Cancer is a leading cause of morbidity and mortality globally and has become a disease of public health concern. The global distribution of predominant cancers has continued to change especially in developing countries. While the Low and Middle-Income Countries (LMIC) accounted for 51% of all cancers worldwide in 1975, the proportion increased to 55% in 2007 and to 70% in 2018. It is necessary for all hands to be on deck to put an end to this ugly trend.
Data from the Cancer Registries across the country as reported by the Nigeria National System of Cancer Registries (NSCR) has been very useful in the formulation of evidence-based cancer control policies and programmes. The activities of NSCR have improved cancer research in Nigeria and have been a reliable source of epidemiological data from Nigeria to Globacan, the global cancer research agency.
Cancer in Nigeria 2009-2016 which is the second edition of the publications of NSCR provides cancer data from 18 Cancer Registries across the country including the National Cancer incidence which was derived from 6 population- based cancer registries nationwide (Abuja, Calabar, Edo, Enugu, Ekiti and Sokoto). It also provides information on the incidence of cancers from different regions of the country as well as the commonest cancers in Nigeria both by sites and by sex. The book also provides detailed history of Cancer Registration in the Nation including the successes and the challenges associated with cancer registration and possible ways of mitigating them.
“We are yet to collect recent data, we are still officially using the data as at 2018 which was the globocan projection from 2013/2014 publication” (source for above view is from Hon. Minister of Health’s speech at 2020, International Cancer Week, in October at Abuja).
The impact of COVID 19 on cancer care is pretty predictable! The scarce resources to drive our health system has been further denuded by the toll of COVID -19 control measures, which have been huge, because the infrastructure needed to manage COVID patients, i.e., functional isolation centres, which were mostly nonexistent, had to be all put together, culminating in huge initial take off costs. Ventilators, which constitute the mainstay of management of late stage cases requiring urgent care, were also unavailable/ inaccessible with dearth of qualified staff familiar with their use! All these challenges, inclusive of the capital intensive expenditure it attracts, all contributed to deny Cancer Control what it needed to ensure stability of the management of Cancer Patients!
Additionally, Cancer Care is handled: Out of Pocket, by the patients, running to almost 18million as initial cost for a new patient with Breast Cancer!
Is the situation getting better or worse?
Again predictably, the situation is getting worse. In the past years, the government showed some commitment in making more cancer screening and treatment facilities available, however the unprecedented pandemic has resulted in; perhaps diversion of funds (not substantiated by any evidence), and other available resources, to COVID 19, screening and treatment.
In the first wave, some hospitals such as Asokoro district hospital, Abuja, were dedicated solely to isolation and treatment of COVID 19 patients. Additionally, some hospital Oncology practices had to take a chance in triaging their cancer patients, to reduce the risk of them being exposed to COVID 19, if allowed to still make their regular routine visits required for follow up with either their chemotherapy or radiotherapy management.
Those patients needing surgical interventions were shelved for a while as hospitals battled to familiarize themselves, with creating a balance between exposing HealthCare Workers (HCWs), to unidentifiable Cancer patient with the double jeopardy of having COVID. Thus hospital theatres were shut down, except for emergencies, even with a lot of apprehension, as the test kits in use in those earlier months were not fast PCR testing services. Thus, even emergencies, had to cool their heels to await the verifying their status. This protocol mostly prevailed unless in hospital facilities where the HCWs had a death wish or chose to stand with the Conspiracy Theory that THERE WAS NO COVID??
From the personal experience of one of my mentees, Dr. Augusta Imomon, on some of her breast cancer research studies; she affirms that: COVID 19 has had a negative impact on their research. In her words; “We had to get ‘a 6 month no pay extension’, from our funders, following the delay in getting ethical clearance and also on training our study staff, as a result of the lock down during the first wave of the virus in Nigeria. The skeletal activities at the intervention sites resulted in poor recruitment rates; in addition, the women who were recruited were unable to get early appointments due to the immense level of backlog at the referral site (the teaching hospital). Many of the study participants also revealed that they wanted to avoid the hospitals and health centres this period, so they chose to manage their conditions at home since, to them, their condition did not feel like emergency.
