Joel Fokum-Domgue
Department of Obstetrics and Gynecology, University Hospital Centre
Yaounde, Cameroon

IGCS Member since 2014

As an African citizen, some of my family members who I cared a lot for have been pulled out of life, sometimes at a young age, due to poorly managed gynecological cancer.

As an African physician and clinical researcher, I quickly noticed the steadily increasing magnitude of gynecological malignancies in my clinical practice. Given the limitations of health systems in Cameroon as in most settings in sub-Saharan Africa, the majority of cancer patients have to be referred to tertiary level hospitals for proper management. However, very few patients can actually afford to visit these referral hospitals, because they are often from rural and remote settings, of low socio-economic level and disadvantaged backgrounds.

Moreover, I realized the little interest of physicians in sub-Sahara Africa for gynecology oncology. In fact, cancer patients often arrive at an advanced stage of the disease, when the management is difficult, costly, long, and multidisciplinary, often resulting in an uncertain outcome. In addition, the lack of chemotherapy, radiotherapy and palliative care services to accompany clinicians in the care of cancer patients in Africa does not arouse their enthusiasm for this specialty. Even those who have an interest in gynecologic oncology barely find locally an academic and clinical structure that offers such training. As far as I know, there is no practicing doctor in Cameroon to date, who is certified in oncology gynecology. Yet, the number of cancer patients in need of adequate care is constantly increasing.  All these factors have prompted me to take an interest in this promising specialty, with the goal of making my modest contribution to raising awareness about the burden of gynecologic cancers in Africa, to help in providing comprehensive care to women’s cancer patients in my country while ensuring the promotion of gynecologic oncology among doctors in Africa.

I work in a reference hospital in my country as a gynecologist and colposcopist. In this capacity, I practice my clinical activity in a unit of gynecology oncology where I take care of patients with gynecological cancers. Briefly, the first step of my work is to confirm the diagnosis, then to determine the stage of the disease, to set up a multidisciplinary care plan, to perform surgical treatment when indicated, or to send patients to other specialized departments (chemotherapy, radiotherapy, intensive care unit, etc…). As a colposcopist, I carry out colposcopic examinations especially in patients referred for abnormal cytology or VIA positive. In this way, I participate in the detection and management of precancerous lesions of the uterus cervix. The treatment options for cervical dysplasia available in my department include crotherapy, LEEP and hysterectomy.

My prevention activities are not confined to cervical cancer but include other gynecological cancers. For instance, clinical breast examination is practiced and breast self-examination is taught to women who consult for various reasons in the department of obstetrics and gynecology of the University Hospital Centre of Yaounde, Cameroon. In families considered to be at risk, genetic screening for breast or ovarian cancers is advised.

In addition, in collaboration with the National Cancer Control Committee of Cameroon, I regularly participate in the organization of awareness campaigns and screening and management campaigns for cervical and breast cancers in rural areas. I also participate in the reflection aimed at elaborating the national strategic plan for gynecological cancers control in my country.

As a clinical researcher, I have noticed that cervical cancer control strategies currently being promoted by WHO do not sufficiently take into account local demands and socio-cultural realities of developing countries. This has led me to get actively involved in research projects aimed at designing realistic and cost-effective strategies for cervical cancer screening and management that are suitable for resource-constrained settings, especially African countries. On the other hand, with the advent of vaccination against HPV, I have started collaborating with partner institutions including US National Cancer Institute (NCI) and the Union for International Cancer Control (UICC), to work out how to contextualize vaccination approaches against HPV in Africa, in order to achieve maximum effectiveness while ensuring scale-up and sustainability of immunization programs.