A multidisciplinary team of experts appointed by the International Atomic Energy Agency (IAEA), World Health Organization (WHO) and International Agency for Research on Cancer (IARC) conducted a comprehensive imPACT Review in Comoros at the end of 2023 to advise the Ministry of Health on cancer control needs and priorities. All aspects of the cancer control continuum were reviewed, including prevention, early detection, diagnosis, treatment, and palliative care. Findings from the mission are intended to inform the development of a National Cancer Control Plan and pave the way for introducing radiation medicine to the country in a safe and secure manner.
Experts from the imPACT Review mission were greeted by Ms Loub-Yakouti Attoumane, Minister of Health, to go over the planned agenda and discuss priorities. (Photo: L. Haskins/IAEA)
"The Comorian government is committed to the fight against cancer. Following the recommendations of WHO, IAEA and IARC experts, a roadmap has been drawn up to strengthen cancer control capacity in Comoros for the benefit of the Comorian population," shared Minister of Health Loub-Yakouti Attoumane in the weeks following the mission. This commitment was also evident during the mission, as a multidisciplinary team of national experts worked alongside the international team to provide guidance, counsel and context.
Comoros extends across over several islands, and the cancer situation is difficult to ascertain because the country does not have a population-based national cancer registry (a point that experts from IARC were keen to see addressed as it ensures that cancer patients are only counted once and then tracked throughout the care they receive in different institutions). In 2022, it was estimated that there were 619 new cases of cancer in Comoros' population of 836 000 people, and 418 cancer related deaths (Globocan 2022). Cervical, prostate and breast cancers are the most prevalent forms of cancer and mortality rates are high (42 per cent of all cancer related deaths in the country are caused by these three cancer types).
WHO attributes 45 per cent of all deaths in the country to non communicable diseases, including cancer. Radiation medicine can help in approximately 50 per cent of all cancer cases, but there are currently no radiotherapy services available in Comoros. However, preparations for such services are well underway.
"Comoros is actively engaged in setting up the foundations for strengthening cancer control in the country, particularly in ensuring the safety of patients and healthcare workers interacting with radiation medicine and the security of radioactive sources," said Ali Mohamed Ali, Director General of Higher Education and Research, Ministry of National Education and IAEA National Liaison Officer. "To that effect, a law is currently under consideration to create the national radiation protection regulatory body to advance on these priorities," he added.
One key recommendation from the mission experts was that a multidisciplinary committee responsible for planning, implementing, monitoring, mobilizing resources and coordinating all aspects of cancer control in the country should be created. Discussions also took place with a view to increasing the prevention and early detection of breast and cervical cancer in women - two cancers that together are responsible for more than one in two woman and girl's deaths from cancer in the country (Globocan 2022).
The full team (international experts plus national focal team) meets in person for the first time to discuss cancer activities and priorities in the country. (Photo: L. Haskins/IAEA)
Civil society organizations such as the Comorian Association for the Fight against Woman and Girl's Cancers (Association Comorienne de Lutte contre le cancer chez la Femme or ACCF), in partnership with the WHO Comoros country office, are actively involved in screening and detecting cervical cancer at the local level. Experts from the imPACT Review mission applauded these efforts and provided advice to see these services integrated more fully into the primary healthcare package on offer for women, alongside vaccination against the HPV virus (as the HPV virus is responsible for 99.7 per cent of all cervical cancer cases worldwide), and the treatment of pre-cancerous lesions.
Comoros has requested support through Rays of Hope - an IAEA initiative to expand access to radiation medicine worldwide. "The new legal and regulatory framework currently under discussion is expected to pave the way for this type of therapy to be introduced in the country in a safe and secure manner," said Michel Warnau, Section Head in the IAEA's Department of Technical Cooperation (TC), in charge of the TC programme for Comoros. "Once the comprehensive nuclear law has been promulgated, a number of technical cooperation projects are intended to support on the one hand the operationalization of the national radiation protection regulatory body, and on the other, the therapy related recommendations of the mission [in particular through training of the required specialized human resources]," he added.
