Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Building capacity for sustainable research programmes for cancer in Africa

Key Points

  • Research has a pivotal role in cancer control planning as it will lead to the development of evidence-based strategies for cancer prevention and control relevant to Africa

  • Cancer research programmes should be multi-disciplinary and contain a research–career component for the development of African scientists as research leaders and mentors, which will lead to sustainable research programmes

  • International funding agencies and pharmaceutical companies should support the creation of long-term funding to foster rigorous and innovative investigator-initiated research

  • The formation of North–South and South–South partnerships and networks is essential for the creation of the infrastructure and environment needed to promote research

  • African scientists should engage country communities and policy-makers to promote community and country ownership of research programmes

  • Cancer research should be accompanied by the highest levels of ethical, legal and socially appropriate standards to ensure the protection of patients

Abstract

Cancer research in Africa will have a pivotal role in cancer control planning in this continent. However, environments (such as those in academic or clinical settings) with limited research infrastructure (laboratories, biorespositories, databases) coupled with inadequate funding and other resources have hampered African scientists from carrying out rigorous research. In September 2012, over 100 scientists with expertise in cancer research in Africa met in London to discuss the challenges in performing high-quality research, and to formulate the next steps for building sustainable, comprehensive and multi-disciplinary programmes relevant to Africa. This was the first meeting among five major organizations: the African Organisation for Research and Training in Africa (AORTIC), the Africa Oxford Cancer Foundation (AfrOx), and the National Cancer Institutes (NCI) of Brazil, France and the USA. This article summarizes the discussions and recommendations of this meeting, including the next steps required to create sustainable and impactful research programmes that will enable evidenced-based cancer control approaches and planning at the local, regional and national levels.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Capacity building framework for cancer research in Africa.

Similar content being viewed by others

References

  1. Ferlay, J. et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int. J. Cancer 127, 2893–2917 (2010).

    Article  CAS  Google Scholar 

  2. Sylla, B. S. & Wild, C. P. A million africans a year dying from cancer by 2030: what can cancer research and control offer to the continent? Int. J. Cancer 130, 245–250 (2012).

    Article  CAS  Google Scholar 

  3. Gondos, A., Brenner, H., Wabinga, H. & Parkin, D. M. Cancer survival in Kampala, Uganda. Br. J. Cancer 92, 1808–1812 (2005).

    Article  CAS  Google Scholar 

  4. Coghill, A. E. et al. Contribution of HIV infection to mortality among cancer patients in Uganda. AIDS 27, 2933–2442 (2013).

    Article  Google Scholar 

  5. de Martel, C. et al. Global burden of cancers attributable to infections in 2008: a review and synthetic analysis. Lancet Oncol. 13, 607–615 (2012).

    Article  Google Scholar 

  6. Mgaya, E. M. & Kitinya, J. N. Histopathology of malignant tumours of childhood in Tanzania. East Afr. Med. J. 77, 435–439 (2000).

    CAS  PubMed  Google Scholar 

  7. Msyamboza, K. P. et al. Burden of cancer in Malawi; common types, incidence and trends: national population-based cancer registry. BMC Res. Notes 5, 149 (2012).

    Article  Google Scholar 

  8. Chintu, C., Athale, U. H. & Patil, P. S. Childhood cancers in Zambia before and after the HIV epidemic. Arch. Dis. Child. 73, 100–104; discussion 104–105 (1995).

    Article  CAS  Google Scholar 

  9. Sinfield, R. L. et al. Spectrum and presentation of pediatric malignancies in the HIV era: experience from Blantyre, Malawi, 1998–2003. Pediatr. Blood Cancer 48, 515–520 (2007).

    Article  CAS  Google Scholar 

  10. Lingwood, R. J. et al. The challenge of cancer control in Africa. Nat. Rev. Cancer 8, 398–403 (2008).

    Article  CAS  Google Scholar 

  11. WHO. National cancer control programmes: policies and managerial guidelines. 2nd edn (WHO, Geneva, 2002).

  12. Kirigia, J. M. & Wambebe, C. Status of national health research systems in ten countries of the WHO African Region. BMC Health Serv. Res. 6, 135 (2006).

