COLORECTAL NEOPLASIA IN SIERRA LEONE - WE WILL ONLY FIND IF WE LOOK

Background There has been an historical assertion that adenomatous polyps and colorectal cancer are rare in Africa, and particularly sub Saharan Africa. The reasons have been felt to be due to the African diet being ‘protective’(1). More recently, this view has been questioned as various publications have reported finding of adenomas and carcinomas (2). An explanation put forward is that there has been a ‘westernisation’ of the African lifestyle and diet. However there may be a more obvious reason – facilities and access to endoscopic evaluations have been poor and therefore, patients have not had access to these, so are not diagnosed. Methods Since 2016, a group of gastroenterologists from Trusts in Northeast UK (all UK certified bowel cancer screeners) have visited Freetown annually to train doctors to perform gastroscopy. Prior to this there were no formalised endoscopy services in the country. The local partners suggested that bowel cancer screening could be offered to individuals for a fee on 2 days of each UK team visit if they wished to have this performed. Fees were used to raise funds towards continuing the training project. Patients were identified prior to the UK team arriving, and information leaflets on the procedure and low residue diet were sent by email. Procedures were performed at Choithram Memorial Hospital. Results 12 patients attended for colonoscopy. Only one of these was a screening procedure, with 11 presenting with lower GI symptoms. 8 were male. Colorectal neoplasia was detected in 7 cases (58%). Table 1 shows details of patients in whom adenomas or cancers were detected. Conclusion This small series further adds to the increasing literature suggesting that colorectal neoplasia is not a rare condition in sub Saharan Africa. Addressing the westernisation of the population (in lifestyle and diet) may not be as important as the provision of diagnostic facilities. The burden of colorectal neoplasia is likely to be much higher than currently reported, and more work on incidence and prevalence of these conditions could support further development of endoscopic services in Africa. References Eur J Cancer Prev. 1998 Oct;7(5):38–1 Niger Med J. 2017 May-Jun; 58(3): 87–91