Malaria, major cause of childhood cancer –Experts

Health experts have identified malaria as one of the major causes of childhood cancer, otherwise known as endemic Burkitt lymphoma.

Endemic Burkitt lymphoma is said to be the most common childhood cancer in equatorial Africa.

Physicians say this is especially so in tropical Africa, where malaria is the number one disease and a major cause of death for the populace.

According to Health Line, an online health portal, Burkitt lymphoma is a rare and aggressive form of non-Hodgkin’s lymphoma, a type of cancer that occurs in the lymphatic system.

It notes that it is prevalent in Sub-Saharan Africa, where there is a high incidence of malaria caused by Plasmodium falciparum, which is transmitted through the bite of female Anopheles mosquito.

According to the World Health Organisation, cancer is a leading cause of death for children and adolescents worldwide.

It notes that in high-income countries, over 80 per cent of children with cancer are cured, while only 20 per cent get the required treatment in many Low Medium income Countries.

On the prevalence of Burkitt lymphoma in Africa, the International Agency for Research on Cancer pegged the number of new cases that occurred in 2018 at about 3,900 – two thirds in males, and 81 per cent in children aged 0-14.

“On a national basis, the geographic distribution of incidence rates among children in sub-Saharan Africa resembles that of the prevalence of infection with Falciparum malaria.

“An estimated 81 per cent of cases are associated with infection with Epstein Barr virus,” it stated.

A study carried out by a team of Nigerian researchers in 2019, and published in Research Gate and Orient Journal of Medicine revealed that endemic Burkitt lymphoma is among the most common childhood cancers in Nigeria, where the prevalence ranges from 18 per cent to as high as 65 per cent of all childhood malignant tumours.

“It mainly affects children of low socio-economic class that are between the ages of four and seven, with a male to female sex ratio of about 2:1,” the research stated.

Speaking with PUNCH HealthWise, Founder, Children Living with Cancer Foundation, Dr. Nneka Nwobi, said in Sub-Saharan Africa, Nigeria inclusive, over 100,000 children die annually from cancer.

She also said no one knows the actual cause of cancer but there are certain factors associated with some of the childhood cancers, which include malaria and Epstein-Barr virus that have been linked to Burkitt lymphoma.

“Yes, malaria with Epstein-Bar virus, together are seen in most slides of children with Burkitt lymphoma. It is seen mostly in areas where malaria is endemic, including Nigeria,” said Nwobi.

According to the WHO, there are three types of Burkitt lymphoma – endemic, sporadic and immunodeficiency-associated.

It, however, noted that endemic Burkitt lymphoma primarily affects African children between the ages of four and seven, and is twice as common in boys.

The symptoms of endemic Burkitt lymphoma include swelling and distortion of facial bones and a rapid growth of lymph nodes, noted the WHO, adding that the enlarged lymph nodes are non-tender.

“Tumours can grow extremely quickly, sometimes doubling their size within 18 hours.

“With the ailment, the facial bones and jaw are often affected. Also, the small intestine, kidneys, ovaries, and breast may also be involved,”

On chances of children surviving cancer in Nigeria, Nwobi, a cancer expert, said children with cancer have every chance of survival, going by the number of qualified cancer specialists in the country.

She, however, said facilities, access to treatment and awareness of the disease itself need to improve.

“We have the brains. Chances of survival might be low, but we are getting there. The chances are about 20 per cent, as opposed to 80 or 90 per cent abroad.

“Cost of treatment, inadequate facilities, lack of access to medicine, ignorance and lack of political will are part of the reasons for the low survival rates,” she said.

The WHO, however, said childhood cancer generally cannot be prevented or screened.

“Improving outcomes for children with cancer requires early and accurate diagnosis, followed by effective treatment.

“Most childhood cancers can be cured with generic medicines and other forms of treatments, including surgery and radiotherapy.

“Treatment of childhood cancer can be cost-effective in all income settings,” WHO said.

Avoidable deaths from childhood cancers in Low Middle Income Countries, the WHO noted, result from lack of diagnosis, misdiagnosis or delayed diagnosis, obstacles to accessing care, abandonment of treatment, death from toxicity, and higher rates of relapse.

It said childhood cancer data systems are needed to drive continuous improvements in the quality of care, and to drive policy decisions.

On effective treatment for endemic Burkitt lymphoma, the world health body says it begins with a medical history and physical examination.

“A biopsy of tumours confirms the diagnosis. The bone marrow and central nervous system are often involved. Bone marrow and spinal fluid are usually examined to see how far the cancer has spread.

“Burkitt lymphoma is usually treated with combination chemotherapy, where drugs are injected directly into the spinal fluid to prevent the cancer from spreading to the central nervous system.

“This method of injection is referred to as intrathecal. People who get intensive chemotherapy treatment have been associated with best outcomes.

“In countries with limited medical resources, treatment is often less intensive and less successful. Children with Burkitt’s lymphoma have been shown to have the best outlook.”

According to WebMD, intensive chemotherapy can achieve long-term survival in more than half the people with endemic Burkitt lymphoma.

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