    Article  Google Scholar 

  13. Kingham, T. P. et al. Treatment of cancer in sub-Saharan Africa. Lancet Oncol. 14, e158–e167 (2013).

    Article  Google Scholar 

  14. Irikefe, V. et al. Science in Africa: the view from the front line. Nature 474, 556–559 (2011).

    Article  CAS  Google Scholar 

  15. Ginsberg, G. M., Lauer, J. A., Zelle, S., Baeten, S. & Baltussen, R. Cost effectiveness of strategies to combat breast, cervical, and colorectal cancer in sub-Saharan Africa and South East Asia: mathematical modelling study. BMJ 344, e614 (2012).

    Article  Google Scholar 

  16. Regional Committee for Africa, WHO. Health financing: a strategy for the African region. (56 session, Addis Ababa, Ethiopia, 2006).

  17. Goldie, S. J. Health economics and cervical cancer prevention: a global perspective. Virus Res. 89, 301–309 (2002).

    Article  CAS  Google Scholar 

  18. Peprah, E. & Wonkman, A. Biomedical research, a tool to address the health issues that affect African populations. Global Health 9, 50 (2013).

    Article  Google Scholar 

  19. Yusuf, S., Baden, T. & Prieto-Godino, L. L. Bridging the gap: establishing the necessary infrastructure and knowledge for teaching and research in neuroscience in Africa. Metab. Brain Dis. http://dx.doi:10.1007/s11011-013-9443-x.

    Article  Google Scholar 

  20. Adesina, A. et al. Improvement of pathology in sub-Saharan Africa. Lancet Oncol. 14, e152–e157 (2013).

    Article  Google Scholar 

  21. John, T. A. Facilities available for biomedical science research in the public universities in Lagos, Nigeria. Niger. Postgrad. Med. J. 17, 6–14 (2010).

    CAS  PubMed  Google Scholar 

  22. Eunice Kennedy Shriver National Institute of Child. Health and Human Development, National Institute of Health. Biomedical/Biobehavioral Research Administrator Development Program [online], (2012).

  23. Office of the Director. National Institutes of Health. NIH Record—BRAD trains in development of research infrastructure [online], (2012).

  24. Association of Research Administrators in Africa [online], (2009).

  25. Hanna, T. P. & Kangolle, A. C. Cancer control in developing countries: using health data and health services research to measure and improve access, quality and efficiency. BMC Int. Health Hum. Rights 10, 24 (2010).

    Article  Google Scholar 

  26. Parkin, D. M. The global burden of cancer. Semin. Cancer Biol. 8, 219–235 (1998).

    Article  CAS  Google Scholar 

  27. Parkin, D. M., Muir, C. S., Whelan, S. L., Gao, Y.-T., Ferlay, J. & Powell, J. (Eds) Cancer Incidence in Five Continents, Vol. VI (IARC Press, Lyon, 1992).

    Google Scholar 

  28. Parkin, D. M. Cancer in developing countries. Cancer Surv. 19–20, 519–561 (1994).

    PubMed  Google Scholar 

  29. Parkin, D. M. F. J., Hamdi-Cherif, M., Sitas, F., Thomas, J. O., Wabinga, H. & Whelan, S. L. (Eds) Cancer in Africa: Epidemiology and Prevention (IARC Press, Lyon, 2003).

    Google Scholar 

  30. Parkin, D. M., Vizcaino, A. P., Skinner, M. E. & Ndhlovu, A. Cancer patterns and risk factors in the African population of southwestern Zimbabwe, 1963–1977. Cancer Epidemiol. Biomarkers Prev. 3, 537–547 (1994).

    CAS  PubMed  Google Scholar 

  31. Parkin, D. M. The role of cancer registries in cancer control. Int. J. Clin. Oncol. 13, 102–111 (2008).

    Article  Google Scholar 

  32. Curado, M. P. et al. Cancer Incidence in Five Continents, Vol IX (IARC Press, Lyon, 2007).

    Google Scholar 

  33. Jedy-Agba, E. E. et al. The role of hospital-based cancer registries in low and middle income countries-The Nigerian Case Study. Cancer Epidemiol. 36, 430–435 (2012).

