VINCENT KURAUN re-examines the state of cancer care in Nigeria as nations celebrate World Cancer Day today.
GLOBALLY, the burden of cancer care continues to grow while exerting tremendous physical, emotional and financial strain on individuals, families, communities and health systems.
Many health systems in low- and middle-income countries are least prepared to manage this burden, and large numbers of cancer patients globally do not have access to timely quality diagnosis and treatment according to the World Health Organisation (WHO).
In countries where health systems are strong, survival rates of many types of cancers are said to be improving thanks to access to healthcare that culminates into early detection, quality treatment and survivorship care.
According to WHO, cancer is also said to be the second leading cause of death globally, accounting for an estimated 9.6 million deaths, or 1 in 6 deaths, in 2018. It further added that lung, prostate, colorectal, stomach and liver cancer are the most common types of cancer in men, while breast, colorectal, lung, cervical and thyroid cancer are the most common among women.
To intensify effort to create awareness about cancer, February 4 of every year is set aside by the Union for International Cancer Control (UICC) to mark World Cancer Day, raise awareness for cancer care and to reimagine a world where millions of preventable cancer deaths are saved and access to life saving cancer treatment and care is equitable for all, no matter where they live and whoever they are.
This year’s celebration marks the final installment of UICC’s three-year “Close the Care Gap” campaign, a global health awareness event led by the UICC. With this year’s theme, “Together, We Challenge Those in Power,” the group urges global leaders to eliminate health inequities in cancer care and address their root causes.
In her message commemorating this year’s celebration, the WHO regional director for Africa, Dr Matshidiso Moeeti, described the cancer situation in Africa is disheartening, but quickly expressed her excitement by the potential of new tools to accelerate access to vaccination, screening, and treatment.
She noted that, “In the year 2020, approximately 1.1 million new cancer cases occurred on the continent, with around 700 000 deaths. About 50 per cent of new cancer cases in adults in Africa are due to breast, cervical, prostate, colorectal, and liver cancers.
“If urgent measures are not taken, cancer mortality in the region is projected to reach about one million deaths per year by 2030.
“Also, in 20 years, cancer death rates in Africa will overtake the global average of 30 per cent. This is more so because cancer survival rates in the WHO African region currently average 12 per cent, much lower than the average of over 80 per cent in high-Income countries.
“Nevertheless, we commend the progress made in cancer prevention and care in our region. For instance, 17 countries have introduced high-performance-based screening tests in line with the WHO recommendations.
“Also, 28 of our member states have introduced nationwide HPV vaccination to reach about 60 per cent of the priority population targeted with HPV vaccination.”
But what is the state of cancer care in Nigeria? Though experts in cancer management have, at some point, acknowledged the significant improvement in cancer care in the country, they also said a whole lot still needs to be done.
One of such experts is the consultant clinical and radiation oncologist and Medical Director, Me Cure Cancer Centre, Dr Adeoluwa Adeniji, who, in his appraisal of cancer care in Nigeria, said “basically, cancer care in Nigeria is improving,” but quickly added that more needs to be done.
Explaining further, he said: “It has improved compared to what it used to be. It has improved a whole lot. About five years ago, it wasn’t like this.
“The state has improved but truly speaking, there is still a lot to be done. There are still many things we are yet to do to compared to the rest of the world.
“For example, the number of radiotherapy machines are very few. We only have one PET/CT (Positron Emission Tomography and Computed Tomography) scan machine in the entire country and West Africa. We also have very few oncologists taking care of patients with cancer all over Nigeria.”
Lamenting on the lack of comprehensive cancer care centers across the country, Dr Adeniji told Sunday Tribune that, “there are many states that are yet to have oncologists and cancer centres. It means that, there is still a lot to be done even though the improvement has come but you would realise that the improvement is only obvious in a few states. For example, Lagos and Abuja have improved significantly.
“Ibadan, which is in Oyo State and then states like Borno and Kano are just trying to pick up. Zaria has picked up as well to some extent but there is still some improvement but not as much as we expect to be. We still have a long journey to go when we compare ourselves to western world.
“The number of specialists, the number of equipment, the number of comprehensive cancer centres and there are only a few centres that have radiotherapy machines and there are many states in Nigeria that don’t even have one oncologist.
“They neither have any cancer center norhave cancer treatment equipment. It is still a long journey. I must admit that, but it is no longer what it used to be. Things have moved on and things have improved a lot and significantly, especially in a few selected states in Nigeria.”
Dr Adeniji, however, added that the level of cancer care in the country is presently being threatened by brain drain.
“Don’t forget that we now have the issue of brain drain. Many of our cancer specialists are now leaving the country. That is another thing that Nigeria as a nation is going to face as a reality,” he warned.
Most prevalent cancer in Nigeria
On the most prevalent cancer in the country, Adeniji explained to Sunday Tribune that, “All over the world, not only in Nigeria, breast cancer is the most prevalent cancer.
“It is the most common in Nigeria in Europe in the US and everywhere, that is among the females and then among the males, prostate cancer is the most common cancer in Nigeria.”
Pathogenesis and increase in cancer cases
Meanwhile, Dr Adeniji attributed the increase in number of cancer patients in Nigeria to westernisation, adding that the risk factors of cancer are now ingrained in the way of life of Nigerians.
