Call To Action For Leukaemia (Blood Cancer)

SEPTEMBER is dedicated to creation of awareness on several cancers including prostate cancer, childhood cancers, leukaemia, lymphoma, and gynaecologic cancers.

This article will focus on leukaemia because although prostate cancer is the most common cancer in Nigerian men, it was discussed in a previous article published in September last year. The prostate cancer article could be accessed on the blog page of www.cecpng.org.

In addition, leukaemia has a 94% death rate in Nigeria, meaning that only one out of every 20 Nigerians with leukaemia survives! Leukaemia is one of the four most deadly cancers in Nigeria (the other common cancers with a death rate of over 90% in Nigeria are liver, pancreatic and stomach cancers). A recent well-known victim of leukaemia was Mr. Remi Olowude, the renowned insurance icon and boardroom guru, who succumbed to the disease on September 27, 2014.

The Nigerian leukaemia situation is unfortunate because, leukaemia is now curable. For instance, the Tata Cancer Centre in India has a 99% survival rate for leukaemia, in sharp contrast from the current situation in Nigeria.

The word leukaemia comes from a Greek word which means ‘white blood’. Leukemia is a cancer that starts in blood-forming cells found in the bone marrow. Most often, leukemia is a cancer of the white blood cells, the part of the immune system which defends the body against infection, but some leukaemias start in other blood cell types.

Leukaemia leads to the over-production of abnormal white blood cells. These abnormal cells usually can’t carry out the normal functions of white blood cells. They crowd the bone marrow and spill into the blood and may then spread into organs such as the lymph nodes, spleen, liver, the brain and spinal cord, lungs, kidneys and testicles, where they can keep other cells in the body from doing their jobs.

Symptoms of leukaemia are notoriously vague and non-specific. This is partly responsible for the late detection and high mortality in Nigeria. It is therefore important for everyone to be aware of these symptoms and to report promptly to the hospital for evaluation. In leukaemia symptoms are more commonly caused by lack of normal blood cells than by the presence of abnormal white cells. As the bone marrow becomes full of leukaemia cells, it is unable to produce the large numbers of normal blood cells, which the body needs.

This leads to: Anaemia – due to lack of red blood cells, causing paleness, weakness, shortness of breath and tiredness; Recurrent infections – due to lack of normal white blood cells; Bleeding and bruising – due to lack of platelets. Other symptoms include Fever, Malaise (feeling unwell) and excessive sweating. In children, there may be pain in bones or joints. There may also be swelling of the belly due to enlargement of the liver (hepatomegaly) or the spleen (an organ of the immune system found just under the ribs on the left hand side) (splenomegaly).

Leukaemia results from damage to the DNA. The cause of this damage is unknown in most cases of leukaemia. However, there are certain ‘risk factors’ which increase the chance of developing leukaemia. These include: Gender – leukaemias are generally more common in males; Genetics – there is a slightly higher chance of development of some forms of leukaemia in close relatives of patients. Smoking; Chemotherapy or other medicines that weaken the immune system; and Certain genetic disorders like Down’s syndrome could also predispose an individual to the disease. Intense exposure to radiation, including radiotherapy for another condition can also lead to leukaemia.

For instance, many of the survivors of the atomic bomb used in World War II developed leukaemia due to the fall-out of radiation. However, no leukaemia has been linked to radiation from x-rays and CT scans.

Another important risk factor for leukaemia is exposure to certain chemicals such as benzene. It is instructive to note that according to the report of the United Nations Environment Programme (UNEP) released in August 2011 on its Environmental Assessment of Ogoniland, drinking water in some areas is contaminated with benzene, at levels 900 times above the WHO guideline.

In addition, benzene was detected in air samples at higher levels than stipulated by WHO. So one could imagine the number of people in these communities who are dying silently from leukaemia and other cancers related to environmental pollution. Most of these cases are never diagnosed due to absence of basic infrastructure for cancer care.

The current statistics of five (5) Nigerians dying of leukaemia every day is thus probably an underestimation. Sadly, the effect of this pollution will out-last the present generation.

The recent move by the Government of Nigeria to fast track the recommendations of UNEP, which had been ignored for four years is commendable. However, government must sustain the political will to ensure that the recommendations are followed through and not abandoned half way. All the other stakeholders, including the oil companies and the members of the affected communities should also play their roles in ensuring a comprehensive and sustained clean-up of these areas whilst preventing future contaminations, in Ogoniland and other oil-producing areas.

The gold standard for the treatment of some forms of leukaemia is stem cell transplant. A stem cell transplant is a procedure that replaces unhealthy stem cells with healthy ones. Stem cell transplant offers a potential cure for blood cancers such as leukemia, lymphoma, and other life-threatening diseases including aplastic anaemia and sickle cell anaemia.