    Article  Google Scholar 

  34. Jensen, O. M. & Whelan, S. Planning a cancer registry. IARC Sci. Publ. 22–28 (1991).

  35. Parkin, D. M. The evolution of the population-based cancer registry. Nat. Rev. Cancer 6, 603–612 (2006).

    Article  CAS  Google Scholar 

  36. African Cancer Registry Network [online], (2013).

  37. Lansang, M. A. & Dennis, R. Building capacity in health research in the developing world. Bull. World Health Organ. 82, 764–770 (2004).

    PubMed  PubMed Central  Google Scholar 

  38. Fogarty International Center. The Medical Education Partnership Initiative [online], (2011).

  39. H3Africa. Human Health and Heredity in Africa [online], (2011).

  40. National Heart, Lung and Blood Institute, National Institutes of Health. United Health and NHLBI Collaborating Centers of Excellence [online], (2009).

  41. Miller, D. et al. Knowledge dissemination and evaluation in a cervical cancer screening implementation program in Nigeria. Gynecol. Oncol. 107, S196–S207 (2007).

    Article  Google Scholar 

  42. Roblyer, D., Richards-Kortum, R., Park, S. Y., Adewole, I. & Follen, M. Objective screening for cervical cancer in developing nations: lessons from Nigeria. Gynecol. Oncol. 107, S94–S97 (2007).

    Article  Google Scholar 

  43. Casper, C. The increasing burden of HIV-associated malignancies in resource-limited regions. Annu. Rev. Med. 62, 157–170 (2011).

    Article  CAS  Google Scholar 

  44. Silberner, J. The Hutch, Uganda gets creative in cancer fight. The Seattle Times (Seattle, Washington, 2012).

    Google Scholar 

  45. Gantt, S. et al. Clinical presentation and outcome of epidemic Kaposi sarcoma in Ugandan children. Pediatr. Blood Cancer 54, 670–674 (2010).

    Article  Google Scholar 

  46. Johnston, C. et al. Impact of HIV infection and Kaposi sarcoma on human herpesvirus-8 mucosal replication and dissemination in Uganda. PLoS ONE 4, e4222 (2009).

    Article  Google Scholar 

  47. Bateganya, M. H. et al. Predictors of survival after a diagnosis of non-Hodgkin lymphoma in a resource-limited setting: a retrospective study on the impact of HIV infection and its treatment. J. Acquir. Immune Defic. Syndr. 56, 312–319 (2011).

    Article  Google Scholar 

  48. Goldman, J. D. et al. Measurement of the impact of antiretroviral therapy coverage on incidence of AIDS-defining malignancies in sub-Saharan Africa [abstract]. Lancet 377 (Suppl.), 969–970 a37 (2011).

    Google Scholar 

  49. Phipps, W. et al. Gender differences in clinical presentation and outcomes of epidemic Kaposi sarcoma in Uganda. PLoS ONE 5, e13936 (2010).

    Article  Google Scholar 

  50. Huo, D. et al. Population differences in breast cancer: survey in indigenous African women reveals over-representation of triple-negative breast cancer. J. Clin. Oncol. 27, 4515–4521 (2009).

    Article  CAS  Google Scholar 

  51. Zhang, J. et al. Recurrent BRCA1 and BRCA2 mutations in breast cancer patients of African ancestry. Breast Cancer Res. Treat. 134, 889–894 (2012).

    Article  CAS  Google Scholar 

  52. Morhason-Bello, I. O. et al. Challenges and opportunities in cancer control in Africa: a perspective from the African Organisation for Research and Training in Cancer. Lancet Oncol. 14, e142–e151 (2013).

    Article  Google Scholar 

  53. Institut de formation et de Rescherche. Institut de formation et de Rescherche en Urologie [online], (2014).

  54. Rebbeck, T. R. et al. Global patterns of prostate cancer incidence, aggressiveness, and mortality in men of african descent. Prostate Cancer 2013, 560857 (2013).

    Article  Google Scholar 

  55. African Organization for Research and Training Cancer. HPV Cervical Cancer Network in Francophone Africa [online], (2013).

