By Tyrus Swaya, Ph.D.
According to the World Health Organization (WHO), 1 in 5 people will develop cancer in their lifetime. Even though the cancer diagnosis process has improved with time, the burden of misdiagnosis significantly contributes to cancer mortality, especially in the low- and middle-income countries, where health systems are under-resourced. A correct cancer diagnosis is the first step towards the right treatment.
Evidence-based diagnosis involves an assessment of individual risk factors for cancer, including age, family history, race/ethnicity, and symptoms. These factors provide recommendations for risk stratification and screening of all malignancies. Misdiagnosis or lack of diagnosis has been associated with the high cost of treatment and is a contributing factor to poor treatment outcomes in many scenarios. Clinical co-morbidities, reluctance to follow-up appointments, poor health-seeking behaviour, under-resourced public health facilities, and socio-cultural decision-making structures are some of the factors associated with cancer misdiagnosis. In the case of infectious diseases, it has led to a surge in antimicrobial resistance.
In Kenya, some, if not the majority, of cancer patients associate cancer diagnoses with subsequent high cost of management. This leads to avoidance of relevant and timely diagnostic procedures or resorting to self- or wrongly prescribed medications to manage their symptoms. Some patients abandon surgical biopsies instead of sending them for histological investigations due to the costs. There is a need to establish primary healthcare offering testing and diagnosis for patients with a history of certain inherited cancers. These strategies will help in early detection and management, enabling individuals to live in dignity with cancer. Caused by either misinformation about cancer diagnostic approaches or limited funds for confirmatory diagnosis, many have lost their loved ones following misdiagnosis.
In Kenya, the current regime has designed a funding model based on the principle that confirmatory diagnosis precedes treatments. If implemented well, this is an excellent initiative, as many Kenyans will seek comprehensive medical attention without worrying about the financial burden. Additionally, those with unique demographic characteristics or chronic illnesses will be able to access the Emergency, Chronic, and Critical Illness Fund to facilitate diagnostic services and critical care. This will be a game changer in tracking and managing chronic diseases such as cancer.
The cancer diagnosis process involves collecting the biopsy, processing, staining, and assessing the tumour’s histopathological characteristics. Any errors in any of the above steps may lead to incorrect diagnoses. In the case of inherited cancers, appropriate genetic evaluation and counselling become a crucial pillar in early detection, risk reduction, and management of these cancers. Individuals with a first-degree relative with certain cancers, such as breast, prostate, and ovarian cancers, are generally twice at risk of developing the disease compared to those without a family history.
Therefore, implementing innovative screening and diagnostic guidelines that empower patients is vital to enhance diagnostic accuracy and reduce the burden of misdiagnosis. Evidence-based research findings will also facilitate informed discussions about the benefits, risks, and uncertainties of cancer diagnosis and treatment options. Finally, we need to encourage collaborative efforts to identify and address the root causes of cancer misdiagnosis, even as healthcare providers and policymakers work towards improving patient outcomes.