Nasopharyngeal carcinoma in sub-Saharan Africa: A tribute to Mr. Peter Clifford

Abstract

Poorly differentiated nasopharyngeal carcinoma (NPC) is a major malignancy in certain areas of Asia. It exists also in Africa, notably among largely Arab populations in North Africa, and in "hotspots" in East Africa among "native" Africans. This article deals with the latter, as studied and defined in depth during the 1960s and 70s by the Irish-born surgeon, Peter Clifford. Through his published works, he has influenced and helped define the field of head and neck cancer as it exists in Kenya. He also did pioneering work on the African childhood malignancy, Burkitt's lymphoma (BL). Both BL and NPC have been ultimately shown to be associated with the human herpes Epstein-Barr virus (EBV). This article is written as a tribute to Peter Clifford, focusing on his work on NPC, where he first defined the disease "hotspots" in the Kenyan Highlands, studied how best to treat the malignancy in the absence of radiotherapy, looked at possible NPC predisposing factors in the Kenyan setting, and ultimately addressed how the cancer cells interact with EBV. Peter Clifford's pioneering work was cut short by accident. Although outside East Africa he remains largely an 'unsung hero' in the field, his influence has been great. It begs to be re-addressed and reconsidered.