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Cancer: What a new plague in Nigeria!

Those who probably saw the broadcaster’s death as a rare occurrence that should not elicit a national health concern were probably proved wrong when Sunny…

Those who probably saw the broadcaster’s death as a rare occurrence that should not elicit a national health concern were probably proved wrong when Sunny Okosun, a famous Nigerian musician, gave up the ghost after being ravaged by cancer of the colon. But while the dust was yet to settle on the death of the music icon, a Senior Advocate of Nigeria and renowned human rights activist, Chief Gani Fawehinmi, was diagnosed of cancer of the lungs. He has since been receiving treatment at a London hospital. The battle against cancer and its destructive effects is gradually building up in Nigeria especially as the World Health Organisation, WHO, estimated that there are 100,000 new cancer cases in the country each year, although observers believe the figure could become as high as 500,000 new cases annually by 2010.

Causes of cancer

According to a research conducted by Dr. Clement Adebamowo, Professor of Surgery, Division of Oncology, Department of Surgery, University of Ibadan, Caffeine may worsen symptoms of fibrocystic breast lumps (a type of benign breast disease) in some women, but there is no evidence that it increases the risk of breast cancer or other types of cancer. The link between coffee and cancer of the pancreas, which got a lot of attention in the past, has not been confirmed by recent studies. There does not appear to be any link between coffee drinking and cancer risk.

There is little evidence that the total amount of fat a person eats affects cancer risk. But diets high in fat tend to be high in calories and may contribute to obesity, which in turn is linked with an increased risk of several types of cancer. There is evidence that certain types of fats, such as saturated fats, may increase cancer risk. There is little evidence that other types of fat (omega-3 fatty acids, found mainly in fish), monounsaturated fatty acids (found in olive and canola oils), or other polyunsaturated fats reduce cancer risk.

Pesticides and herbicides can be toxic when used improperly in industrial, agricultural, or other occupational settings. Although vegetables and fruits sometimes contain low levels of these chemicals, overwhelming scientific evidence supports the overall health benefits and cancer-protective effects of eating vegetables and fruits. At present, there is no evidence that residues of pesticides and herbicides at the low doses found in foods increase the risk of cancer, but fruits and vegetables should be washed thoroughly before eating.

In recent years, substantial evidence has pointed to the link from overweight and obesity, to many types of cancer such as oesophagus, colorectum, breast, endometrium and kidney. The composition of the diet is also important since fruit and vegetables may have a protective effect by decreasing the risk for some cancer types such as oral, oesophageal, gastric and colorectal cancer.

Regular physical activity has also been seen to have a protective effect in reducing the risk of breast and colorectal cancer. High intake of preserved meat or red meat might be associated with increased risk of colorectal cancer. Another aspect of diet clearly related to cancer risk is the high consumption of alcoholic beverages, which convincingly increases the risk of the oral cavity, pharynx, larynx, oesophagus, liver and breast cancers.

Projections by experts

Medical experts feared that by 2020, cancer incidence for Nigerian males and females may rise to 90.7/100,000 and 100.9/100,000 respectively. It is also anticipated that by 2020, death rates from cancer in Nigerian males and females may reach 72.7/100,000 and 76/100,000 respectively.

But these statistics might just be a child’s play if the estimation of the WHO is anything to reckon with.

The health organisation recently predicted that global cancer rates could further increase by 50 per cent to 15 million new cases in the year 2020. This is the gloomy prediction by the 2008 World Cancer Report – a 351-page, comprehensive global examination of the disease to date issued by the IARC – part of the World Health Organization (WHO).

In another report, the World Health Organisation (WHO) has identified cancer of the cervix as one of the second most common cancer among women globally, with a spill over effect touching Nigeria.

WHO says about 85 percent of the estimated 493,000 new cases and over 273,000 deaths from cervical cancer occur in developing countries, including Nigeria, and that if not detected early, cervical cancer can be fatal.

