Cancer: a looming public health crisis in Africa-a call to accelerate equitable access to medicines.

Africa is currently witnessing an unprecedented increase in cancer cases and deaths. Cancer-related deaths among people under 50 are rising quickly, leading to more young orphans across the continent. If the cancer burden is not addressed, it could develop into a major public health crisis. To effectively tackle this rapidly escalating challenge, healthcare leaders and policymakers must prioritize the development of robust cancer care systems. Expanding access to life-saving medications and diagnostic tools must be matched by sustained investments in healthcare infrastructure, oncology training, and research. Governments throughout Africa should align their strategies with sustainable development goals 1-5 to reduce this cancer crisis. By strengthening cancer medicine regulation and procurement processes and by fostering collaboration between local and international stakeholders, African nations can lay the foundation for equitable, effective cancer care that reaches every community.

Introduction

Cancer represents a significant public health and economic challenge, particularly in Africa, where the situation is expected to worsen without immediate intervention. Globally, cancer incidence and mortality are rising rapidly, especially in low- and middle-income countries, contributing to what can be described as an “emerging cancer epidemic.” Sub-Saharan Africa is witnessing an unprecedented surge in cancer cases. 1 Although the continent accounts for 17% of the global population, it bears 25% of the world’s cancer burden. 2 The World Health Organization (WHO) forecasts a 70% increase in cancer cases in Africa by 2030, highlighting the urgent need to address this impending public health crisis. 3 The International Agency for Research on Cancer predicts that by 2045, annual cancer cases in Africa will nearly double, reaching approximately 1.4 million new cases and 1 million deaths. 4 Cancer is becoming a defining public health challenge in Africa, threatening to reverse decades of progress against infectious diseases. By 2030, cancer-related mortality in Africa is expected to surpass deaths from malaria, tuberculosis, and HIV/AIDS combined. 4

Despite this alarming trajectory, cancer control efforts in Africa remain under-prioritized and under-resourced. A critical aspect of this challenge is the limited access to essential cancer medicines, which significantly contributes to poor survival outcomes. While 5-year survival rates for many cancers exceed 80% in high-income countries, they often fall below 30% in many African nations. 5 Despite the rising burden, access to timely diagnosis and treatment remains severely limited. Many African countries face critical shortages in oncology specialists, diagnostic equipment, radiotherapy units, and essential cancer medicines. 6 Even when available, cancer medicines are often unaffordable due to fragmented procurement systems, lack of local manufacturing, and weak regulatory frameworks. 7

The costs associated with cancer diagnosis, treatment, and care are substantial, encompassing healthcare services, medications, hospitalizations, and supportive care. This financial burden leads to inadequate management of cancer within the region. Additionally, the loss of productivity due to cancer-related morbidity and premature deaths exacerbates the economic impact. 8–11

This paper aims to highlight the urgent cancer crisis in Africa by detailing the current and projected cancer burdens across the continent. It identifies the key factors contributing to this crisis and the significant obstacles that hinder equitable access to cancer medications.

Additionally, the paper proposes evidence-based strategies to improve access to these essential medicines. It outlines immediate interventions needed to address this growing threat, ultimately helping to prevent a potential public health catastrophe and ensuring that no one is left behind in the fight against cancer.

The rising burden of cancer in Africa

The global cancer burden is increasing, with Africa facing a significant rise in this challenge. Although the absolute number of new cancer cases and deaths in Africa may not be as high as in some other regions, the projected rate of increase on the continent by 2045 is alarmingly the highest. In contrast, Europe is anticipated to experience much lower increases of only 22.5% in incidence and 32.2% in mortality during the same period ( Tables 1 and 2 ). By that year, Africa is expected to see a total of 2.5 million new cancer cases and 1.6 million deaths, reflecting staggering increases of 106.8% in incidence and 111.7% in mortality compared to 2022. 12 , 13 These figures for Africa may even underestimate the true burden, as many cancer cases often go unnoticed, undetected, undiagnosed, and untreated. Additionally, the cause of death is frequently unknown, particularly in rural areas where over 51.76% of the African population resides. 14 Many deaths remain unregistered, with individuals dying at home without a diagnosis, and autopsies are often refused by relatives. Only about 0.25% of the sub-Saharan African population is covered by accurate death registration systems. 15

