World Cancer Day: Grim day, bright tomorrow

It is bitter, but that is the truth. Four out of every five Nigerians diagnosed with cancer ends up dying. This very distressing statistics confirmed by the World Health Organisation (WHO), and the International Agency for Research on Cancer (IARC) is not just grim, it also confirms that Nigeria holds the world’s worse cancer deaths record.
 
But that notwithstanding, the country is making some progress in cancer treatment and prevention. That is why experts, on this year’s World Cancer Day, predict that there are happy days ahead for cancer sufferers. 

Specifically, with the recent assent to the National Institute for Cancer Research and Treatment (Establishment) Bill in December 2017, there is hope for commitment on the part of growth.

The Act if implemented, will provide national direction in cancer research, control and treatment; guide scientific improvements to cancer prevention, treatment and care, coordinate and liaise between the wide range of groups and health care providers with interest in cancer.

According to the WHO statistics, cervical cancer, which is virtually 100 per cent preventable kills one Nigerian woman every hour, breast cancer kills 40 Nigerians daily while prostate cancer kills 26 Nigerian men daily. 

This year’s World Cancer Day theme: “We Can, I Can”, calls on individuals and organisations, to get involved in cancer interventions, especially through awareness creation in order to solve the late presentation issue in the country.

In addition to this recent step taken by the Federal Government, reports also indicate that some non-governmental organisations have equally been doing a lot of work with regards to cancer prevention, diagnoses and treatment.

A few months ago, the National Hospital, Abuja, received two multileave linear accelerator LINAC radiotherapy machines, which experts say is one of the best in West Africa.

Minister of Health, Prof. Isaac Adewole, said during the inauguration that with these machines, about 100 cancer patients could be treated daily. Already, plans are afoot to install similar machines in the Lagos University Teaching Hospital (LUTH) by the end of the second quarter. 

Wives of some state governors and private organisations have also been actively involved in the fight against cancer treatment/ management. For instance, in Ibadan, the Oyo State capital, the First Lady, Mrs. Florence Ajimobi, through her ABC Medical Foundation, has established one of the best cancer diagnostic centres in the country, which has capacity for immunotherapy treatment.

Her Ogun State counterpart, Mrs. Olufunso Amosun, also donated ultra-modern cancer centres at the General Hospital in Abeokuta, General Hospital, Sango, as well as the Olabisi Onabanjo University Teaching Hospital (OOUTH) in Sagamu.

In Kwara State, First Lady, Omolewa Yetunde Ahmed, has been creating a lot of awareness on breast and cervical cancer scourges, providing access to regular screening and psychological support for cancer sufferers, through her LEAH Foundation. 

The foundation has established a well-equipped screening centre at Ilorin, the state capital city, and other basic (VIA) screening centres in all local councils of the state.

The Medicaid Cancer Foundation in Kebbi State, established by the First Lady, Dr. Zainab Bagudu, is actively involved in cancer treatment and diagnoses in the state.

Other organisations such as the Committee Encouraging Corporate Philanthropy in Nigeria (CECP), the Cancer Aid Foundation, and others, are making conscious efforts in providing funds to the less privileged for cancer treatment and screening.

With all these efforts, a consultant in Clinical and Radiation Oncology, Professor Francis Durosinmi-Etti, told The Guradian that, “There is hope for cancer sufferers in the near future. Government is playing a major role in ensuring that cancer treatment is provided at designated centres, and many facilities are going to come very soon. The International Cancer Centre initiated by Mrs. Turai Yar’Adua will soon be revived. The Delta State University, and the Ondo State government have begun preliminary preparations for the establishment of cancer centres.

“This is in addition to a new organisation, Cancer Trust Fund, which is on the way, and is aimed at supporting cancer organisations with funds for cancer care and equipment. With the Cancer Institute for Research Act in place, research into cancer drugs will begin,” he added.

A professor of Oncology and Radiology at University of Nigeria Teaching Hospital (UNTH) Enugu, Prof. Ifeoma Okoye, said her organisation, Breast Without Spot, has been creating a lot of awareness and education to both rural and urban women/men, on early presentation of cancer, thereby reducing the late presentation burden.

