The Dual Crisis: Why Cervical and Prostate Cancer Dominate Zambia's Health Landscape
- Betty Soonga
- Aug 21, 2025
- 8 min read
Updated: 4 hours ago
In the quiet corridors of Zambia's healthcare facilities, a silent epidemic rages one that claims thousands of lives each year while remaining largely preventable. Zambia faces one of the highest cancer burdens in Africa, with cervical and prostate cancers emerging as the nation's leading oncology challenges. Behind these clinical terms lie human stories: women like Karen Nakawala, who advocates for better treatment after her own battle with cervical cancer, and countless men who present with advanced prostate cancer after years of silent suffering (5). The prevalence of these specific cancers in Zambia is not merely a statistical coincidence but rather a complex interplay of viral infections, healthcare limitations, cultural barriers, and geographical disparities. This article explores the multifaceted reasons behind Zambia's cervical and prostate cancer crisis and examines what can be done to address this pressing public health emergency.
1. The Stark Reality: Zambia's Cancer Burden
Zambia's cancer landscape presents a distressing picture. According to studies analyzing data from the Zambia National Cancer Registry (ZNCR), cervical cancer leads with an age-adjusted incidence rate of 186.3 per 100,000, followed by prostate cancer at 60.03, and breast cancer at 38.08 (1). The geographical distribution of cancer prevalence reveals concerning disparities, with the highest concentrations found in the southern regions of the country, including Lusaka, Eastern, Central, and Southern provinces(1).
The case fatality rates for cancer in Zambia paint an even grimmer picture. Leukemia (38.1%), pancreatic cancer (36.3%), lung cancer (33.3%), and brain/nervous system cancers (30.2%) show the highest mortality rates among diagnosed cases 1. These alarming statistics highlight the critical challenges in early detection, access to treatment, and timely intervention that plague Zambia's healthcare system.
Table: Top Cancers in Zambia by Age-Adjusted Incidence Rates
Cancer Type | Age-Adjusted Rate (per 100,000) | 95% Confidence Interval |
Cervix uteri | 186.3 | 181.77 – 190.83 |
Prostate | 60.03 | 57.03 – 63.03 |
Breast | 38.08 | 36.0 – 40.16 |
Kaposi's sarcoma | 26.18 | 25.14 – 27.22 |
2. Cervical Cancer: A Perfect Storm of Risk Factors
2.1 The HPV-HIV Synergy
Cervical cancer represents Zambia's most significant oncology challenge, with the country bearing the third highest burden globally5. The disease demonstrates an incidence rate of 71.5 per 100,000 women and a mortality rate of 49.4 per 100,0005. This alarming situation stems largely from the devastating synergy between Human Papillomavirus (HPV) and Human Immunodeficiency Virus (HIV).
HPV infection causes nearly 99.7% of cervical cancers, with subtypes 16 and 18 responsible for approximately 70% of cases worldwide. In Zambia, the HIV epidemic has dramatically amplified the risk of HPV progression to malignancy. Women living with HIV are five times more likely to develop invasive cervical cancer, and the progression from precancerous lesions to full-blown cancer occurs much more rapidly in immunocompromised individuals (12).
Studies have found HIV seroprevalence rates among cervical cancer patients ranging from 46% to 93% significantly higher than in the general population (14). This correlation helps explain why cervical cancer accounts for 23.8% of all new cancer cases and 41.1% of new cancer cases in women specifically in Zambia (5).
2.2 Geographical and Healthcare Access Disparities
The distribution of cervical cancer cases across Zambia reveals substantial geographical inequalities. Research shows that crude and age-standardized incidence rates in Lusaka are 2 to 4 times higher than in Southern and Western provinces(14). In the 15-49 age group, Lusaka shows an ASR of 82.1 per 100,000, compared to 25.5 in Southern province and just 17.2 in Western province(14).
This disparity likely results from a combination of factors: better diagnosis and reporting in urban areas, higher population density, and possibly different sexual behavior patterns. However, it may also reflect significant under diagnosis and underreporting in rural regions, where healthcare access is more limited (14).
The concentration of specialized services in Lusaka creates tremendous barriers for women in remote areas. The Cancer Diseases Hospital (CDH), established in 2006, remains the only comprehensive cancer center in the country, offering radiotherapy and specialized surgical services7. For women living in distant provinces, accessing these services requires overcoming significant financial, logistical, and social obstacles.