The rising incidence of cancer in Africa can be attributed to several factors, including population growth, aging, urbanization, lifestyle changes, and increased exposure to carcinogenic agents and environmental pollutants. 3 , 16 , 17 With improvements in healthcare and living conditions, life expectancy in Africa has increased, leading to a larger aging population. According to the WHO assessments, healthy life expectancy in the African region rose by an average of 10 years per person between 2000 and 2019, more than any other region during that period. 18 Age is a well-known risk factor for cancer; as life expectancy increases, so does the risk of developing the disease. Additionally, the establishment of more population-based cancer registries has led to an increase in reported cancer cases in sub-Saharan Africa, with the number of such registries rising from 21 in 2013 to 35 across 25 different countries by the end of 2021. 19

Rapid population growth, poverty, and cancer in Africa

Africa is experiencing a significant surge in population growth, coupled with pervasive poverty and a rising incidence of cancer ( Figures 1 and 2 ). This demographic expansion outpaces that of other regions, yet it is not accompanied by corresponding economic development. This imbalance exacerbates the strain on already overburdened healthcare systems, restricting access to care and leading to inadequate cancer management.

The ten countries experiencing the highest population growth rates in the world are all located in sub-Saharan Africa. 20 By 2030, it is projected that nearly 9 out of every 10 people living in extreme poverty will reside in this region. 21 Some argue that population growth is a primary cause of poverty and underdevelopment, while others believe that both population growth and poor health significantly contribute to worsening poverty. 22 Regardless of the perspective, poverty and rapid population growth are interconnected issues.

Poverty can significantly increase the risk of developing cancer, while a cancer diagnosis can exacerbate financial hardship, creating a 2-way vicious cycle that is difficult to break. 23 Poverty is a well-documented risk factor for cancer due to multiple interrelated factors. It can lead to early marriage, as families might see it as a way to lessen financial burdens. In some communities in Africa, adolescent girls are given up to marriage to older men who already have other wives may increase risk of HPV acquisition. Early marriage, often occurring in the context of poverty, is associated with early sexual debut, prolonged exposure to high-risk human papillomavirus infection, and higher childbirth rates, thereby increasing cervical cancer risk. 24

Additionally, stress and lack of resources may lead to higher rates of smoking, alcohol use, poor diet, and sedentary lifestyles, all of which are established risk factors for various cancers. 25 , 26 . Furthermore, people in impoverished conditions are more likely to be exposed to environmental carcinogens, such as air and water pollution, which can elevate cancer risk. 27 Educational disparities further exacerbate the problem, as lower educational levels, often linked with poverty, can result in a lack of awareness about cancer prevention and the importance of early screening. 28 Individuals living in poverty also often have limited access to healthcare services, including cancer screening and early detection programs, which delays diagnosis and worsens outcomes.

A cancer diagnosis and treatment can plunge individuals and families deeper into poverty, affecting generations. The cost of cancer treatment can be exorbitant, even for those with insurance, and can lead to significant financial strain or bankruptcy. 29–31 Caregiving can be very challenging in cancer cases, and family members may have to reduce working hours or stop work, and this may lead to loss of income, thus reducing household income. 32

Poverty is linked to a low human development index (HDI), and many African nations fall within the low HDI category. Studies consistently show that low-HDI countries have higher rates of premature death compared with countries with high HDI.

For instance, a recent study found that in countries ranked low on the HDI scale, as much as 72% of cancer deaths among women were premature (occurring before age 70), compared to only 36% in countries ranked as very high HDI. 33 The poverty rate has a negative correlation with HDI, and HDI itself has a significant negative correlation with the mortality incidence ratio across all cancer types. 33

Rising orphanhood in Africa due to cancer

In Africa, cancer patients face significantly higher mortality rates compared to those in other regions of the world. The continent’s youthful population, coupled with the increasing incidence of cancer and younger age at diagnosis, is likely to result in a growing number of orphans due to this disease. Lack of awareness of cancer, poor knowledge of the disease, and limited access to healthcare all lead to late presentation. Africa’s cancer mortality rates are exacerbated by late-stage diagnoses (70% of cases) and limited access to treatment due to poverty and poor health care infrastructure. 34