My personal experience, was that moving pathology specimen to centres outside the country, linked to the studies by Material Transfer Agreement (MTA), was impossible! None of the courier companies was willing to touch human tissue, due to risk of transmission!
Environmental pollution contributes up to 80% to risk factors for cancer!
Poor handling of refuse disposal, such that both biodegradable and non bio-degradable are left to cause a lot of putrefaction fumes, and release of dangerous bio-wastes that can pollute also our drinking water sources, available to both humans and livestock!
Vehicular fumes and Industrial fumes contribute seriously to environmental air pollution in Nigeria. Last year, the World Bank reported that 94% of the population in Nigeria is exposed to air pollution levels that exceed WHO guidelines (compared to 72% on average in Sub-Saharan Africa in general) and air pollution damage costs about 1% post of Gross National Income (2015)!.
At a CNN interview, Dr Maria Neira, WHO Director, Department of Public Health, Environmental and Social Determinants of Health, opined; The contributing factors to pollution are a reliance on using solid fuels for cooking, burning waste and traffic pollution from very old cars,”
At home, due to unreliable electricity supplies, many Nigerians rely on generators, which spew out noxious fumes, often in unventilated areas. On the street, car emissions go unregulated. There is no serious ROAD WORTHINESS OVERSIGHT OF VEHICLES IN NIGERIA, and with the little there is, owners bribe their way across regulators!
Neira adds: “In Africa, unfortunately, the levels of pollution are increasing because of rapid economic development and industry without the right technology.”Indeed, Nigeria’s economy has raced forward in the past decade, overtaking South Africa as the continent’s largest economy in 2014, following a recalculation of its GDP.
Agriculture, telecoms and oil are all driving this growth at a certain environmental cost
All these leave our lungs in a permanent state of inflammation and could possibly increase risk of coming down with serious complications of COVID!
Some mining areas like Jos, Tin, Lead and Iron Ore, Coal in Enugu, etc are all emitters that have implicated carcinogenic effects, often by direct exposure or contaminants of drinking water.
Food additives/ sharp practices in food production and manufacture & handling! Examples are ripening agents like Carbide used by Sellers of fruits to ripen fruits such as Banana, pawpaw, Mangoes, etc, food colouring to redden stews, palm oil, food enhancers with bleaching & carcinogenic properties, containing Monosodium Glutamate (MSG), cubed and powdered enhancers, sweeteners with Aspartame, uncontrolled use of insecticides/pesticides to de-weevil grains and antibiotics, hormones in poultry and fish farming, de-furring of cattle, sheep and goats with kerosene and tyres (and so many others)
What can we do about cancer?
It may not be possible to completely avoid cancer, but there is a lot we can do to reduce the risk of getting some cancers and detecting them early through routine screening. And for Cervical Cancer, fortunately, there is available and accessible efficacious vaccination (HPV: Human Papilloma Virus, Vaccine), that easily achieves Primary Prevention!
To improve early detection, we need to put the following in place;
- Community advocacy/mobilization (planned, annually rostered and sustained; AWARENESS CAMPAIGNS)
- Increased focus on screening programmes
- Imperatively, the oft forgotten need of providing training/capacity building of health workers, particularly, community health workers and nurses who serve as primary contacts for women in rural areas.
Recommendations
- Our strong recommendation is for a shift of focus from ‘SICK-CARE’, to ‘PREVENTIVE CARE’, with attention to lifestyle modifications and control of environmental pollutants/ food additives/ sharp practices in food production and manufacture by gating the window period between our farms and the market places that distribute food to the consumers (end users of food products) through more vigilant oversight and legislature for stringent punitive measures.
