Focus on Uro-Oncology Practice in Chad: A Call to Action

In 2014, Unger-Saldaña et al. [1] reported that one in six deaths worldwide is caused by cancer. This significant figure continues to rise in low- and middle-income countries (LMICs), primarily because patients generally present when the disease is at an advanced stage. This observation is corroborated by other authors [2,3], who observe that the global cancer burden disproportionately affects LMICs.

In 2023, Shahait et al. [3] noted the scarcity of data on the nature and challenges of genitourinary oncology practice in LMICs. In a recent publication, Majdalany et al. [4] conducted a review titled Challenges of Urologic Oncology in Low- and Middle-Income Countries. Their findings can be summarized as follows: LMICs face a rising incidence of and mortality from urological cancers, driven by diagnostic delays and limited access to advanced treatments. To address these disparities, it is essential to bridge the gap in local data and implement strategies such as patient empowerment, technological advancements, and simple improvements in medical practices.

Building on this publication and various observations, we present an overview of the current state of uro-oncological practice in Chad, a sub-Saharan African country. These findings may reflect similar conditions in other nations within the region. Our contribution focuses on statistical data, diagnostic approaches, targeted therapies, and future perspectives.

In Chad, urological cancers represent a significant proportion of oncological pathologies, yet the available data remain limited due to the absence of a national cancer registry. In urological practice, prostate cancer is the most frequently diagnosed urological cancer, followed by bladder cancer and kidney cancer. Diagnosis is often made at an advanced stage. The mortality rates associated with these conditions are high, reflecting challenges in access to care, early detection, and the availability of therapeutic options.

The diagnosis of urological cancers in Chad relies primarily on basic clinical examinations, often constrained by limited resources. Tools such as prostate-specific antigen (PSA) testing for prostate cancer screening or urinary cytology for bladder cancers are available only in a few urban centers. Most reference centers continue to report PSA test results qualitatively. Access to advanced imaging modalities such as MRI and CT scans remains difficult. Only one center in the country is equipped with MRI capabilities, and multiparametric prostate MRI is not yet feasible. Biopsies, essential for histological confirmation, are hindered by a lack of expertise and specialized laboratories, resulting in delays in diagnosis and limiting access to appropriate treatments.

Therapeutic options in uro-oncology in Chad face numerous obstacles. Surgical interventions, often performed by multidisciplinary teams, are limited to a few well-equipped hospitals in the capital. Chemotherapy, although available, is expensive and largely inaccessible to the majority of patients. Furthermore, the absence of radiotherapy represents a significant gap in cancer treatment, forcing some patients to seek costly solutions abroad. Targeted therapies and immunotherapy, despite their promising potential, are currently unavailable in the country.

To improve the management of urological cancers in Chad, efforts must focus on strengthening local capacities. Establishing a national cancer registry is a priority for collecting reliable data. The development of diagnostic and treatment infrastructures, including the installation of radiotherapy centers and access to advanced technologies, is essential. Additionally, training more specialists in uro-oncology and raising public awareness about the importance of early screening are crucial steps. Finally, international partnerships and targeted funding programs could accelerate the integration of modern therapies and mitigate the impact of health inequalities.

The current reality in Chad is mirrored in several other countries within the region. The landscape of uro-oncological practice can be approached from two perspectives: starting with a single country and expanding toward a regional or multi-country framework, or conversely, examining regional trends and narrowing the focus to a specific nation.

In conclusion, health systems, particularly in regions grappling with economic instability and medication shortages, face considerable financial strain that impacts both medical structures and patients. These challenges underscore the urgency of fostering international cooperation and promoting efficient resource allocation. Such actions aim to eliminate economic barriers hindering access to urological care in low- and middle-income countries, with the ultimate goal of improving health outcomes and ensuring equitable access to advanced treatments. Socioeconomic limitations and insufficient healthcare infrastructure remain major issues perpetuating disparities in oncological care worldwide. These disparities are especially pronounced in resource-limited regions, where implementing screening programs, early diagnoses, and appropriate treatments proves challenging. Bridging these gaps requires strengthening local capacities and mobilizing global support to guarantee quality care at all levels [5,6].