According to GLOBOCAN 2022 estimates, in Africa, breast cancer was the most frequently diagnosed malignancy, accounting for 16.8 % of all new cancer cases, followed by cervical cancer (10.6 %) and prostate cancer (8.7 %) among both sexes combined. 12 These cancers disproportionally affect adults aged 30-60 years, a period critical for child-rearing, and the high mortality associated with them leads to young orphans. In sub-Saharan Africa, 1 in 5 children who lose a parent to cancer become orphans before age 18. 35 Women play a major role in child rearing in Africa. The most prevalent cancers among women in Africa are often diagnosed at a younger age, and the relatively low survival rates contribute to the rising incidence of maternal orphans, who are usually under 18 years old. A recent meta-analysis examined breast cancer cases in Africa, involving a total of 33,199 individuals, of whom 97% were female. Notably, 58% of these patients were under the age of 50. In East Africa, 38% of the cases (95% CI, 31-45) were diagnosed before the age of 40. This is in stark contrast to high-income countries, where only 16-22% of breast cancer cases are diagnosed before the age of 50. 36 , 37 Other studies have consistently highlighted the younger age at which breast cancer is diagnosed in Africa. For instance, a population-based study in Burkina Faso reported an average diagnosis age of just 33.4 years, 38 while research in Lagos, Nigeria, indicated an average age of 49.6 years. 39 Additionally, a 7-year review in Southern Ethiopia found a median age of 38 years among breast cancer patients. 40 Another Ethiopian study revealed that the median age of cancer-related deaths was 37 years, which is significantly younger than for other causes of death, with a median duration of illness of about one year. 41

A recent study found that in 2020, approximately 4.4 million cancer deaths among women globally resulted in 1.05 million new maternal orphans. 42 Notably, around 63% of these new maternal orphans were the result of female cancer deaths occurring between the ages of 35 and 49, while 22% lost their mothers after age 50, and 16% were orphaned when their mothers were under 35. Nearly half (48%, or 508,000) of these orphaned children were in Asia, with over one-third (35%, or 370,000) in Africa. 42

Research has shown that maternal orphans are at an increased risk for numerous adverse outcomes, including teenage pregnancy, infectious diseases such as HIV/AIDS during adolescence, and chronic health issues later in life. 43 These children also face heightened risks of mental health disorders, suicide, and sexual violence. Many drop out of school, become involved in substance abuse, and are more likely to experience poverty as a result of their circumstances. 44 According to a World Bank report in 2020, Africa could lose 5% of its GDP annually by 2030 due to educational gaps linked to orphanhood.

Cervical cancer, breast cancer, and upper gastrointestinal cancers are among the leading causes of maternal deaths due to cancer in Africa. 45 These cancers are often preventable and typically affect women during critical stages of their lives when they are financially and socially essential to their families.

Increasing pediatric cancers

Sub-Saharan Africa is also confronting a childhood cancer crisis. Recent data suggest an increasing trend in the incidence of pediatric cancers across Africa. This rise can be attributed to several factors, including improved diagnostic capabilities, increased awareness, and demographic changes such as population growth. Moreover, with over 90% of children living with HIV residing in Africa, these children are at increased risk for HIV-related cancers, such as acute leukemia and Kaposi sarcoma. 46

Nearly 90% of the more than 100,000 children diagnosed with cancer in the region each year succumb to the disease. 47 In stark contrast, 85% of pediatric cancer patients in high-income countries survive, thanks to access to advanced pediatric cancer care.

Missed diagnosis is common, as the usual signs and symptoms of pediatric cancers may mimic those of common infectious diseases in Africa, like malaria, tuberculosis, and HIV/AIDS. Cultural beliefs and stigma associated with cancer can prevent families from seeking timely medical care for their children. High rates of delayed or missed diagnoses, underdiagnosis, and limited healthcare access contribute to the suboptimal care and high mortality rates observed in pediatric cancer cases.

