Early detection, proper care key to surviving cancer – Dr. Olaogun

Dr. Julius Gbenga Olaogun, an honorary consultant to the Ekiti State University Teaching Hospital and senior lecturer at Ekiti State University, specialises in cancer treatment.

A Fellow of West Africa College of Surgery, he spoke with SEYE OLUMIDE (Southwest Bureau Chief) on what governments and individuals must do to reduce incidences of cancer, and improve its management and challenges facing the health sector, among other issues.

What are the challenges confronting the health sector in Nigeria and how do we address them?
The major problem in the health sector is inadequate funding at all levels of government – at Primary Health Care (PHC), Secondary and Tertiary – there is gross, inadequate funding. This is why most hospitals lack basic facilities to adequately manage patients. 

Don’t you see any shortcomings on the part of medical practitioners themselves?
There are challenges because resources are inadequate for patient management. Aside from this, there is also the challenge of poor remuneration for doctors, which is why there is a lot of brain drain. Many are aspiring to travel out to countries where their welfare would be better.

What informed your specialisation in prostate cancer treatment?
While I was in university, I liked anatomy as a course. And before I graduated from the University, I knew that I would specialise in general surgery. But what spurred my interest in Oncology was what I saw during residency when a lot of people from Ekiti State and from other neighbouring states were coming to Ile-Ife in Osun State because that was the main teaching hospital that was closer to Ekiti. I saw a lot of challenges patients from Ekiti went through. I just decided that after my residency programme, I will pick an interest in oncology to be able to alleviate the sufferings of people, in the hope that if I am closer to them, they would not need to travel miles before they can access good healthcare.

Cancer is considered to be a dreaded ailment, which most Nigerians assume is exclusively a disease of the rich. How true is this?
It is a dreaded ailment because of the misconception that it is a death sentence for whoever has it. That is the reason people fear it a lot but I must say that it has no respect for any social class. It afflicts both women and men, young and old; and it doesn’t have respect for the rich or poor. Anybody can have it.

Is it preventable and what are the causes?
For most cancers, we can say the causes are unknown. But there are risk factors or health habits that can predispose an individual to have it. Though this depends on which cancer we are talking about because the risk factors for breast cancer may be different from risk factors of stomach cancer and all others.

Other risk factors include highly menarche and late menopause. What do I mean by this, when a girl menstruates before 12 years and still menstruates to like 50 to 55 years of age, there is a prolonged estrogen exposure because the growth of breast cancer is hormone dependent. So, when there is prolonged exposure to that hormone, the risks of having breast cancer increase. This is also called a period of nulliparity (not giving birth to a child because breastfeeding has been found to be protective in one way or the other, as it breaks the circle of continuous estrogen exposure). When there is nulliparity, no child, definitely that individual would not breastfeed. 

Also, with the use of hormone drugs or oral contraceptive pills, the risk becomes significant for the patient that has taken it for over 10 years. Apart from dietary habits like increased fat consumption and smoking cigarettes and the use of exogenous hormones, like hormone replacement therapy, those who have attained menopause, especially in developed countries are at risk. If there is cancer of the ovary or uterus in females, those people are at more risk of developing breast cancer. Exposure to radiation also increases the risk of cancer.

There is the concern that men who abstain from sexual intercourse may be at risk of having prostate cancer. How true is this?
It is in the literature, especially for prostate cancer, that those people who are exposed to sex early or people who have had maybe gonococcal infection are more at risk of developing prostate cancer. However, one thing about cancer is that the cause is unknown.

For prostate cancer, age is the main predisposing factor because it is not common in men below the age of 50. The youngest patient I have seen so far with cancer of the prostate is about 58.

Is prostate cancer a death sentence?
There are many types of cancers. There are some that patients would have and regardless of how rigorous the treatment might be, that patient may not likely live beyond six months to one year, like cancer of the liver, lungs and some other bad ones.

But most cancers are curable if detected early. For us to be able to speak in the same language, we have criteria for staging all cancers. Talk of breasts and prostate cancer, we have stages one, two, three and four. For stage one and two, especially stage zero, one and two in breast cancers, we classify them as early. Most patients that come with early breast cancer would be cured but for those that come with the advanced stage, like three, the chances of cure might be very remote except if we have the required facilities. At times, the patient at stage three might still stand a chance of cure but if we don’t have the material to manage the patient, the patient may not live long. But for stage four it has become a systemic disease. Cancer has already spread from that primary site to other parts of the body. Then, the prognosis or the outcome is not usually good.

