By H.E. The First Lady of Niger State and Chairperson of First Ladies Against Cancer (FLAC), Dr Amina Abubakar Bello
Cancer is acknowledged as the second-leading cause of death worldwide. According to World Cancer Day research “70% of cancer deaths occur in low-to-middle income countries”. The Cancer Atlas report has identified cancer as “a major [global] public health and economic issue and the burden is set to spiral”. The report further highlights that globally, there were over 18 million cancer cases, 9.6 million cancer deaths and 43.8 million people prevalent to cancer in 2018. The global number of cases is expected to increase to 29 million by 2040. It is estimated that Sub-Saharan Africa had 752 000 new cancer cases and 506 000 cancer deaths in 2018.
Nigeria has one of the highest burdens of cancer cases in Africa. In 2020, an estimated 124,000 new cases of cancer were diagnosed while 78,0000 deaths from cancer were recorded (Globocan). The most frequently diagnosed cancers in Nigeria were Breast, Prostate, Cervical and Colorectal. Factors that contribute to the high death rates from cancer in Nigeria include: poor knowledge on cancer, late presentation to hospital, Inadequate diagnostic and treatment services and the huge financial burden of cancer treatment.
Cancer occurs when the processes that regulate the growth of cells in the body become disrupted leading to uncontrolled, abnormal growth in the cells. The factors that induce these changes are many and could be genetic, environmental, chemical and social. This causes a lump (which is called a tumour ) to occur within the affected tissues. Some tumors are confined to the tissue or organ they developed from and are called Benign Tumours.
These are treatable and, in some cases, harmless and may not require treatment at all. For cancer however, which is called a malignant tumour, it spreads to other organs – which is the main characteristic of cancer that makes it a difficult disease to treat and is the main cause of death.
Early detection is one of the best chances for survival from cancer. People diagnosed early with cancer are not only more likely to survive, but significantly experience better levels of care, lower treatment morbidity, and improved quality of life. Additionally, a third of all cancers can be prevented from occurring by modifying lifestyle habits and environmental factors. It is therefore critical to understand and implement early detection and treatment of Cancer if we are to prevent and reduce cancer related deaths in Nigeria.
Breast and cervical cancers which are the most common cause of cancer-related deaths affecting women in Nigeria are both preventable and treatable through early diagnosis and screening. Screening is the presumptive identification of an unrecognized disease in an apparently healthy person through test and examinations. In the case of breast cancer, living a healthy lifestyle with regular exercise, avoiding alcohol and smoking cigarette, can prevent a third of breast cancer cases. Screening for early breast cancer cases by regular examination of the breast by a clinician in addition to an X-ray examination of the breast called a Mammogram, significantly increases the chances of diagnosing Breast cancer at early stages.
For cervical cancer, which is caused by a virus called Human Papilloma Virus (HPV), screening is done by tests that either identify the presence of HPV in the cervix or detects precancerous lesions within the cervix that can be treated completely. There is a vaccine available that prevents infection from HPV which prevents cervical cancer from occurring completely.
Prostate cancer is the most common cancer in men in Nigeria. When diagnosed early, it increases the chances for cure and survival significantly.
Screening for Prostate cancer is done by testing for the levels of a particular protein called Prostate Specific Antigen (PSA) in the blood.
Detecting high levels of PSA may be indicative of cancer and so having regular checks increase the chances of early detection. The screening tools are available in Nigeria but unfortunately, access to these tools as well as other preventive measures for the majority of women and men in as Nigeria is lacking.
Additionally, and equally important is that many Nigerians lack basic knowledge about cancer. Many are unaware of what the risk factors for cancer are, the symptoms and signs and when to present themselves to the hospital for a checkup. In addition, misconceptions and misinformation about cancer, is a major reason why most cases of cancer in Nigeria present at the late stages when only palliative care can be offered.
The treatment for cancer is multidisciplinary involving different modalities which include Surgery, Chemotherapy, Radiation therapy and Immune therapy among others. Effective treatment for cancer requires a team that comprises specialists from all the different fields including counsellors and palliative care specialists. There are very few centres in Nigeria that can provide these services. More often, patients will visit an average of at least three facilities in different parts of the country to be able to access the different treatment modalities they require. Research by the World Health Organization (WHO) on Nigeria’s health system capacity concluded that there are 8.6 mammographs, 0.5 external beam radiotherapy, 15.6 CT scanners, 5.0 MRI scanners and 0.0 CT scanners per 10 000 patients.
For a country with 200 million citizens, that is concerning when compared with South Africa which has a population of just over 58 million and has 27.1 mammographs, 9.0 external beam radiotherapy, 28.6 CT scanners, 14.3 MRI scanners and 1.3 CT scanners per 10 000 patients. The Nigerian health system is currently inadequately equipped to absorb increasing rates of new cancer patients in the long run.
Grassroots organizations are crucial to raising cancer awareness through advocacy to bring the necessary changes to cancer care in Nigeria. The First Ladies Against Cancer FLAC), a coalition of current and former Nigerian First Ladies, is one example of a coalition with an overarching goal to reduce cancer incidence and mortality and improve the quality of life of people living with cancer by increasing cancer awareness. Through strategic partnerships with key stakeholders such as government officials, religious leaders, community influencers and traditional leaders, organizations like FLAC can dispel the misconceptions about cancer. By addressing commonly held beliefs and providing correct information to communities; thereby giving people the freeway to make informed decisions and present themselves to the hospitals for early detection.