Counting the cost of cancer in South Africa
In common with many other countries in sub-Saharan Africa, South Africa's top cancer killers are cancers of the breast, cervix and prostate. Early screening and treatment could save thousands of lives.
Even when screening does occur, the National Cancer Registry's data has revealed some problems.
"As many as 33% of the women who had a pap smear in Soweto in 2000-2001 were failed," he said. "Two years later, according to a CERG study, they had full blown cervical cancer."
The NCR was established in 1986 and is South Africa's main cancer statistics source; it collates and analyses cancer cases diagnosed in public and private pathology laboratories nationwide and reports annual cancer incidence rates according to sex, age and population groups.
Dr Buddy Modi (Pictured right), Clinical Executive at Bankmed, agreed that South Africa is dominated by preventable cancers and that screening is an issue.
Dr Modi also referred to the high incidence of cervical cancer and breast cancers in South Africa. Together these account for 26% of the cancer deaths recorded in the country.
In men, prostate and testis cancers account for 9.9% of cancer deaths, according to an IMSA NHI Policy Brief. Aids-related cancers, such as Kaposi sarcoma, are also on the rise, accounting for 6.8% of the cancer deaths according to the survey.
"Cancer is a disease of ageing," he said, "so there is a real cost implication for medical schemes. In addition, our current focus is on secondary care: there is a lower than ideal usage of preventative care. It is the secondary care which is driving up the costs of cancer treatment."
Referring to chemotherapy, Dr Modi said that the top 20 drugs account for 75% of the costs incurred. Branded drugs are responsible for 83% of the costs, even though in many instances generic equivalents are available.
Dr Leon Gouws, founder member of the Independent Clinical Oncology Network (ICON) and a cancer survivor, was outspoken about the role of patients in their own care, and criticised the current version of Prescribed Minimum Benefits (PMBs) which he said "deny palliative care".
"What kind of system do we have when those diagnosed with cancer are being driven to bankruptcy?" he asked. "Drugs and expensive technology are being used injudiciously. Our ultimate goal should be to ensure the delivery of the best possible care where it has the biggest impact."
Dr Gouws called for a system of multidisciplinary care, where cancer is treated by a team, each member of which has the experience of their core disciplines.
"It is how we were all taught, and it is how it works in the public sector. But in the private sector, we are not doing this. A multidisciplinary approach gives access to a full therapeutic range and is in accordance with nationally agreed standards."
Dr Gouws also pointed out the problem of access to cancer care.
"Critical staff are skewed towards the private sector," he said, "and together the private and public sectors have capacity to treat just 60% of the population. That leaves 40% without care. We need far more resources, and NHI could be the catalyst to giving more people access to the care they need."
Dr Gouws was particularly distressed by what he called "inappropriate end of life care."
"We are treating patients on their deathbeds. As oncologists we need to acknowledge our role in driving up costs and to lead the way as agents of change," he said.