Challenges in cancer treatment in Africa

Cancer treatment is expensive worldwide. Research that has led to a better understanding of carcinogenesis has resulted in new treatments that have helped reduce cancer mortality in many developed countries. These new treatments are not available in many countries in Africa, and where they are available, they are not affordable, as many Africans do not have health insurance and must pay out of pocket. Many are poor and cannot afford the cost of cancer treatment. There is a drought of workforce in cancer management. Many countries in sub-Saharan Africa lack trained healthcare professionals, including oncologists, pharmacists, nurses, and other specialists needed in cancer management.

Medicines, along with surgery and radiotherapy, are crucial in the management of cancer. Unfortunately, many cancer patients in Africa do not have access to these drugs. Generic drugs could offer more affordable options, but they are not available due to regulatory barriers, intellectual property issues, and a lack of manufacturing capacity in African countries. As a result, counterfeit drugs are widespread, and approximately 40% of all fake cancer drugs end up in Africa. A recent study conducted in Ethiopia, Kenya, Malawi, and Cameroon found that 32 (17%) of 191 unique lots of seven anticancer products collected from these four countries in sub-Saharan Africa in 2023-2024 did not contain the correct amount of active pharmaceutical ingredient. 48 Also, substandard or falsified products were found in major cancer hospitals and on the private market in all four countries. 48 In some countries, the lack of regulations on who can import medicines exacerbates the problem.

In high-income and upper-middle-income countries, most of the medicines incorporated into the WHO Model List of Essential Medicines are on the formulary. They are available to patients at either no cost or on a subsidized basis. 49 This is not the same in Africa, where many cancer patients cannot afford the cost of treatment, especially if they lack adequate insurance coverage, government reimbursement, or funding. 50 Furthermore, in many African countries, a good number of the medicines on the WHO Essential Medicines List (EML) are unavailable and not listed on their National Essential Medicine List (NEML). A recent study on access to cancer drugs in 3 countries in sub-Saharan Africa—Kenya, Uganda, and Rwanda—found that cancer treatment regimens based on WHO EML indications, which include novel cancer drugs, were not affordable to governments in sub-Saharan Africa. 51 Some countries did not have cancer drugs listed on their NEML. Additionally, almost all cancer treatment regimens were unaffordable to individuals paying out of pocket. 51 A study from Ghana found that the availability of cancer medicines was very low and less than the WHO target of 80%, and affordability remains suboptimal, as most patients cannot afford the cancer medicines. 52

Overburdened healthcare system in Africa

The healthcare system in Africa is grappling with significant challenges, including limited resources, a high prevalence of infectious diseases, workforce shortages, inadequate budgetary allocations, ongoing conflicts, and political instability. 53 The rising incidence and mortality of cancer in the region threaten to further strain this already burdened system, potentially compromising the effectiveness of healthcare delivery.

As resources are redirected toward cancer treatment—such as radiotherapy, chemotherapy, immunotherapy, and palliative care—funding for essential public health initiatives, including vaccination programs, screening for diseases, and efforts to control infectious diseases, may diminish. This shift could exacerbate existing health crises, leading to increased rates of cancer, maternal mortality, and infectious diseases, as well as a rise in mental health issues and overall mortality rates. The consequences of this resource reallocation could have far-reaching implications for the health and well-being of communities across the continent.

How to avert the looming public health crisis from the rising burden of cancer in Africa. Governments in Africa must prioritize cancer and increase budgetary allocation to health. African Union member states met in Abuja, Nigeria, in April 2001, where they committed to allocating 15% of their government budgets to health. 54 This is yet to be implemented by many African countries. They should address SDGs 1-5, as this will go a long way toward reducing the burden of cancer in Africa (Box 1) .

Sustainable Development Goals (SDGs) 1-5.

SDG 1—No poverty: End poverty in all its forms everywhere.

SDG 2—Zero hunger: End hunger, achieve food security and improved nutrition, and promote sustainable agriculture.

SDG 3—Good health and well-being: Ensure healthy lives and promote well-being for all at all ages.

SDG 4—Quality education: Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all.

SDG 5—Gender equality: Achieve gender equality and empower all women and girls.