  56. Denny, L. Cervical cancer prevention: new opportunities for primary and secondary prevention in the 21st century. Int. J. Gynaecol. Obstet. 119 (Suppl. 1), S80–S84 (2012).

    Article  Google Scholar 

  57. Viviani, S. et al. 20 years into the Gambia Hepatitis Intervention Study: assessment of initial hypotheses and prospects for evaluation of protective effectiveness against liver cancer. Cancer Epidemiol. Biomarkers Prev. 17, 3216–3223 (2008).

    Article  Google Scholar 

  58. Peto, T. J. et al. Efficacy and effectiveness of infant vaccination against chronic hepatitis B in the Gambia Hepatitis Intervention Study (1986–1990) and in the nationwide immunisation program. BMC Infect. Dis. 14, 7 (2014).

    Article  Google Scholar 

  59. Fackenthal, J. D. et al. High prevalence of BRCA1 and BRCA2 mutations in unselected Nigerian breast cancer patients. Int. J. Cancer 131, 1114–1123 (2012).

    Article  CAS  Google Scholar 

  60. Arowolo, O. A. et al. Neo-adjuvant capecitabine chemotherapy in women with newly diagnosed locally advanced breast cancer in a resource-poor setting (Nigeria): efficacy and safety in a phase II feasibility study. Breast J. 19, 470–477 (2013).

    CAS  PubMed  Google Scholar 

  61. Zheng, Y. et al. Fine mapping of breast cancer genome-wide association studies loci in women of African ancestry identifies novel susceptibility markers. Carcinogenesis 34, 1520–1528 (2013).

    Article  CAS  Google Scholar 

  62. Adebamowo, C. A. et al. Obesity and height in urban Nigerian women with breast cancer. Ann. Epidemiol. 13, 455–461 (2003).

    Article  Google Scholar 

  63. Ogundiran, T. O. et al. Case-control study of body size and breast cancer risk in Nigerian women. Am. J. Epidemiol. 172, 682–690 (2010).

    Article  Google Scholar 

  64. Fackenthal, J. D. et al. Complete allelic analysis of BRCA1 and BRCA2 variants in young Nigerian breast cancer patients. J. Med. Genet. 42, 276–281 (2005).

    Article  CAS  Google Scholar 

  65. Oluwasola, A. O. et al. Use of web-based training for quality improvement between a field immunohistochemistry laboratory in Nigeria and its United States-based partner institution. Ann. Diagn. Pathol. 17, 526–530 (2013).

    Article  Google Scholar 

  66. Tindana, P. O. et al. Grand challenges in global health: community engagement in research in developing countries. PLoS Med. 4, e273 (2007).

    Article  Google Scholar 

  67. Ogwang, M. D., Bhatia, K., Biggar, R. J. & Mbulaiteye, S. M. Incidence and geographic distribution of endemic Burkitt lymphoma in northern Uganda revisited. Int. J. Cancer 123, 2658–2663 (2008).

    Article  CAS  Google Scholar 

  68. Ogwang, M. D., Zhao, W., Ayers, L. W. & Mbulaiteye, S. M. Accuracy of Burkitt lymphoma diagnosis in constrained pathology settings: importance to epidemiology. Arch. Pathol. Lab. Med. 135, 445–450 (2011).

    PubMed  PubMed Central  Google Scholar 

  69. Schmitz, R. et al. Burkitt lymphoma pathogenesis and therapeutic targets from structural and functional genomics. Nature 490, 116–120 (2012).

    Article  CAS  Google Scholar 

  70. Baik, S. et al. A case-control study of Burkitt lymphoma in East Africa: are local health facilities an appropriate source of representative controls? Infect. Agent Cancer 7, 5 (2012).

    Article  Google Scholar 

  71. Mbulaiteye, S. M. et al. African Burkitt's lymphoma: could collaboration with HIV-1 and malaria programmes reduce the high mortality rate? Lancet 375, 1661–1663 (2010).

    Article  Google Scholar 

  72. Aka, P. et al. Incidence and trends in Burkitt lymphoma in northern Tanzania from 2000 to 2009. Pediatr. Blood Cancer 59, 1234–1238 (2012).

