Prostate cancer in sub-Saharan Africa

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Published: 21 Nov 2017
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Dr Timothy Rebbeck - Dana-Farber Cancer Institute, Boston, USA

Dr Rebbeck speaks with ecancer at AORTIC 2017 about the paucity of data from men with prostate cancer in sub-Saharan Africa.

This has led to the establishment of the MADCaP network which aims to improve care and capacity of care for prostate cancer patients.

With few known causes, Dr Rebbeck considers how the context of research in Africa may improve understandings of cause and treatment among a significant patient population.

Prostate cancer is the leading cancer in men in sub-Saharan Africa and also the leading cause of death from cancer among men in Africa. So it’s a major public health problem across the African continent. Currently we don’t have very much information about what causes prostate cancer in African men and we don’t have very much we can do to address that problem by reducing risk, preventing cancer or even screening.

What kind of data is there available to look at?

Currently there’s very little data available. Most of the data on prostate cancer, despite the fact that it’s an incredibly large problem for public health, there are very few studies, the studies are small and not very well epidemiologically designed. So what we’re currently trying to do is develop a pan-African network of centres and individuals that will address the problem of prostate cancer in Africa. Our group is called MADCaP, Men of African Descent and Carcinoma of the Prostate. This MADCaP network covers many centres all across Africa and the goal is to get large numbers of prostate cancer cases and controls and just study risk factors, epidemiological risk factors, to understand the genomics of prostate cancer, both inherited genetics as well as somatic tumour genomics and to use all of this information to get a better handle on the causes of prostate cancer and then how we can better address prevention and treatment kinds of issues in prostate cancer in African men.

The second main goal of this work, though, is to build capacity. So, we are addressing an important public health problem in prostate cancer but we’re also building the resources for many types of cancer research problems, including genomics of other cancers, epidemiology of other cancers, treatment etc. We’ve done this by building biobanks and pathology resources, networks for processing and shipping. We’re even doing our genomics in Africa so all of the work is in Africa by Africans and not only do we address an important public health problem but we do it by building the capacity for this kind of research in the African continent.

Could this be related to diet and development?

The evidence that we have from all other research in the world is that prostate cancer isn’t really strongly associated with diet, lifestyle, exposures that we know of. In fact, of all the leading cancers, prostate cancer probably has one of the shortest lists, the fewest risk factors that we’ve been able to identify so far. Having said that, very little of that research has been done in Africans and so it’s entirely possible that by doing research in Africa we may identify risk factors that haven’t been seen in other populations to date. That could be because the pattern, the natural history, of prostate cancer is quite different in Africa but also because the genomics and the risk factor exposures really differ quite a bit from what we might see in North America and Europe. So we hope by using these studies in Africans we’re going to find some new information that can eliminate the causes of prostate cancer that haven’t yet been detectable in North American or European white populations.

What about bladder cancer?

Bladder cancer is also a major cause of cancer death across the African continent. It’s not as common as prostate or breast or some of the other leading cancers but it’s a very interesting disease because we know a lot about what causes bladder cancer. We know that the major forms of bladder cancer are caused by schistosomiasis infection and the other major form by tobacco exposure and smoking. So we have two risk factors that are responsible for the vast majority of bladder cancer on the continent and both of these risk factors are modifiable. It’s not easy to eliminate smoking, it’s not easy to decrease schistosomiasis but they are at least areas in which we know we can target to reduce bladder cancer incidence and death. So, unlike many cancers including prostate cancer, we have a target that we can at least focus on to limit the mortality and the public health burden in Africa.