African governments should also implement public health campaigns to raise awareness about the causes and risk factors for cancer in Africa. This can help people understand the importance of early detection and treatment. Several studies have shown that a lack of awareness of cancer in both patients and healthcare providers has led to delayed presentation and diagnosis, leading to high mortality. 55 , 56

Governments in Africa must implement widespread screening programs for common cancers, such as cervical and breast cancer, to facilitate early diagnosis and timely intervention. They should invest in building and strengthening healthcare systems in Africa to ensure that there are enough healthcare professionals, facilities, and resources to effectively diagnose and treat cancer. Governments should provide incentives to encourage healthcare professionals to specialize in oncology and serve in rural and underserved communities. Furthermore, investing in mobile clinics and telemedicine can significantly enhance access to healthcare services in these areas. In 2016, the WHO Executive Board firmly asserted the necessity of strengthening health systems to ensure early diagnosis and guarantee accessible, affordable, high-quality care for all cancer patients. 57

Cervical and liver cancers are prevalent in Africa and are significant contributors to premature mortality. Both types of cancer can be effectively prevented through vaccination. Governments must ensure that the HPV vaccine and the hepatitis B vaccine are readily available and provided free of charge to the population.

African governments should allocate resources to support cancer research throughout the continent, as research is key in cancer care. It is essential to increase cancer research across Africa. Research drives the creation of innovative and enhanced treatments for diseases. However, a recent study revealed that there are only a limited number of active cancer research projects across the continent. 58 African researchers should collaborate with their peers both within the continent and globally to strengthen capacity and expertise. Furthermore, clinical trials for cancer drugs should involve African patients residing in Africa to ensure that the findings are relevant and applicable to the local population.

Governments should take decisive action to lower tariffs and trade barriers on cancer medications, making them more affordable for patients across Africa. Collaborative efforts between governments and pharmaceutical companies are essential to boost the production of generic cancer medicines, which typically offer a more cost-effective alternative to brand-name drugs. Furthermore, governments must prioritize and support local manufacturing initiatives for cancer medicines. This strategy will not only help to reduce costs but also enhance availability and accessibility for patients throughout the continent.

African countries can negotiate better drug prices by leveraging collective bargaining through regional initiatives like the African Medicines Agency. In addition, they should collaborate with international organizations, such as the World Health Organization and the World Cancer Research Fund, to develop strategies for making cancer medicines more available, accessible, and affordable to all patients.

Finally, the implementation of universal health coverage programs is crucial to ensure that all citizens can access essential cancer treatments, irrespective of their financial situation.

Table 3 summarizes the proposed key actionable policy priorities to accelerate equitable access to cancer prevention, diagnosis, and treatment in Africa and to avert the looming public health crisis.

Conclusions

Cancer is rapidly becoming a public health crisis in Africa, and the lack of equitable access to cancer medications is worsening the situation. Without urgent intervention, both the incidence and mortality rates of cancer will continue to rise, placing an overwhelming strain on healthcare systems and economies. Governments, policymakers, and global health stakeholders must collaborate to enhance access to affordable cancer medicines, strengthen healthcare infrastructure, and ensure that every cancer patient in Africa receives timely and effective treatment.

Addressing this crisis demands a multi-sectoral approach that prioritizes universal health coverage, local drug production, research, and innovative policy solutions. The time for action is now—cancer should not be a death sentence due to a lack of access to life-saving medications.

Contributor Information

Rose I Anorlu, Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, 100254, Nigeria.

Lemchukwu C Amaeshi, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York City, New York, 10467, United States.

Kehinde S Okunade, Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, 100254, Nigeria; Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, 100254, Nigeria.

Adeyemi A Okunowo, Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, 100254, Nigeria; Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, 100254, Nigeria.

Ephriam O Ohazurike, Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, 100254, Nigeria.

Adaiah P Soibi Harry, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, 30322, United States.

Okechukwu N Duru, Department of Surgery, Federal Teaching Hospital, Owerri, 460211, Nigeria.

Ann Murphy, Society for Translational Oncology, Colorado Springs, CO 80904, USA.

Author contributions

Rose Ihuoma Anorlu (Writing—original draft, Writing—review & editing), Lemchukwu Chukwunonye Amaeshi (Writing—original draft, Writing—review & editing), Kehinde Okunade (Writing—review & editing), Adeyemi Okunowo (Writing—review & editing), Ephraim Ohazurike (Writing—review & editing), Adaiah P. Soibi-Harry (Writing—review & editing), Okechukwu Duru (Writing—review & editing), and Ann Murphy (Conceptualization, Writing—review & editing)

Funding

No funding was was received for this study..