3. Prostate Cancer: The Silent Epidemic Among Zambian Men
3.1 Biological and Diagnostic Challenges
Prostate cancer has emerged as the leading cancer among Zambian men, with an incidence rate of 60.03 per 100,000 (1). The disease poses particular challenges in the Zambian context due to its asymptomatic early stages and the complex diagnostic requirements for detection.
The exact causes of prostate cancer remain unknown, but risk factors such as age, race, family history, and diet are known to increase susceptibility (4). Diagnosis typically relies on a combination of clinical evaluation, digital rectal examination (DRE), prostate-specific antigen (PSA) testing, biopsies, and imaging (4). While PSA testing is available in nearly all healthcare centers across Africa, more advanced diagnostic capabilities remain limited (9).
A recent survey of urological practices across Africa revealed significant variations in biopsy techniques: ultrasound-guided biopsies were available in 30 centers, digital-guided biopsies in 20 centers, and MRI-guided biopsies in only 5 centers (9). One center reported no capacity to perform biopsies at all due to lack of expertise (9). These diagnostic limitations contribute to delayed detection and advanced presentations.
3.2 Cultural Barriers and Health-Seeking Behavior
Prostate cancer care in Zambia faces profound cultural and societal challenges that significantly impact health-seeking behaviors. Throughout sub-Saharan Africa, cultural beliefs and stigmas surrounding prostate cancer often deter men from seeking timely medical care (4).
The disease frequently becomes entangled with concepts of masculinity and sexual prowess, leading to embarrassment, shame, and denial. Some communities associate prostate cancer with spiritual causes or view it as a consequence of sexual misconduct (4). These misconceptions are particularly prevalent among men with lower education levels and those in rural communities (4).
A systematic review of prostate cancer care in sub-Saharan Africa found that many men perceive screening negatively due to:
Fears of discomfort during rectal examinations
Social stigma associated with the diagnosis
Fatalistic attitudes about cancer outcomes
Misconceptions about causes and transmission (4)
These cultural barriers, combined with limited awareness of early symptoms, result in most men presenting at advanced stages of the disease when treatment options are limited and outcomes are poor (4).
4. Common Systemic Barriers to Cancer Care
4.1 Healthcare Infrastructure Limitations
Zambia's healthcare system faces profound structural challenges that affect both cervical and prostate cancer outcomes. The concentration of specialized services in Lusaka creates enormous barriers for the majority of the population living in rural areas (7). The Cancer Diseases Hospital, while a critical resource, is equipped with only three tele-therapy machines (one linear accelerator and two cobalt machines) and two brachytherapy suites to serve a population of over 18 million people (7).
Diagnostic capabilities remain limited across the country. While CT scans are available in 56 centers and MRI in 54 centers according to an African urology survey, more specialized imaging like PET scans is accessible in only 14 centers, and scintigraphy in 29 centers (9). This limited infrastructure contributes to the reality that over 90% of new cases present at late stages with severe symptoms (7).
4.2 Financial Constraints and Poverty
The economic burden of cancer care creates insurmountable barriers for many Zambians. While the government technically covers treatment costs, patients face substantial indirect expenses including transportation, accommodation in Lusaka, and lost income during treatment (5). These costs are particularly devastating for rural families, often plunging them into poverty (5).
As cervical cancer survivor and advocate Karen Nakawala explains: "With limited treatment available here in Zambia, they are looking at other options, options that will cost money and can plunge a family into poverty" (5). Another patient, Mitondo, described the immense physical, emotional, and financial stress of having to travel abroad for treatment, leaving her daughter behind for months (5).
4.3 Human Resource Challenges
Zambia faces critical shortages of specialized healthcare professionals capable of managing complex cancer cases. The country has limited numbers of gynecologic oncologists, radiation oncologists, and urologic surgeons (9). This shortage is particularly acute outside urban centers, creating dramatic disparities in care quality and accessibility.
The limited research capacity further compounds these challenges. A systematic review of Zambian cancer research found that despite increasing output, only 43% of first authors and 45% of last authors were Zambian researchers, indicating significant dependency on international leadership (2). Moreover, over 90% of the most prolific research funders were international, predominantly from the United States and the United Kingdom (2).
5. Path Forward: Strategies for Change
5.1 Strengthening Prevention and Early Detection
Addressing Zambia's cervical cancer crisis requires enhanced prevention strategies, including expanded HPV vaccination programs. In September 2023, Zambia launched a major HPV vaccine campaign that reached over 63% of the country's 1.42 million girls between 9-14 years old (5). Maintaining and expanding this coverage is essential for long-term reduction of cervical cancer incidence.
