Mary, a 30-year-old woman from Kenya has been diagnosed with oesophageal cancer after visiting six different hospitals within a span of 5 years. At her diagnosis, the cancer is at stage IV and end-of-life care is the glaring option. At each of these facilities, she presented with the “red flags of malignancy”, including unintentional weight loss. She has been treated for gastritis and pharyngitis countless times. Are our healthcare workers too busy and not paying attention or are they too far removed from a cancer diagnosis to give it any consideration?

Globally, the burden of cancer is greatest in low and middle-income countries and is projected to rise in the near future. Additionally, a report by the World Health Organization showed that many cancers have a chance at a cure if detected early. Data from Kenya’s Health Ministry shows that cancer is the third leading cause of mortality in Kenya. This translates to a huge financial burden on both patients and the healthcare economy. A 2023 report by the United Nations Development Program showed that 36% of Kenyans live below the national poverty line. For these individuals, their daily income is fully stretched to cover costs of rent and daily living. Mary consequently cannot afford the daily bus fare to the hospital, good nutrition, nor medication. It therefore comes as no surprise when she succumbs to the disease one year later.

Traditionally, late cancer diagnosis in low and middle-income countries has been attributed to factors such as poor health seeking behaviour and lack of cancer awareness. Both public and non-governmental organizations have invested heavily on raising awareness among the population through campaigns. However, with the rising cases of late cancer diagnosis perhaps it is time to start questioning why a male patient presenting with a chronic cough and weight loss is presumptively treated for tuberculosis (TB) and pneumonia in peripheral facilities for several years before a definitive cancer diagnosis. Or why are patients with abdominal pain and weight loss treated for H. pylori gastritis for years without an alternative diagnosis being considered?

Tackling the cancer menace will require concerted efforts from multiple stakeholders, including global agencies, as much of the financial aid expended to low and middle-income countries is channelled to healthcare. There is no clear distinction as to whether the delay in cancer diagnosis is attributed to apathy, inadequate information, or that a cancer diagnosis has to be made in the corridors of “high-level facilities” at which point it is too late to have any meaningful intervention.

One of the ways of handling this challenge is by encouraging robust re-sensitization of healthcare workers on cancer presentation, prevention, and management. The effect of this intervention can be assessed by carrying out a longitudinal study. Oncologists and related stakeholders can also come up with simplified screening manuals, which can be made available to community healthcare promoters who are the first line of contact with the public. Additionally, training more oncology specialists will translate into extra human resources hence alleviating the current burden on the healthcare system. Finally, a detailed and functional chain of referral for hospitals in rural areas would go a long way in aiding this process. By taking these measures, Kenya can better equip its healthcare workers to help people like Mary get the answers they need before it is too late to treat.