Conflicts of interest

The authors declare no potential conflict of interest.

Data availability

No new data were generated or analyzed.

References

1. Ngwa W, Addai BW, Adewole I, et al. Cancer in Sub-Saharan Africa: a Lancet Oncology Commission. Lancet Oncol. 2022;23:e251-e312. 10.1016/S1470-2045(21)00720-8

2. WHO 2023. Global Cancer Burden. Accessed February 10, 2025. https://www.afro.who.int/regional-director/speeches-messages/world-cancer-day-2023

3. Hamdi Y, Abdeljaoued-Tej I, Zatchi AA, et al. Cancer in Africa: the untold story. Front Oncol. 2021;11:650117. 10.3389/fonc.2021.650117

4. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209-249. 10.3322/caac.21660

5. Llemani C, Matsuda T, Di Carlo V, et al. Global surveillance of trends in cancer survival 2000–14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. The Lancet. 2018;391:1023-1075. 10.1016/S0140-6736(17)33326-3

6. Stefan DC. Cancer care in Africa: an overview of resources. J Glob Oncol. 2015;1:30-36. 10.1200/JGO.2015.000406

7. World Health Organization. WHO Model List of Essential Medicines-22nd List. Geneva: WHO; 2021. Accessed March 5, 2025. https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2021.02

8. Alzehr A, Hulme C, Spencer A, et al. The economic impact of cancer diagnosis on individuals and their families: a systematic review. Support Care Cancer. 2022;30:6385-6404. 10.1007/s00520-022-06913-x

9. De Camargo Cancela M, Monteiro dos Santos JE, Lopes de Souza LB, et al. The economic impact of cancer mortality among working-age individuals in Brazil from 2001 to 2030. Cancer Epidemiol. 2023;86:102438. 10.1016/j.c

10. Kingham TP, Alatise OI, Vanderpuye V, et al. Treatment of cancer in Sub-Saharan Africa. Lancet Oncol. 2013;14:e158-e167. 10.1016/S1470-2045(12)70472-2

11. Timmons A, O’Leary D. The economic impact of cancer: a review of the literature. Health Econ Rev. 2019;9:1-14. 10.1186/s13561-019-0233-1

12. Globocan 22 Cancer Today. Accessed June 14, 2024. https://gco.iarc.fr/today/home

13. Globocan 22 Cancer Tomorrow. Accessed June 14, 2024. https://gco.iarc.fr/today/home

14. Rural population, percent country rankings. Accessed April 18, 2024. https://www.theglobaleconomy.com/rankings/rural_population_percent/Africa/#:∼:text=Rural%20population%2C%20percent%20of%20total, countries%20where%20data%20are%20available

15. Mathers CD, Fat DM, Inoue M, Rao C, Lopez AD. Counting the dead and what they died from: an assessment of the global status of cause of death data. Bull World Health Organ. 2005;83:171-177.

16. WHO Africa. Health Topics. Accessed June 8, 2024. https://www.afro.who.int/health-topics/cancer#:∼:text=The%20rise%20in%20the%20number,of%20alcohol%20and%20tobacco%20use

17. Larkin HD. Cancer deaths may double by 2030 in Sub-Saharan Africa. JAMA. 2022;327:2280. 10.1001/jama.2022.10019

18. WHO Africa. Healthy life expectancy in Africa rises by almost ten years. Accessed March 6, 2024. https://www.afro.who.int/news/healthy-life-expectancy-africa-rises-almost-ten-years

19. Omonisi AE, Liu B, Parkin DM. Population-based cancer registration in Sub-Saharan Africa: its role in research and cancer control. JCO Glob Oncol. 2020;6:1721-1728. 10.1200/GO.20.00294

20. Country comparisons – Population growth rate. The World Factbook. Central Intelligence Agency. Accessed May 17, 2024. https://www.cia.gov/the-world-factbook/field/population-growth-rate/country-comparison/