For both cervical and prostate cancers, community-based screening programs that overcome geographical barriers are critical. The WHO recommends screening women aged 30-49 years using methods such as HPV DNA testing, visual inspection with acetic acid (VIA), or Pap smears (12). For prostate cancer, developing culturally sensitive awareness campaigns and making PSA testing more accessible in rural areas could improve early detection.
5.2 Improving Diagnostic and Treatment Infrastructure
Zambia urgently needs to decentralize cancer care services beyond Lusaka. Plans to establish comprehensive cancer centers in Ndola and Livingstone represent steps in the right direction, but require adequate funding and staffing (7). Additionally, strengthening pathology services across referral hospitals would improve diagnostic capabilities and reduce delays.
The recent expansion of cervical cancer screening and treatment programs offers a promising model. Zambia has introduced HPV DNA testing and trained nurses like Gloria Mwale to perform loop electrosurgical excision procedures (LEEP), even establishing the country as a hub for south-south collaboration in building a robust health workforce (5).
5.3 Addressing Cultural and Educational Barriers
Developing culturally tailored interventions is essential for improving cancer outcomes. This includes community engagement, media outreach, healthcare provider education, and enhancing accessibility to screening services, particularly in rural areas (4). Engaging traditional leaders and survivors as advocates can help address misconceptions and reduce stigma.
For prostate cancer, interventions should specifically target masculinity norms and emphasize that preservation of life and quality of life represent true strength. For cervical cancer, addressing gender power dynamics and involving men in prevention efforts could improve screening uptake.
Conclusion: A Call for Comprehensive Action
Zambia's disproportionate burden of cervical and prostate cancers represents not merely a healthcare challenge, but a multifaceted societal problem requiring integrated solutions. The convergence of biological factors (HIV-HPV synergy), health system limitations (centralized services, diagnostic constraints), and socio-cultural barriers (stigma, gender norms) has created a perfect storm that claims thousands of lives annually.
Addressing this crisis requires coordinated action across multiple sectors: strengthening healthcare infrastructure, expanding prevention programs, addressing financial barriers, and challenging harmful cultural beliefs. It demands both international support and local leadership to ensure that solutions are sustainable, context-appropriate, and equitable.
As Zambia works toward achieving the WHO's 90-70-90 targets for cervical cancer elimination (90% HPV vaccination, 70% screening, and 90% treatment of precancerous lesions), the lessons learned can inform broader cancer control efforts (12). With committed investment, strategic planning, and community engagement, Zambia can transform its cancer landscape and ensure that all citizens, regardless of geography or gender, can access life-saving prevention, diagnosis, and treatment services.s of geography or gender, can access life-saving prevention, diagnosis, and treatment.
REFERENCES
"A significant variation in Cancer incidence and prevalence..." PMC.ncbi.nlm.nih.gov. 2021 Sep;33(3):186–195. doi: 10.4314/mmj.v33i3.6 (1)
"Mapping the cancer research landscape across Zambia..." ecancer.org. Published: 02/07/2025. ecancer 2025 (2)
"The intersection of culture and prostate cancer care in Sub-Saharan Africa..." African Journal of Urology volume 31, Article number: 41 (2025) (4)
"Ending a cycle of poverty and protecting our children." WHO.int. April 2024 (5)
"Zambia's National Cancer Centre response to the COVID..." PMC.ncbi.nlm.nih.gov. 2020 May 28;14:1051. doi: 10.3332/ecancer.2020.1051 (7)
"Uptake of cervical cancer screening and its determinants in..." PMC.ncbi.nlm.nih.gov. 2025 Jul 21;20(7):e0328103. doi: 10.1371/journal.pone.0328103 (8)
"Prostate cancer diagnosis and management: current practices in Africa..." Frontiers in Urology. 17 March 2025 (9)
"Cervical cancer." WHO African Region. https://www.afro.who.int/health-topics/cervical-cancer (12)
"Global burden of prostate cancer: age-period-cohort analysis..." World J Surg Oncol. 2025 Mar 20;23(1):98. doi: 10.1186/s12957-025-03733-1 (13)
"Observed and Expected Incidence of Cervical Cancer in..." ScienceDirect.com. https://www.sciencedirect.com/science/article/abs/pii/S1048891X24015548
Comments