A shining example of how this procedure can give a new lease of life to leukaemia patients is the Nigerian-American Oluwaseun Adebiyi. Thirty- two year old Seun is a graduate of the Yale Law School, a former corporate attorney at Goldman Sachs, and a trained pilot. Seun survived leukaemia (diagnosed a week before his 26th birthday), because he had access to stem cell transplant at the Memorial Sloan-Kettering Cancer Centre, in Manhattan, USA. That experience transformed and redirected his life.

Today he is a Project Manager of the American Cancer Society as well as the Founder/CEO of the Bone Marrow Registry in Nigeria (“BMRN”), Enugu. The BMRN is a not-for-profit organization established in 2012 to connect stem cell donors with patients who need stem cell transplant. If Seun had been in Nigeria rather than in USA, he would most likely not be with us today.

In 2011, the University of Benin Teaching Hospital (UBTH) successfully pioneered stem cell transplantation in Nigeria. Unfortunately, the UBTH facility has fallen to desuetude, mainly because at five million naira per patient the cost of the procedure is beyond the reach of most Nigerians. Since inception four (4) years ago, only three (3) cases of Sickle Cell Anaemia have benefited from this procedure that is now available locally. Meanwhile, Nigeria has one of the highest incidences of sickle cell anemia in the world! No case of leukaemia has been treated. What a waste of scarce resources! Nigeria should as a matter of urgency provide subsidy to bring this life-saving treatment within the reach of the common man.

The sad situation at UBTH also underscores the importance of focusing first and foremost on prevention which is cheaper and surer. Even if the best of treatment were available, it would be useless if the illness is not diagnosed. It is important to note that the results of a simple blood count could help to diagnose leukaemia; yet most Nigerians get picked up late, leading to the high mortality. An excellent starting point in the effort to ensure access to optimal, accessible and affordable preventive healthcare is through the use of the Mobile Cancer Centres (MCC), as being championed by Committee Encouraging Corporate Philanthropy (CECP-Nigeria) for the BIG War Against Cancer.

CECP’s operational partner for the BIG War Against Cancer is the National Cancer Prevention Programme (NCPP), a non-governmental initiative founded in 2007. Over 100,000 Nigerians have been directly screened and treated so far, and through the awareness created, the NCPP is helping to protect millions of Nigerians from cancer. This monumental effort has contributed immensely to the reduction of cervical cancer deaths in Nigeria from 26 daily in 2008 to 22 daily in 2012 (WHO data). The MCC will facilitate the process of scaling up this effort.

An MCC is much more than a Mobile Mammogram. Rather, it is a clinic on wheels, in which screening, follow-up and treatment (including surgeries), can take place. It includes facilities for mammography, sonology, colonoscopy, colposcopy and cryotherapy, as well as a surgical theatre. It is also equipped with facilities for screening against most common diseases, including the Ten Major Cancer-related killer diseases (Diabetes, Renal Disease, Obesity, Malaria, Schistosomiasis, Helicobacter pylori, Hepatitis, HIV/AIDS, Human Papillomavirus (HPV) and Hypertension). Thus the MCC would tackle the double burden of disease, i.e. Communicable & Non-Communicable.

The MCC is perhaps the single most important means of raising the life expectancy of Nigeria which is currently the 12th lowest globally. Cancer and these ten disease conditions are the main culprits responsible for this low life expectancy. A single MCC in a state of Nigeria could make a huge positive difference. That state would be divided into smaller units such that every community would be reached by the Mobile Cancer Centre at least once a year.

The cost of one MCC is $600,000 only (about N120, 000, 000 at the current exchange rate) and its operational cost for one year (including cost of personnel, supplies and maintenance), is $685,000.

To actualize its vision, the CECP is involved in a fund-raising campaign, known as the #GivingTide. #GivingTide commences on the first Tuesday in December every year, known as #GivingTuesday. #GivingTuesday is a global movement, aimed at celebrating and encouraging generosity.
Every Nigerian whether at home or in diaspora is invited to join in the #GivingTuesdayNigeria movement. In this regard, it is important to note that CECP is an approved body listed under the 5th Schedule of the Companies Income Tax Act (CITA). Therefore all companies making donations to CECP are entitled to take tax deductions for their donations. Further information on the #GivingTuesday could be obtained at www.givingtide.org (www.givingtuesday.org.ng)

“By moving forward together we have the potential to show Cancer: It is not beyond us.”- UICC 2015

• Dr. Abia Nzelu (Executive Secretary, CECP-Nigeria) can be reached via info@cecpng.org or info@givingtide.org