- Embracement of better health seeking habits, regular medical checkups to screen for Non-Communicable Diseases (NCDs), advice on sedentary lifestyle and diet which is essentially skewed to 3/4 fruits and vegetables with 1/4 shared between the carbohydrates and protein source!
- To ingest more wholesome complex and natural carbohydrates rather than the more processed starch products they order to be associated with being enlightened and bourgeois!
- Health education and promotion of knowing more on how their body works, so people can pay close attention to their bodies and alert their healthcare providers as soon as they notice any abnormal changes.
- Regular Screening; for breast cancer for instance, women should practice regular ‘Self-Breast Examination (SBE) 2-3 days after their period. While they can get vaccinated against the Human Papillomavirus which causes cervical cancer, (between ages 9-14 years, & up to 26 years), and ensure regular screening with HPV testing or PAP smear, or Visual Inspection Techniques with Culposcopy.
- Practice general preventive measures such as maintaining a healthy weight, being physically active; avoid smoking, drinking alcoholic drinks or sugary drinks excessively and unnecessary exposure to radiation, industrial and environmental toxins such as asbestos fibres, benzene, aromatic amines, and Polychlorinated Biphenyls (PCBs).
- In terms of surviving cancer, patients can join support groups that comprise of people who also have a similar diagnosed condition, so they can support themselves and lend their voices as the theme of this year’s World Cancer Day, recommends: I AM AND I WILL!
- Finally, so many medications are available with different stages of the Tumour Biology to see if cure can be achieved. Some Nigerian Bench Scientists have some candidate products that from their studies, suggest potential to treat Cancers! Our recommendation is that Nigerian government should henceforth be proactive in providing funds for Clinical Trials, to take the bench studies through to the bedside and to the market place!
To sum up, the key to reducing the number of deaths arising from cancers is early detection and improved access to treatment. Cancers like prostate, breast and cervical cancers (being acknowledged by the Federal Government of Nigeria, to be the three most prevalent cancers in Nigeria), have a better prognosis when they are detected early. And for Cervical Cancer, with vaccination and vigilant screening; NO WOMAN NEEDS TO DIE FROM CERVICAL CANCER, and yet 26 women still die from cervical cancer every day in Nigeria!
THE QUAGMIRE OF EARLY DETECTION WITHOUT SUPPORTING INFRASTRUCTURE FOR CARE AND AFFORDING MANAGEMENT
However, after detection, it has been noted that patients find it difficult to access specialist care because of the limited number of treatment centres within the country and also due to ‘out of pocket payment’ of life threatening crippling medical bills. Little wonder, that Nigeria has one of the worst Cancer death statistics, globally and in Africa! 1 out of every 5 persons with cancer die and late detection due to lack of planned and structured screening programmes , no offer to get screened at the point of care, and ‘IT IS NOT MY PORTION SYNDROME’, borne out of fear that Cancer is a Death Sentence, procrastination, and stigmatization and abandonment by family, especially ‘Spousal rejection’
These issues, inclusive of an available, accessible and affordable health insurance scheme, have to be addressed for a reduction in the number of deaths, ‘Survivor population’ or People Living With Cancer; to share their Stories, to be achieved and a change of narrative occur.’
Each voice counts
PROFESSOR IFEOMA OKOYE
Professor of Radiation Medicine @ the UNN/UNTH, with Bias for Oncology
Foundation Director of the University of Nigeria Center for Clinical Trial (UNNCECT)
Member of the National Cancer Control Implementation Committee,
National Committee for implementation of the Catastrophic Cancer Fund,
Member of the NCDC Nigerian COVID Research Committee (NCRC),
Founder of Breast Without Spot, Cancer NGO (BWS)
- AUGUSTA IMOMON (MBBS Nigeria)
Founder Medics Express Mobile Healthcare
Research Associate at the International Research Centre of Excellence,
Institute of Human Virology Nigeria
BWS Assistant Program Director Research
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