“We aim to further improve survival statistics for breast cancer, by providing vaccination against cervical cancer and screening for cancers and other non-communicable diseases, so as to reduce late detection, and finally create a sustainable pool of funds that would assist indigent breast cancer patients pay their medical bills”, she said.

Despite progress made so far, Okoye, said more proactive measures need to be taken to reduce the horrific deaths occuring every second from cancer in Nigeria.

“While the outcome for several forms of cancer have improved over the last decade in developed countries, mostly due to vast technological and scientific advancements, the outlook remains grim in Nigeria. Across Africa, just five per cent of childhood cancers are cured, compared to a cure rate of nearly 80 per cent in the developed world.

“The awareness level of Nigerian women to breast and cervical cancer is very low, and this is heightened by procrastination, fear, (It is not my portion syndrome), socio-economic, and superstitious/cultural restraints. This has given rise to the crisis of these two scourges in our environment. So, more than 83-87 per cent of affected women present late, incurring unaffordable bills of N150, 000 to N350, 000 every three weeks on drug treatment, followed closely by rapid deterioration and death, with resultant high morbidity and mortality in young and middle age groups when they are best productive in contributing to the socio-economic development of our nation.”
 
Executive Director Sebeccly Cancer Care, and a consultant radiation and clinical oncologist at the LUTH, Dr. Omolora Salako, revealed that over 70 per cent of cancer patients do not go to the hospital on time and this seriously limits their chances of getting cured even with the best cancer specialists, facilities or chemotherapy agents. 

However, one of the reasons why cancer patients run away from hospitals and from conventional treatment is the high cost of treatment.

According to Prof. Okoye, it costs about N170, 000 to carry out the necessary preliminary cancer tests (work up tests) before treatment.

Lending credence to this, Dr. Durosinmi-etti, told The Guardian that one drug for breast cancer could cost as much as N1m. “By the time you pay for 12 months, you must have spent about N12million. And this is apart from the money you will pay for the laboratory diagnosis and the radiotherapy.”

Although the National Health Insurance Scheme (NHIS), has started taking up some of the costs, he said only a few persons have benefitted from the NHIS.

Since government has started installing linear accelerator radiotherapy machines, there is need to do same at other centres. Presently, only the two machines at Abuja are working, apart from smaller machines at the University of Ibadan Teaching Hospital and some private hospitals, he said.

“Government needs to do more to see that the price of these drugs are further reduced.  What is important though is that government is committed to cancer eradication,” he explained.

Given that many cancer cases are presented late, Dr. Salako, said implementation of a national awareness and screening of cancer as prevention and early detection programme will prevent at least 30, 000 cancers yearly in the country. 

Also, there is need to optimise and equip cancer treatment centres to deliver quality and prompt care and the implementation of a cancer care fund, either through health insurance or another financial mechanism, which will discount cost of care for patients, she added.

While many are still in a quandary regarding the actual causes of cancer, experts suggest that diet and lifestyle change play a crucial role in keeping cancer at bay.

According to a WHO study, 30 per cent of cancer deaths are caused by five leading behavioral and dietary risks including being overweight, not eating enough fruits and vegetables, little or no exercise, tobacco and alcohol use. Of these, tobacco use has the highest risk of cancer, causing around 20 per cent of global cancer deaths and around 70 per cent of global lung cancer deaths.

“By avoiding smoking we can prevent 33 per cent of cancers related to tobacco smoking, avoiding or reducing alcohol consumption will avert 3-5 per cent of cancers, avoiding the harmful rays of the sun will prevent over 80 per cent of skin cancers in our albinos, who must be taught early in life that exposure to the sun is their greatest enemy.

Lack of exercise, obesity are known and avoidable risk factors; avoiding multiple sex partners and having protected sex when inevitable will prevent cancer of the cervix due to Human Papilloma Virus.

Regular medical checks like self-breast examination and other age-related breast examinations will help prevent breast cancer. Regular check and screening of the prostate gland in men will help reassure them, or if necessary, ensure early and curative treatment,” Dr. Durosinmi-Etti said.