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Swaziland to Use IAEA Recommendations to Address its Growing Cancer Burden

International cancer control experts meet staff at the surgery ward of the Mbabane Government Hospital located in Swaziland’s capital, Mbabane. (Photo: A. Juric/IAEA)

Swaziland will expand its cancer services to address the increasing number of cases, which is adding pressure to an already burdened health system. It will act on recent recommendations by the International Atomic Energy Agency (IAEA) to address the urgent need for specialist radiologists and the passing of the nuclear law, officials have said.

“Cancer is becoming a major public health concern and Swaziland needs to apply the same diligence in cancer control as in the fight against HIV,” said Sibongile Simelane, Minister of Health. UNAIDS has recently commended the country for its fight against HIV/AIDS. “We will focus our efforts on developing a national cancer control plan, coordinating cancer projects and establishing equity in the delivery of services,” she said. The Ministry of Health recently announced plans to establish a cancer control unit to spearhead the development and implementation of the national plan.

The IAEA, at the request of the Ministry of Health, led a team of international experts nominated by the IAEA, the World Health Organization’s Regional Office for Africa (WHO-AFRO) and the International Agency for Research on Cancer (IARC) to Swaziland to assess its cancer control capacities. Such assessments, known as ‘imPACT reviews’, are often the first step countries take to understand their cancer capacity gaps and to develop their national cancer control strategies accordingly.

The members of the review mission were impressed by the country’s commitment to expand cancer care services including radiotherapy treatment, , said Arsen Juric from the IAEA’s Programme of Action for Cancer Therapy (PACT). “There is an immediate need to recruit skilled radiologists at public healthcare facilities to read and understand x-rays, ultrasound and mammography scans,” he said. “The adoption of the nuclear law, currently under development, is also urgently required to enable a framework for the safe and secure operation of healthcare facilities.”

Cancer: a growing burden

According to the International Agency for Research on Cancer (IARC), over 900 people in Swaziland, a country of just 1.3 million, develop cancer each year and almost 600 die from it. These numbers are expected to rise by more than a third by 2030. The two most common cancers, Kaposi’s sarcoma – a cancer originating from lymph nodes or blood vessels – and cervical cancer, account for almost half of all cases in the country. HIV infection considerably increases the risk to acquire these types of cancer. Swaziland has the highest HIV/AIDS prevalence in the world, with almost 30 percent of its adult population infected.

Swaziland's Minister of Health, Sibongile Simelane, speaking at a meeting to launch the imPACT mission. (Photo: Swazi TV)

In the fight against cancer, Swaziland established a cancer registry in 2015 and initiated cervical and breast cancer screening activities at 80 primary care clinics. Cancer care services are currently limited: only minor surgery is performed at three public hospitals and some basic chemotherapy is available for a few cancer sites at the Mbabane Government Hospital. Given the limited treatment options and the absence of radiotherapy, the Government refers the majority of its cancer patients, for treatment to neighbouring South Africa. Establishing treatment facilities in Swaziland would make these services accessible to a greater number of patients.

Concerning the early detection of cancer the WHO Representative for Swaziland, Tigest Ketsela Mengestu, said, “Swaziland has taken the right steps to screen female patients who are receiving anti-retroviral treatment for cervical cancer. This goes a long way to improve cancer diagnosis and care, enabling more cases to be detected early.” Mengestu further recommended that “appropriate measures such as cancer policy and funding are put in place to ensure patients can receive treatment in time”.

The IAEA will support Swaziland in the promulgation of an effective nuclear legislation, including for radiation safety and security in the health sector. In the medium term the IAEA stands ready to support Swaziland in training radiologists, in developing a national cancer control programme (in cooperation with WHO), and in establishing radiotherapy and nuclear medicine services, Juric said.