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Foreword
Introduction
Managing Water Resources
Food Security for the Poor
Health Problems of the Poor
 Rolling back Malaria
 Saving a Mother´s Life
 Benefits of Fortification
 Making Thai Food Safe
Environmental Management
Strengthening Nuclear Safety
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Saving a Mother’s Life: Radiotherapy Offers Hope to Women with Cancer

Genet

Genet Ashenafi was suffering from cervical cancer, which strikes Ethiopians at four times the rate of women in industrial countries. Some 200,000 women in developing countries die each year from the disease.

Awasa, Ethiopia. When the sickness wouldn’t go away and the bleeding persisted, Genet Ashenafi, a 34-year-old Ethiopian mother of two, became alarmed. At the regional hospital, in Ethiopia’s southern city of Awasa, her worst fears were confirmed. Four months after she had first noticed vaginal bleeding and a discharge she was diagnosed with invasive cervical cancer.

Genet felt her life collapse: in less than two years she would probably be dead and the fate of her two sons left to chance. She prayed and wept.

In Ethiopia, cancer of the cervix—the mouth at the entrance of the womb—is among the most common forms of cancer in women. It is usually fatal because of late detection and the dearth of treatment facilities.

Cervical cancer mostly affects Ethiopian women over 30 years old and peaks in the 40–45 year old age group.

The rate at which it strikes is more than four times the average incidence in developed countries where routine screening, providing early detection, leads to usually simple and effective treatment. An estimated 200,000 women in developing countries who die from the disease each year.

In July 2001, Genet boarded a bus in Awasa, with her teenaged son, and made the journey of about 300 kilometres north to the nation’s capital, Addis Ababa. She had been referred by her local hospital to Dr. Bogale Solomon, director of the Black Lion Hospital radiotherapy department.

The centre opened in 1997, a joint project between the government of Ethiopia and the IAEA. Ethiopia is the poorest country in the world to introduce radiotherapy. In its first four years the department has treated 1,300 patients and the number of patients being treated is growing steadily.

Today is the seventh day of treatment in a 30-day course Genet is receiving. Already the bleeding and the discharge that alerted doctors to her condition has stopped. Yes, she has an upset stomach and her appetite has decreased. But she’s relieved that the symptoms are improving: she’s feeling more confident, less desperate.

Breast cancer is most common in women worldwide, but cervical cancer in disadvantaged women is almost as prevalent, accounting for 17 per cent of all cancers.

Genet has joined a group of patients, mostly other women, who attend the clinic daily as outpatients. These patients are exposed to small doses of radiation, lasting one to two minutes, a process known as fractionation, that best spares healthy cells. The treatment entails directing multiple beams of radiation from outside the body at the tumour in the pelvic region. The radiotherapy machine being used is Chinese made and its radioactive source is Cobalt-60, first used therapeutically 50 years ago.

Genet was married when she was 12 years old. She had her first child when she was 14 years old. Her chances of being cured are good, says Dr. Bogale, an internist and Ethiopia’s sole radiation oncologist. “Although her disease was too advanced to be operated on, she’s an early case,” he explained. “The cancer hadn’t spread (out of the pelvis).”

Women make up about 70 per cent of the patients at the centre, and cancer of the cervix is the most common disease comprising over one-third of all female patients treated. The incidence of cervical cancer is high all across sub-Saharan Africa, where lifestyle is blamed for its proliferation. The main factors include trauma from repeated births and poor hygiene linked to poverty. Recently, the spread of HIV (the virus that causes AIDS) has also increased the risk of women getting cervical cancer.

Unfortunately, many of the patients referred to the Black Lion lab are not diagnosed until the disease is far advanced. Nevertheless 50 per cent of patients treated there are still alive four years after it began delivering treatment, Dr. Bogale said.

Statistics reveal that the Black Lion radiotherapy department is a small beacon of light in a large and troubled sea. Ethiopia has only one radiotherapy machine to serve a population of 60 million plus. In Europe, there’s one machine for every 250,000 people. Addis Ababa alone has a population of about 3.5 million.

“There is increasing recognition of cancer in developing countries,” says Victor Levin, head of the IAEA section of Applied Radiation Biology and Radiotherapy. “Although the spectrum of cancers in developing countries differs from that in the more affluent world, the perception that there is less chance of getting cancer in developing countries is proving increasingly false,” Levin says.

Cases have risen from two million in 1985 to five million in 2000 and are projected to reach 10 million in 2015. The waiting list for treatment at the Black Lion clinic is lengthening. The department now remains open until 10 pm and treats 52 people every day. Dr. Bogale is the only radiation oncologist in the department. He’s had no holiday in four years.

Dr. Bogale continues to seek funding to expand the Black Lion treatment capabilities. It has facilities for brachytherapy, a procedure that reduces side effects by directing a large controlled dose of radiation from a device inserted next to a tumour. But brachytherapy requires that patients are admitted and there are not sufficient funds to pay nurses to look after the 20 beds with which the department is outfitted.

In Ethiopia, where disease runs the gamut from malaria, to TB, and HIV, and cash is scarce, there are clearly conflicting priorities about the delivery of essential medical services. There are plans to install radiotherapy machines in regional hospitals, including the new Mek’ele hospital in northern Ethiopia to relieve pressure on the Black Lion’s operations.

The IAEA’s Levin says that the treatment of cervical cancer with radiation is among the oldest and most resounding success stories of radiotherapy. “The number of machines that provide the treatment across Africa nearly tripled in the 1990s, largely due to the successful transfer of technology by the IAEA,” Levin said.

National cancer control programmes, that offer preventive and early detection, a modest mixture of treatments by surgery, radiotherapy and chemotherapy, result in the cure of 45 per cent of all cancers in developed countries. It is a target to which a developing country such as Ethiopia and the dedicated staff at the Black Lion Hospital can also aspire.

Meeting the Growing Demand for Radiotherapy Services in Developing Countries

With the incidence of cancer on the rise in developing countries, there is an increased demand for IAEA assistance in the field of radiotherapy. Assistance through the TC programme includes the provision of radiation sources and equipment, personnel training in medical physics and safety, and the establishment and proper maintenance of radiotherapy programmes for cancer treatment. The IAEA has supported a number of countries in establishing their first radiotherapy centers. Over the last seven years, modern radiation therapy services have successfully commenced in in Ethiopia, Ghana, Mongolia, Namibia and Uganda. Overall, it is estimated that over 2,100 megavoltage teletherapy machines are currently installed in developing counties. This is significantly below the estimated current needs of roughly 5,000 machines.

While acquiring the necessary sophisticated equipment is important, the IAEA’s Victor Levin points to the even more critical elements, “Successful cancer treatment requires knowledgeable, skilled people operating well-calibrated radiotherapy equipment. Our assistance attempts to provide a balance of all supporting elements including the clinical, dosimetric, safety, and maintenance.”

  Focusing Science on the Health Problems of the Poor
  Introduction...

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Ethiopian flag

Ethiopia, map

Because of late
detection and the dearth of treatment facilities, an estimated 200,000 women in developing countries
die from cervical cancer each year.
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