By: Aryeh J. Price
Dr. Dennis Laryea is the head of Public Health at the Komfo Anokye Teaching Hospital in Ghana, a public health specialist at the Ghana Ministry of Health, and a lecturer at Kwame Nkrumah University of Science and Technology. He graduated from the KNUST Medical School Kumasi, Ghana. Dr. Laryea’s focus is on integrating public health in clinical practice.
In “Cancer incidence in Ghana, 2012: evidence from a population-based cancer registry”, Dr. Laryea and colleagues provide a proof of principle for the prospect of introducing population-based cancer registries in Ghana and elsewhere in sub-Saharan Africa. The study provides an epidemiological overview of the tumour types observed in Ghana and proposes a model for compiling population-based data on cancers in developing regions.
In the article, you mention that there have been scattered efforts for cancer prevention and establishment of registries in Ghana. How effective have they been so far?
So far the efforts at achieving these are ongoing and with some more commitment and determination, we will see the establishment of adequate numbers of cancer registries in Ghana to provide evidence for cancer prevention and control programmes.
As a researcher in Ghana, what challenges have you faced working and practicing in this setting and culture?
Funding is a major challenge as one would expect for a country with limited resources and several competing health issues. Getting articles published in international journals or presenting at international forums are also challenges as these help bring the issue to the fore and help in establishing international contacts to support both financially and with the expertise to help improve research in Ghana.
What is the public’s perspective on cancer in Ghana? Has it changed in the face of better and more informative data provided by the cancer registries?
Personally, I have not conducted any survey on the public’s perception but there is quite an appreciable level of knowledge on cancer as a disease particularly those of the breast, cervix and prostate for obvious reasons. The level of knowledge particularly with respect to screening and prevention may most likely be low. Our cancer registry is a young one and we have not yet projected the information we have gathered to the general public yet. The concept of cancer registration is quite new even for some health workers so a lot needs to be done to make cancer registries relevant and we are working on that.
The majority of cancers that were histologically diagnosed were moderately differentiated. Does this reflect late presentation by the patients, and what factors may prevent them from seeking care?
The grading of tumours do not relate to the stage at presentation. Histological diagnosis of our cancers is important from the diagnostic perspective as it guarantees the cases we are dealing with are cancers. However, late presentation is still a problem and this must be addressed through appropriate programming
Is there any data available that can explain why females and female-specific cancers are overrepresented in cancer incidence?
Why females are overly represented in the case burden is not clear to us at the moment although I have to say that a similar picture has been found in Nigeria too as we mentioned in the publication. It is one of the issues we want to explore in future.
What kind of treatment is available to patients in Ghana?
Treatment for cancers are available although the spectrum of treatment options may be limited in addition to challenges resulting from the geographical location on facilities with the requisite human resource to deal with such cases. Currently, surgery, chemotherapy, radiotherapy are available.
For those patients who do seek treatment, is there any data on survival? How does it reflect the cancer care being delivered in Ghana?
We have not conducted any survival analysis yet but we have started following up on cases and we hope to publish survival data on cancer cases seen in Kumasi in the near future.
What is preventing the establishment of a national disease database?
I am not very sure what the issues are but I believe the need for a national or regional database on cancers is well known by all concerned. The availability of funding and the requisite human resource can enable this to see the light of day.
What kind of financial and political support is needed to make establishment of cancer registries and data collection more feasible?
Support in the areas of training and provision of logistics for managing data on cancers as well as sensitization of all stakeholders to contribute to effective reporting of cases may be all that is required. The political will has been demonstrated verbally but has not been translated into action in terms of financial support.
You mention that the next steps will be to use the data from the registries to develop cancer prevention and control programs. What kinds of programs do you envision in Ghana?
There is a non-communicable disease control plan for Ghana and this requires data to estimate the burden of disease, monitor progress towards achieving the programme objectives as well as provide basis for research and planning. It is therefore important that more population-based cancer registries are established to ensure the availability of good quality data on cancers in Ghana.