According to him, “there are many reasons why cancer is on the increase. We call them risk factors. The risk factors have increased and people are practicing them significantly.
“The causes of cancer are known in few types of cancer and not in all types of cancer, but the root factors are well known. Number one risk factor is that there is something called westernisation.
“People are now behaving like the those in the western world, and that is the reason why some of the cancers we see in America and Europe are coming to Africa now.
“People smoke a lot, people have multiple sexual partners, they do homosexuality and practice all those things that we didn’t have before. People now take a lot of alcohol, hard drugs and a lot of high fat diets and things like that unlike in those days when people used to take vegetable soup more. People now take a whole lot of these processed foods or processed meals.
“These are the risk factors that are well known and of course there are family factors too. There are some types of cancer that families can inherit although it is not common. Those are the major reasons why cancer has increased.
“And don’t forget that people now go to the hospital more than before to check their health and are able to tell that something is going on in their bodies unlike in those days that people would stay in their houses till something happened to them.”
Rise in liver cancer according to recent data
Explaining the rate of increase in cancer cases, going by recent data, Adeniji said, “that breast cancer is very common in Nigeria and it is constituting about 27 to 30 per cent of the cases every year and then cervical cancer is about 14 per cent.
“And liver cancer is now increasing. Lver cancer used to be very few but now more people are having liver cancer in Nigeria.
“The percentage has gone up from about 2 to 4 per cent to about 12 per cent. In fact, it is the type of cancer that is significantly prevalent or the percentage has increased significantly compared to other types of cancer in the past few years.
“Prostate cancer used to be more or less the second most common cancer before now, but we are having data that shows that prostate cancer is going as the third one and liver cancer is now coming up. Among the men, prostate cancer is the most common cancer and of course new cancer cases every year goes above 100,000 cases.
“We are having data showing that it is about 140,000 people having or developing cancer anew every year. And the mortality rate has increased significantly also.
“For example in America, the breast cancer cases used to be about 90 in every 1,000 women, in Nigeria, it used to be about 35 in 100,000 women but the mortality between the two countries is almost the same thing.
“Americans have higher values and they are saving more lives. People are surviving more over there, but in Nigeria, even though the number of people having breast cancer is not as high as the one you have in America, you see that the proportion of mortality is almost the same and that is because the equipment we have are fewer, the comprehensive cancer centers are fewer and of course the insurance.
“Health insurance is absent and people have to do out-of-pocket payments. You can’t ask people that cannot afford three square meals, to pay for cancer care.
“They are going to find it more difficult to do. So, a lot of them would rather stay away from the hospital and probably have morbidity and mortality from the cancer than to go to the hospital that they can’t afford and the government is not doing anything about that. The non-governmental organisations (NGOs) can’t treat everybody for free or provide resources for free for everyone,” he explained.
Why we need collective action
Explaining the need for collective action and why the government needs to invest more in the health sector in the country, Adeniji said, “The solution now is that as much as possible, the Nigerian government needs to invest more into the health sector, especially the oncology centres.
“We need more radiotherapy machines, we need more comprehensive cancer centres, we need more PET/CT machine, we need more oncologists to be trained without stress. We need all of these things and also the oncology team –the nurses, the pharmacists, the medical physicists and oncologists. They need to increase their remuneration so that they are not leaving the country for greener pastures because we need them here.
“Those countries where they are going to have more oncologists but they are still taking them because they want to have enough oncologists to take care of entire cancer patients they have out there.
“So the government needs to invest more and partner with the private sectors so that more comprehensive centres can come and more equipment can come.
“These are the major things and of course some of these equipment that we used for cancer care need to be made tax-free. They need to make sure that the custom duty is less and people are not making it more difficult to bring in some of these equipment to use for our men.
“Imagine you are bringing in a radiotherapy machine and they are taxing you and delaying you a lot, people will be discouraged. The Central Bank of Nigerian (CBN) cannot even source for the dollars that people are trying to get in order to bring it in these equipments.
“Government has a major role to play in this, as private individuals are trying to play their role, the government also has to play its role well,” he concluded.
Speaking extensively on what needs to be done to curb cancer spread in Nigeria and other African countries, WHO regional director, Dr Moeeti disclosed that every person must be afforded an equal chance at the prevention, diagnosis, and treatment of cancer, regardless of socioeconomic status, geographic location, age, and gender.
She also called on the region’s countries, communities, partners, and civil society to unite and foster universal access to cancer prevention and care.
“Stakeholders must identify feasible priorities, implement evidence-based population-wide interventions and invest in cancer control.
“Countries should use the updated WHO Best Buys , the facilitative tool designed to enable governments to select lifesaving policies and interventions for noncommunicable diseases.
“Leaders are responsible for ensuring that cancer prevention and care deploy technologies and therapies that are available at low cost to affected persons and their families, which are value for money. Furthermore, countries should strengthen information systems to gather quality data for decision-making.
“We reiterate that civil society, especially organisations of cancer survivors or persons with lived cancer experiences, are critical in the fight against cancer in Africa.
“Such a whole-of-society approach to cancer prevention and care is the essence of this year’s World Cancer Day theme,” the statement read.
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