21. Barne D, Wadhwa D. World Bank Group year in review: 2018 in 14 charts. Accessed March 6, 2025. https://www.worldbank.org/en/news/feature/2018/12/21/year-in-review-2018-in-14-charts

22. Kibirige JS. Population growth, poverty, and health. Soc Sci Med. 1997;45:247-259. doi.org/10.1016/S0277-9536(96)00341-3

23. Çiğdem. Is poverty another cause of cancer? An Empirical Analysis World Journal of Cancer Research. 2019;6:e1226. 10.32113/wcrj_20193_1226

24. Louie KS, De Sanjose S, Diaz M, et al. International Agency for Research on Cancer Multicenter Cervical Cancer Study Group. Early age at first sexual intercourse and early pregnancy are risk factors for cervical cancer in developing countries. Br J Cancer. 2009;100:1191-1197. doi.org/10.1038/sj.bjc.6604974

25. Manderson L, Jewett S. Risk, lifestyle and non-communicable diseases of poverty. Global Health. 2023;19:13. 10.1186/s12992-023-00914-z

26. Gatto NM. Environmental carcinogens and cancer risk. Cancers. 2021;(13:)622. 10.3390/cancers13040622

27. Cockerham WC, Hamby BW, Oates GR. The social determinants of chronic disease. Am J Prev Med. 2017;52:S5-S12. 10.1016/j.amepre.2016.09.010

28. Wardle J, Steptoe A. Socioeconomic differences in attitudes and beliefs about healthy lifestyles. J Epidemiol Community Health. 2003;57:440-443. 10.1136/jech.57.6.440

29. Zafar SY, Abernethy AP. Financial toxicity, part I: a new name for a growing problem. Oncology (Williston Park). 2013;27:80-81.

30. Guy GP Jr, Yabroff KR, Ekwueme DU, et al. Healthcare expenditure burden among non-elderly cancer survivors, 2008-2012. Am J Prev Med. 2015;49:S489-97. 10.1016/j.amepre.2015.09.002

31. Short PF, Vasey JJ, Moran JR. Long-term effects of cancer survivorship on the employment of older workers. Health Serv Res. 2008;43:193-210. 10.1111/j.1475-6773.2007.00752.x

32. Van Houtven CH, Ramsey SD, Hornbrook MC, et al. Economic burden for informal caregivers of lung and colorectal cancer patients. Oncologist. 2010;15:883-893. 10.1634/theoncologist.2010-0005

33. Frick C, Rumgay H, Vignat J, et al. Quantitative estimates of preventable and treatable deaths from 36 cancers worldwide: a population-based study. Lancet Glob Health. 2023;11:e1700-e1712. 10.1016/S2214-109X(23)00406-0

34. Stefan DC, Tang S. Addressing cancer care in low- to Middle-income countries: a call for sustainable innovations and impactful research. BMC Cancer. 2023;23:756. 10.1186/s12885-023-11272-9

35. UNICEF Annual Report 2023. Accessed May 15, 2025. https://www.unicef.org/reports/unicef-annual-report-2023

36. Adewale Adeoye P. Epidemiology of breast cancer in Sub-Saharan Africa. Breast cancer updates. IntechOpen. 2023. Accessed October 12, 2024. 10.5772/intechopen.109361

37. Olayide A, Isiaka A, Ganiyu R, et al. Demographic pattern, tumor size, and stage of breast cancer in Africa: a meta-analysis. Asian Pacific J Cancer Care. 2021;6:477-492. 10.31557/APJCC.2021.6.4.477

38. Fasotröbele Ströbele L, Kantelhardt EJ, Traoré Millogo TFD, et al. Prevalence of breast-related symptoms, health care seeking behaviour and diagnostic needs among women in Burkina Faso. BMC Public Health. 2018;18:447. doi.org/ 10.1186/s12889-018-5360-6

39. Fatiregun OA, Olagunju AT, Erinfolami AR, et al. Anxiety disorders in breast cancer: Prevalence, types, and determinants. J Psychosoc Oncol. 2016;34:432-447. 10.1080/07347332.2016.1196805

40. Gebretsadik A, Bogale N, Negera DG. Epidemiological trends of breast cancer in Southern Ethiopia: a seven-year retrospective review. Cancer Control. 2021;28:10732748211055262. 10.1177/10732748211055262.

