typhoid are the leading cause of cancers in Uganda, Dr Fred Okuku, a medical oncologist at Uganda Cancer Institute (UCI) has revealed.

These cancers include Burkitt’s lymphoma, associated with malaria and affects children between four and seven years, Kaposi's sarcoma caused by the Human Herpes Virus 8 (HHV8) whose risk increases dramatically in people with HIV infection and Hepatocellular Carcinoma (cancer of the liver) caused by the Hepatitis B Virus (HBV).

According to Dr Okuku, the HBV is a hundred times more infectious than HIV and out of 100 people who get infected with it, 70% will be affected with cancer of the liver and 30% will have dry livers.

Other infection-related cancers are blood, cervical, bladder and stomach cancers.

Last year, UCI recorded a total of 2,800 patients with infection-related cancers, accounting for more than 50% of the cancer burden in the country. Children with frequent malaria that is not treated promptly are at a higher risk of acquiring the Epstein-Barr virus that causes Burkett’s lymphoma, a potentially fatal and disfiguring virus that often develops in the jaw or abdomen.

Seven-year-old Diana was among the new incidence cases of Burkitt’s lymphoma that was recorded at the institute last year. At the age of four, her chest was swelling at an uncontrollable rate and her breathing was a staccato rhythm. 

After being tested, it was discovered that her heart was twice its normal size and surrounded with fluid. This complicated her breathing. Meanwhile, she was afflicted with malaria and it was later discovered that she was infected with HIV.

Three years later, she is battling Burkitt’s lymphoma that has not only left her abdomen swollen, but left her struggling to keep her ailing body in check. Everyday, she lives off oxygen for breath and is being supported by Bless a Child foundation, a local NGO helping children afflicted with cancer to access treatment.

 “Some of these children are still treated with Chloroquine and despite the fact that it is resisted by most people’s bodies. By the time they come for treatment, their immunities are already weakened and susceptible to cancer,” Dr Okuku says.

Also, the local herb omululuza, a cheap resort for many has been discovered to reduce blood sugar thus damaging the genes (mutations) and immunity. Others, however, believing that they have been bewitched, resort to witchdoctors who cut their skin to insert medicine to avert the ‘bad omen.’ This exposes one’s body to infections which may be an onset of cancer.

Cancers caused by infections generally have a higher mortality rate than other cancers, according to a study on these cancers published in the journal, Lancet Oncology.  Of the 7.5 million deaths from cancer worldwide in 2008, approximately 1.5 million were due to infections.

The research further reveals that 70% of infection-related cancer deaths occur in low- and middle-resource countries, 50 % of which are in sub-Saharan Africa, often placing the disease burden on health systems that are least equipped to address it.

By 2020, of the predicted 16 million new cases of cancer every year, 70% will be in developing countries.

“If the infections are not reduced sooner than later, cancer is going to be the next big epidemic in the country,” Dr Okuku warns.

Meanwhile HIV-positive women are at least five times more likely to be diagnosed with cervical cancer and Kaposi sarcoma than uninfected women. Also, research from the U.S. National Cancer Institute indicates that people living with HIV are at a risk of being diagnosed with non-Hodgkin lymphoma (one of the most common to develop in HIV-infected individuals).

Since the advent of HIV, Hodgkin lymphoma has become increasingly common, with a 30% annual increase in incidence in the last 15 years in Uganda.

Solutions

Recommended interventions to interrupt the spread of HBV that is spread mostly from mother to unborn baby is routine vaccination of children and by testing blood for transfusion and destroying infected blood.

 “Cancers like HPV and HBV can be prevented by stopping the spread of infection through vaccination, behaviour change, improving hygiene and sanitation, and treating infection, or finding the cancer caused by the infection very early when cure of the cancer is possible,” Dr Okuku says.

According to Brian Walusimbi, the team leader at Bless a Child foundation, there is need to dispel myths attached to cancer such as cancer being a death sentence and a result of witchcraft.

Thus, there is need for awareness among communities to encourage early diagnosis of the disease.