Cameroon is located in central Africa at the bottom of the gulf of Guinea at 2-13° northern latitude and 6-16° Eastern longitude. It has a surface area of 475.000 km², a maximum altitude of 4094 m and a population of 15.8 million inhabitants. It is bounded in the west by Nigeria, to the north and northeast by Lake Chad and Chad, in the south and southeast by Equatorial Guinea, Gabon, and Congo, and in the East by the Central African Republic. The most common diseases are infectious, the dominant infection being malaria. The health system of Cameroon is a pyramidal structure comprising three levels of care. In the periphery are the health centers managed by a nurse, health centers managed by doctors, and the district hospitals. At the intermediate level are the provincial hospitals, including some which come under the Ministry of Public Health. At the tertiary (central) level are the general hospitals, the central hospitals, the teaching hospitals and the main hospitals of the Ministry of Public Health.

Cancer was, until recently,rare with little information being available on incidence, although hospitals have recorded an increase in referrals in the last ten years. Currently, cancer patients are managed only in tertiary care hospitals, of which there are five. Because of the larger number of patients being seen, a National Committee for the Fight against Cancer (NCCC) was created less than three years ago. A cancer registry was launched approximately two years ago. This report provides an overview of the Medical Oncology Service of the Yaoundé General Hospital (SOMHGY) which sees both children and adults.

In 2005, the three most frequent cancers seen in the SOMHGY were breast cancer, which accounted for 26.54% of all cancers, lymphomas (17.05%), and Kaposi sarcoma (4.19%). In women, breast cancer accounted for 42.14% of all cases, and in men, the most frequent cancer was lymphoma, which accounted for 24.06% of cases. In children, lymphomas were the most frequent cancer, and accounted for 50% of the cases.

The most prevalent risk factors for breast cancer are a family history of cancer, low parity and advanced age at the first childbirth. In some patients there are no recognized risk factors. Lymphoma and Kaposi sarcoma occur particularly in patients with HIV infection.

SOMHGY was opened in 1997 and is led by Dr. Paul Ndom, a medical oncologist (the only one in Cameroon), assisted by three general physicians, seven nurses and three nursing aides. The facilities of SOMHGY are basic, and there is a need for improvements in various areas, including the protection of the personnel preparing and administering chemotherapy (there is no laminar airflow hood). There is a shortage of trained personnel. Cancer registration and campaigns relating to the prevention of cancer are organized by the NCCC, while an NGO, Sochimio, provides public educational sessions on a monthly basis. The most difficult obstacle to the delivery of care remains the cost of treatment which, in spite of assistance granted by the Ministry of Public Health, remains high, thus limiting the quality of care available to the majority of the patients with cancer. The only external source of assistance to cancer patients is the PPTE Fund (Pays Pauvre Très Endetté).

INCTR staff accompanied by Drs. Paul Ndom (center left) and Anderson Doh (center right) and others on a tour of Yaoundé General Hospital.

After several international conferences on cancer held in the country and several awareness campaigns conducted by SOCHIMIO, the government accepted cancer as public health priority and after creating the NCCC ordered a National Cancer Control Plan to be created. The General Hospital of Yaoundé has formed a subcommittee against cancer and organizes regular multidisciplinary staff meetings on cancer management which practitioners from other hospitals also attend.

Dr. Ndom and his staff at regular departmental meeting.

The Minister of Public Health for the Cameroon and the President of INCTR signed an agreement on April 5, 2006 to collaborate in the fight against cancer. The agreement calls for an INCTR branch to be established at the Yaoundé General Hospital. SOMHGY will likely begin to participate in INCTR clinical projects and educational programs. Additional assistance has been provided by the International Agency for Research on Cancer, which collaborated with Cameroon in the establishment of the Yaoundé Cancer Registry. Bilateral agreements also exist with the Centre Jean Perrin in France (which has sent antimitotics to Yaoundé) and the ERASME Hospital in Brussels relating to cancer management. The latter relationships have had a minimal effect in Cameroon, in part because they did not involve education and training or a continuing partnership. It is hoped that the relationship with INCTR will be more productive.

Medical Resources Additional departments at the Yaoundé General Hospital include: Gynecology/Obstetrics, Internal Medicine, Nuclear Medicine, Surgery, Radiotherapy, Pediatrics and Cancer Registry. Beds devoted to cancer care 26 Human Resources:   - Nurses 7 - Dedicated oncology nurses 7 - Pathologist 1 - Medical oncologist 1 - Radiotherapists 2 - Radiologists 3 - Pediatric oncologist 0 - Specialized surgical oncologist 1 - Oncologist in training 1 - General and specialized surgeons 6 Equipment:   - CT Scanner 1 - MRI Scanner 0 Patients   Total patients in the last full calendar year 486 Adult cancer patients > 16 yrs 457 Pediatric cancer patients < 16 yrs 29

Paul Ndom
Director of INCTR Cameroon Office