According to a health based  non governmental organisation, Mass Medical Mission,  most cases of cancer of the cervix occurring in Africa are detected very late, mainly due to poor access to screening facilities and the lack of awareness. Coordinator of the Mission, Dr. Kin J-Egwuonwu, however, said that “Unlike other cancerous ailments, cervical cancer is 100 percent preventable, and there is even a vaccine for it now,”

Central to the worrisome predicament is the relative ignorance of the nature of the disease among a vast majority of Nigerians.  Besides, clinical services for cancer are grossly inadequate and poorly distributed. Only a few centres have functioning radiotherapy equipment. Radiologic services are generally available, but access is seriously limited by high cost.

 

Most people who spoke to Sunday Trust expressed complete ignorance concerning the existence and nature of cancer in Nigeria. For instance, Bamowo, Odekunle, a resident of Abuja said that “I know cancer is a deadly disease, but I really do not have any information as to its causes and steps to be taken in order to prevent an infection”. Others like Vivian Okeke and Fatima Idimba confirmed that they had preliminary knowledge of cancer, especially breast and cervical cancer, but not very little is known about the disease compared to other famous ones like Hiv/Aids and malaria.

Dr. Clement A. Adebamowo, Professor of Surgery, Division of Oncology, Department of Surgery, University of Ibadan, is of the view that “The most common cancers in Nigeria are carcinoma of the uterine cervix and breast for women and liver and prostate cancers for men. Cancer registration started in 1960 but a National Headquarters of Cancer Registries in Nigeria was not established until 1990. However, this institution is currently dormant. Some hospitals have screening programmes for cervical cancer, but these programmes are poorly funded, unsystematic, and not comprehensive. There is no national or regional mammographic screening programme, either, although some institutions offer mammographic services. In Nigeria, patients tend to present at a younger age than in developed countries. Although this is often discussed in the clinical literature, it is almost certainly a “birth cohort effect,” reflecting the age distribution of the population and other factors, including access to health care. Lack of knowledge is also well docueanted and is a reflection of general poor health education in this country. Comprehensive health education programmes are more likely to be beneficial than disease-specific programs in tackling this problem.”

Similarly, Dr. Kingsley Adebayo of the Stripes Clinic and Maternity, Abuja, is of the opinion that clinical services for cancer are grossly inadequate and poorly distributed. Only a few centres have functioning radiotherapy equipment. Radiologic services are generally available, however, access is limited by cost. There is only one nuclear medicine department in the country. Although chemotherapy is available, high cost prevents most patients from taking advantage of modern regimens. Pathology services are generally available, but the scope of services is limited. Molecular diagnostic methods are not widely available. Surgery is often performed by surgeons whose primary clinical practice is not oncology, and there is a very limited scope for multidisciplinary cancer care. There is increasing awareness of modern palliative care and pain management, which is particularly useful as patients often present with advanced disease, and physicians have limited access to treatments that offer the prospect of prolonged survival.

Kin Egwuonwu, Resident Minister of the Chapel of the Healing Cross, Lagos University Teaching Hospital, LUTH, is of the view that to prevent cervical cancer there is the need to sensitise Nigerian women on the importance for regular screening.

According to him, “There was a major breakthrough in the search for breast cancer vaccine in 2008. The vaccine that targets breast cancer caused by an excess protein, called HER2, was discovered by some medical experts. The team based at the Cancer Research Centre in London, said the HER2 can also contain many more receptors than are needed to promote a particular aggressive type of tumour that affects up to 30 percent of all breast cancer patients.”

As part of the efforts to raise awareness of the deadly disease among Nigerians and, perhaps, proffer solutions, the first lady, Hajia, Turai Yar’adua recently flagged off a cancer screening centre in Abuja where cases of cancer would be given early diagnosis and possible treatment ,but medical sources have been sceptical about the impact such centres will have on Nigerians. According to an Abuja-based medical doctor who pleaded anonymity, “the idea of having a cancer screening centre in Abuja is a brilliant one, but I believe more than this, what Nigerians need is to be aware of the disease itself because only few people know about its existence and even those who know that there is a   disease called cancer do not have any understanding on how to detect and measures to be taken in order to prevent it”

Breast cancer is the commonest cancer affecting women in Nigeria, followed by cervical cancer, while prostate cancer is the commonest among men.