    Article  Google Scholar 

  73. National Cancer Institute. The Epidemiology or Burkitt Lymphoma in East African Children and Minors (EMBLEM) [online], (2010).

  74. Harif, M., Traore, F., Hessissen, L., Moreira, C. & Atteby, J. J. Challenges for paediatric oncology in Africa. Lancet Oncol. 14, 279–281 (2013).

    Article  Google Scholar 

  75. Michener, L. et al. Aligning the goals of community-engaged research: why and how academic health centers can successfully engage with communities to improve health. Acad. Med. 87, 285–291 (2012).

    Article  Google Scholar 

  76. Odedina, F. T. et al. The African cancer advocacy consortium: shaping the path for advocacy in Africa. Infect. Agent Cancer 8 (Suppl. 1), S8 (2013).

    Article  Google Scholar 

  77. Segal, R., Odedina, F. T. & Pressey, S. Proceedings of the international workshop on cancer advocacy for african countries. Infect. Agent Cancer 8 (Suppl. 1), 8 (2013).

    Google Scholar 

  78. Mano, M. S., Rosa, D. D. & Dal Lago, L. Multinational clinical trials in oncology and post-trial benefits for host countries: where do we stand? Eur. J. Cancer 42, 2675–2677 (2006).

    Article  Google Scholar 

  79. Arai, R. J., Mano, M. S., de Castro, G. Jr, Diz Mdel, P. & Hoff, P. M. Building research capacity and clinical trials in developing countries. Lancet Oncol. 11, 712–713 (2010).

    Article  Google Scholar 

  80. Hanna, M. et al. Development of a checklist of quality indicators for clinical trials in resource-limited countries: the French National Agency for Research on AIDS and Viral Hepatitis (ANRS) experience. Clin. Trials 10, 300–318 (2013).

    Article  Google Scholar 

  81. Fogarty International Center. International Research Ethics Education and Curriculum Development Award [online], (2012).

  82. Agence Nationale de recherches sur le sida et les hepatites virale. Ethic Charter for Research in Developing Countries, 1–12 (Paris, France, 2008).

  83. Glass, R. International research ethics education. J. Empir. Res. Hum. Res. Ethics 8, 1–2 (2013).

    Article  Google Scholar 

  84. Adebamowo, C. A., Mafe, M. A., Yakubu, A. A., Adekeye, J. M. & Jiya, J. J. Developing ethical oversight of research in developing countries: case study in Nigeria. Harvard Health Policy Review 8, 96–106 (2007).

    Google Scholar 

  85. Yakubu, A. & Adebamowo, C. A. Implementing National System of Health Research Ethics Regulations: The Nigerian Experience. BEOnline 1, 4–15 (2012).

    PubMed  PubMed Central  Google Scholar 

  86. Olliaro, P. & Smith, P. G. The European and developing countries clinical trials partnership. J. HIV Ther. 9, 53–56 (2004).

    PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank all of the attendees of the “Cancer in Africa: building transnational research collaborations” for their tremendous contribution to the discussions during the meeting.

Author information

Authors and Affiliations

Authors

Contributions

I.A., D.N.M., M.J.W., C.A., K.B., C.B., C.C., C.P.W. and D.J.K. researched data for article. I.A., D.N.M., M.J.W., C.A., C.C., S.M.M., F.T.O., O.I.O., C.O.O., D.M.P., T.R.R., H.R., J.T., C.P.W. and A.M.Y. made a substantial contribution to discussion of content. I.A., D.N.M., M.J.W., C.A., C.B., C.C., R.L., S.M.M., F.T.O., O.I.O., D.M.P., T.R.R., H.R., L.A.S., J.T., C.P.W. and A.M.Y. wrote the article; and all authors reviewed and edited the manuscript before submission.

Corresponding author

Correspondence to Isaac Adewole.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

PowerPoint slides

Rights and permissions

Reprints and permissions

About this article

Cite this article

Adewole, I., Martin, D., Williams, M. et al. Building capacity for sustainable research programmes for cancer in Africa. Nat Rev Clin Oncol 11, 251–259 (2014). https://doi.org/10.1038/nrclinonc.2014.37

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrclinonc.2014.37

This article is cited by

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing