Cancer in Africa: WBCPC joins the 14th AORTIC Conference

The World Bladder Cancer Patient Coalition joined for the first time the 14^th Cancer in Africa conference in Dakar, Senegal to better understand the realities of bladder cancer patient care in the region. Organised by the African Organisation for Research and Training in Cancer (AORTIC), the conference took place during November 2-6, 2023. The Conference brought together multidisciplinary specialists from the global cancer community focused on efforts to reduce the impact of cancer in Africa.

As a global coalition, the World Bladder Cancer Patient Coalition is committed to building our understanding of bladder cancer impact in Africa. We seek to connect with people affected by bladder cancer in the most affected countries understanding the unique circumstances which affect awareness, incidence, and treatment of bladder cancer. The congress organised by AORTIC, allows us these opportunities so we can ensure that we can work with local and regional partners to address the needs of bladder cancer patients and that no person affected by bladder cancer has to face the diagnosis alone.

The AORTIC Cancer in Africa conference offered wealth of insights on pan-cancer topics to bladder cancer-specific presentations and posters, allowing for deeper insight into the impact of bladder cancer in Africa. WBCPC President Dr Lydia Makaroff captured in great detail the learnings from the conference in this post, and here are some of the highlights from the conference that are directly or indirectly related to bladder cancer:

Bladder cancer pathology in Africa

Dr Mathias Banzi’s poster on muscle-invasive bladder cancer in Tanzania demonstrated that the types of muscle-invasive bladder cancer prevalent in Tanzania differ from those in Europe, with 54% being squamous cell carcinoma (which begins in the flat cells of the bladder and is often linked to chronic inflammation and Schistosomiasis), 6% being adenocarcinoma (which starts in the glandular cells), and 39% being transitional cell carcinoma (which originates from the bladder’s lining and is generally more treatable when detected early).

From Malawi, the BEED (Bladder Cancer Epidemiology and Early Detection in Africa) study in Malawi study conducted by the International Agency for Research on Cancer presented data indicating that 83% of bladder cancer cases were squamous cell carcinoma, 5% were transitional cell carcinoma, and 12% were other or undetermined.

Dr Babacar Sine talked about the profile of bladder tumours in Senegal. Bladder cancer is diagnosed or treated in 2.7 million people around the world and is responsible for 3% of cancers in Senegal. Transitional cell carcinoma has recently emerged as the most prevalent histological type (80%), while squamous cell carcinoma, more common in women and people under 40, accounted for 11%. Just over 78% of tumours were muscle-invasive. He highlighted a shift in the dominant histological type from squamous cell carcinoma to urothelial carcinoma, potentially linked to changes in schistosomiasis infestation and smoking habits. These observations were echoed by Senegal urologist Dr Oumar Gaye.

Schistosomiasis – a major risk factor of bladder cancer

Schistosomiasis, caused by a parasite, is a major risk factor for bladder cancer. It is found in freshwater rivers and lakes and is widespread in sub-Saharan Africa, including 13 out of 14 regions in Senegal. Globally, over 200 million people are affected by Schistosomiasis, predominantly in sub-Saharan Africa, making it one of the most severe endemic diseases in tropical regions.

In Senegal, Schistosomiasis eggs have been found in 14% of bladder cancer cases and showed a significant association with squamous cell carcinoma. In Malawi, when asked about their exposure to unsafe water, 28% of bladder cancer patients had been exposed due to their work in rice farming, and 19% had been exposed due to their work in fishing.

Global efforts, including the work of the Global Schistosomiasis Alliance, demonstrate a commitment to reducing the burden of schistosomiasis. In 2020, despite challenges posed by the COVID-19 pandemic, 77 million people received treatment for schistosomiasis globally, representing a coverage of 32%.

Engaging the community to raise awareness

Dr Sine stressed the need to increase awareness among the Senegalese population about the seriousness of detecting blood in urine.  In Senegal, the average age of people with bladder cancer was 62 years, with approximately 62% of the patients being men and 38% being women. In Malawi, the average age was 54 years, with 41% men and 59% women. There is a notably higher proportion of women diagnosed with bladder cancer compared to Europe, hinting at a possible under-awareness, under-diagnosis, and under-treatment of the disease in men.

In Senegal, blood in pee was the most common presentation of bladder cancer (92%). In Malawi, 73% of bladder cancer patients reported blood in their pee, compared to 25% of similar people without bladder cancer.

In Cameroon, 90% of patients with urological cancers arrive late at treatment facilities, and 20% of these patients discontinue their treatment prematurely. In Senegal, more than half of all bladder cancer patients sought medical consultation within 6 months after the onset of their symptoms, 15% sought medical consultation within 6 to 12 months after the start of symptoms, and 24% delayed seeking medical consultation for more than a year. The median overall survival rate of just 12 months for people with muscle-invasive bladder cancer in Tanzania underscored the need for improved awareness and better treatment.

Learn more about how our Bladder Cancer Awareness Month grants are making a difference in communities in Africa.