1. CERVICAL CANCER: EARLY DETECTION, DIAGNOSIS & TREATMENT in LRS By Dr D. A. Kombe, MD, Mmed (Rad/onc) 2 nd East Africa WE CAN Breast & Cacx Advocacy, Education and Outreach Summit September 11-13,2014

2. NEW ORCI

3. OLD ORCI

4. INTRODUCTION ANNUAL CANCER INCIDENCE IN TZ (Glob can 2012): – 40,000 new cancer cases In Tz there is a well-established patient referral system from health centers to referral hospitals; however no proper guideline for cancer patients’ referral. It is the policy of our government to treat cancer patients for free (once diagnosed).

5. TANZANIAN HEALTH SYSTEM … Health promotion & education, cancer advocacy, prevention and early detection/screening are not yet a priority for funding in our health system!!! Reasons:The Government is overwhelmed with a burden of both communicable and non- communicable diseases; therefore, a bigger portion is allocated mainly to treatments!

6. EARLY DETECTION For reasons mentioned above, prevention and early detection/screening are still an up-hill battle. This is done in few places mainly by ORCI and international NGOs – eg: ICAP, JHIPIEGO, IMA world, PSI, MST UMATI and probably a few national NGOs such as MEWATA. However, currently there has been recognition and therefore efforts are now being directed towards this goal.

7. PRECISE DIAGNOSIS OF CANCER Oncologists (medical & radiation) are aware of the crucial need and closer collaboration with surgeons and pathologists for precise diagnosis and staging of cancer patients when planning subsequent management... THIS IS PARAMOUNT!!! Lack of such collaboration leads to poor decisions of treatment planning on the side of the oncologist! And, this further compromises the ability to offer optimal treatment to the patient. We have a good team –tumour board for this

8. DIAGNOSIS: CURRENT STATUS Few/non pathologists in some referral centers. Pathology services available are slow & often lack proper reporting. It has been observed in general, that prompt referral is a major problem for most of cases.

9. TREATMENT OF CANCER IN TZ: CURRENT STATUS Like most countries in Africa, Tz is among the low resource countries. Even with this fact, the policy of our government policy is to treat cancer patients for free.

10. CURRENT STATUS... So far ONLY ONE Treatment center for ˃ 45million population. - Two cobalt-60 machines (one is down) working round the clock including w/ends… - Two HDR machines which are currently not operating (mechanical problem which need to fix). - Never enough chemotherapy drugs. Demand & supply always is out of proportion!

11. CHALLENGES Serious lack of financial and material/equipment resources. Rapidly increasing cancer burden: Number of new cases doubling every 3 years (With no resource to accommodate them)! Late Presentation: Approx. 75% of cases present with FIGO III- IV stage. Serious lack of awareness of cancer symptoms and signs in majority of these women!

12. Recommendation Whilst efforts of addressing cancer awareness advocacy & screening are taking toll, more and more patients are coming requiring treatment. Currently bookings at ORCI are approaching January 2015!!! Therefore then, parallel with the above, there is a great need to advocate for and improve tertiary care as well. The latter can not be over- emphasized.

13. Indeed, WE CAN