What makes patients stay till cancer gets to stage three and or four before coming for treatment?
It baffles us when we see such patients too but ignorance is part of it. Some people don’t really know what to do. Some people would just have painless swelling or lumps in their body and because it is painless, they will neglect it and say it is not painful. 
 
Then lack of awareness might also affect those people living in the rural communities. Apart from that fear of treatment, some people might be afraid of the possibility of having their breasts removed. That is the fear in most women. They are also afraid of surgery. These factors scare some people from coming out early until when they cannot help themselves again. 

Over there in the Western world, cancer patients get their drugs at subsidised rate. So, financially those people don’t face the type of challenges patients have here. Here people are poor and salaries are not regular, and when some are undergoing treatment, they lack the resources to buy drugs. They don’t have money to go for radiotherapy. If you send people to go for radiotherapy here, they can’t spend less than a million. And if they go to public hospitals, it can take them up to four to six months before they will be attended to. The facilities for treating cancer are so scanty in the country. There are not more than 11 pieces of radiotherapy equipment across the country, and there was a time we had only four functional ones, whereas, in a country like Canada with only about 33 million population, they have many radiotherapy equipment. 

Why is this so here? 
It is not that Nigeria cannot afford this equipment for cancer treatment but our government does not prioritise health. Otherwise, adequate funding would be budgeted for the health sector. There is no political will on the part of the government to make an adequate budget to fund the health sector. 

Is there anything like stigmatisation in cancer management?
Some patients would always tell you that they have experienced it even from their family members, and this is because people lack adequate knowledge of what cancer is. If someone has HIV and is being stigmatized, you could say maybe it is because of the healthy habit of the person or lifestyle that made him or her contact with such disease. But cancer is different because it is not something that should attract stigmatisation from any segment of society, especially if they know the genesis of cancer. We have to continue to do awareness campaigns so that people can know that with or without risk factors, someone could have cancer.

How functional and well equipped are the oncology units of various government hospitals in Nigeria? 
There is no adequate funding for the health sector so we don’t have the required facilities to adequately manage cancer patients. And the problem is not just at the level of treatment but even at the level of diagnosis. There are barriers to diagnosis, there are some patients we would see and want to refer for some investigations but just because the equipment is not readily available, we would just waive it. For instance, we don’t have a single scanner in the whole of Ekiti State. If someone wants to do the test, maybe the person would be referred to University College Hospital (UCH) just for us to see whether the cancer has spread to the bone. 
 
Then immunohistochemistry is something that can be a major determinant in the management of patients. It is not available everywhere. We have it in just a few centres and they are primarily in tertiary institutions. We don’t have it in Ekiti State. So when we can’t do it, we are helpless and at the end of the day, some doctors would just prescribe drugs blindly without any scientific basis. But if there are facilities to be able to do investigations, we would be able to give the best treatment to our patients. Inadequate funding is a barrier to many things in cancer management. 

It is obvious that the treatment of cancer is very expensive. How can government intervene for patients?
The treatment is very expensive right from the stage of diagnosis. My appeal to various governments is that they should prioritise health and subsidise most of the drugs used for the treatment. Drugs should be made available. It is not all the drugs that are available in this country. Government should make the National Health Insurance Scheme (NHIS) possible. The coverage of the NHIS is still less than 10 per cent across the nation. 
 
I am also appealing to NGOs and philanthropists in the society to join hands with the government in the management of cancer. Radiotherapy equipment can be donated by individuals to centres for the treatment of cancer patients. 

Could food, drugs, body cream, perfume or even bleaching creams cause cancer?
There are some chemicals in perfumes and in creams that can cause cancer. Those ones in creams can cause skin cancer, which explains why someone that has been using it over time could start having some blisters and funny changes on the skin. Some perfumes can also cause lung cancer. Even passive smoking in the streets can cause lung cancer in some people. There are some drugs that are toxic to the system that can cause cancer but not the common drugs that we take.