The Current Landscape of Pancreatic Cancer Management in Sub-Saharan Africa - A Perspective Review.

Abstract

Background and aims: Pancreatic cancer remains a significant public health challenge in Sub-Saharan Africa (SSA), with a high mortality-to-incidence ratio driven by late-stage diagnoses, limited therapeutic access, and systemic healthcare disparities. This perspective aims to synthesize current evidence on the epidemiology, diagnostic capacity, treatment options, and structural barriers contributing to poor outcomes, while highlighting opportunities for targeted interventions and policy reforms.

Methods: We conducted a narrative review of peer-reviewed literature, regional reports, and epidemiological studies describing the burden and management of pancreatic cancer across SSA. Data were synthesized to characterize diagnostic pathways, surgical and palliative care practices, workforce capacity, and environmental risk factors. Strategies to address identified gaps were developed based on published evidence from similar resource-constrained settings.

Results: Available data indicate that over 80% of patients in SSA present with advanced or metastatic disease. Diagnostic imaging, including CT and MRI, remains inaccessible in many regions, and biopsies are frequently obtained intraoperatively due to limited endoscopic capacity. Curative surgical resections are rare (< 10%), with palliative bypass procedures predominating. Chemotherapy and radiotherapy services are inconsistently available, and access to opioid analgesics remains below 50% in many centres. Contributing factors include underdeveloped infrastructure, insufficient specialized training, high out-of-pocket costs, and heavy metal environmental exposures.

Conclusion: Improving pancreatic cancer outcomes in SSA requires a comprehensive, multi-sectoral response that prioritizes infrastructure investment, workforce training, and equitable access to diagnostics and therapies. Establishing regional cancer centres, expanding perioperative and palliative nursing roles, strengthening cancer registries, and enforcing environmental regulations are critical steps. Collaboration with international organizations and community stakeholders will be essential to develop context-specific guidelines and sustainable solutions that can reduce disease burden and improve survival rates in the region.