41. Ayele W, Führer A, Braun GA, et al. Breast cancer morbidity and mortality in rural Ethiopia: data from 788 verbal autopsies. BMC Womens Health. 2022;22:89. 10.1186/s12905-022-01672-7

42. Guida F, Kidman R, Ferlay J, et al. Global and regional estimates of orphans attributed to maternal cancer mortality in 2020. Nat Med. 2022;28:2563-2572. 10.1038/s41591-022-02109-2

43. Galukande M, Schüz J, Anderson BO, et al. Maternally orphaned children and intergenerational concerns associated with breast cancer deaths among women in Sub-Saharan Africa. JAMA Oncol. 2021;7:285-289. 10.1001/jamaoncol.2020.6583

44. Case A, Paxson C, Ableidinger J. Orphans in Africa: parental death, poverty, and school enrollment. Demography. 2004;41:483-508. 10.1353/dem.2004.0019

45. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74:229-263. 10.3322/caac.21834

46. Lubega J, Chirande L, Atwine B, et al. Addressing the childhood cancer crisis in Sub-Saharan Africa. Lancet Oncol. 2023;24:729-732. 10.1016/S1470-2045(23)00173-0

47. Stefan C, Bray F, Ferlay J, et al. Cancer of childhood in Sub-Saharan Africa. Ecancermedicalscience. 2017;11:755. 10.3332/cancer2017.755

48. Wilfinger MJ, Doohan J, Okorigwe E, et al. Substandard anticancer medications in clinical care settings and private pharmacies in Sub-Saharan Africa: a systematic pharmaceutical investigation. Lancet Glob Health. 2025;13:e1250-e1257.

49. Cherny NI, Sullivan R, Torode J, et al. ESMO International Consortium Study on the availability, out-of-pocket costs and accessibility of antineoplastic medicines in countries outside of Europe. Ann Oncol. 2017;28:2633-2647. 10.1093/annonc/mdx521

50. World Health Organization. Technical report: Pricing of cancer medicines and their impacts: a comprehensive technical report for the World Health Assembly Resolution 70.12: operative paragraph 2.9 on pricing approaches and their impacts on availability and affordability of medicines for the prevention and treatment of cancer. World Health Organization, 2018. Accessed 20 September 2024. https://iris.who.int/handle/10665/277190

51. Kizub DA, Naik S, Abogan AA, et al. Access to and affordability of World Health Organization essential medicines for cancer in Sub-Saharan Africa: Examples from Kenya, Rwanda, and Uganda. The Oncologist. 2022;27:958-970. 10.1093/oncolo/oyac143

52. Mattila PO, Biritwum RB, Ud-Din Babar Z. A comprehensive survey of cancer medicines prices, availability and affordability in Ghana. PLoS One. 2023;18:e0279817. 10.1371/journal.pone.0279817

53. Oleribe OO, Momoh J, Uzochukwu BS, et al. Identifying key challenges facing healthcare systems in Africa and potential solutions. Int J Gen Med. 2019;12:395-403. 10.2147/IJGM.S223882

54. The Abuja Declaration. Accessed 20 September 2024. https://32894-file-2001-abuja-declaration.pdf - African Union.

55. Kale S, Hirani S, Vardhan S, et al. Addressing cancer disparities through community engagement: lessons and best practices. Cureus. 2023;15:e43445. 10.7759/cureus.43445

56. Minas TZ, Kiely M, Ajao A, et al. An overview of cancer health disparities: new approaches and insights, and why they matter. Carcinogenesis. 2021;42:2-13.

57. World Health Organization. Early cancer diagnosis saves lives, cuts treatment costs. Geneva: World Health Organization; 2017. Accessed 20 September 2024. https://www.who.int/news/item/03-02-2017-early-cancer-diagnosis-saves-lives-cuts-treatment-costs

58. Mutebi M, Lewison G, Aggarwal A, et al. Cancer research across Africa: a comparative bibliometric analysis. BMJ Glob Health. 2022;7:e009849. 10.1136/bmjgh-2022-009849

Associated Data

Data Availability Statement

No new data were generated or analyzed.