Institutionalise screening at PHCs for better outcomes in cancer care
Breast and cervical cancers are the most common causes of female cancer-related mortality in Nigeria today. Early detection and treatment significantly decreases cancer mortality rates and the First Ladies against Cancer (FLAC) and Roche Nigeria have combined their efforts to advocate for cancer screening to be incorporated into the country’s National health system at the Primary health care level.
This is because cancer treatments are very expensive and over 75 per cent of Nigerians pay for health care out of pocket. This is a huge burden on the resource of the average Nigerian. Prevention and early detection of cancer not only improves chances of survival and reduces morbidity, it also reduces the financial burden associated with the cost of treatment. Primary health care centres/clinics are the closest access to healthcare for people and institutionalizing screening of cancers at that level increases early detection thereby reducing the incidence of cancer. It also helps to remove both the economic and cultural barriers that may exist.
Past efforts to raise awareness for cancer and treatment options have not been completely successful in improving cancer health behaviour amongst women in Nigeria. This is because cancer screening is viewed as an added cost and inconvenience. However, if it is institutionalized as one of the requisite tests, then it becomes a compulsory exercise for women.
Some other factors affecting women’s resistance to cancer screening include low perception of cancer risk, and physician gender preferences. In addition, lack of spouse permission and support; belief that cancer is a death wish and societal discrimination are amongst the common socio-cultural barriers to screening. It is therefore imperative that stakeholders upscale efforts to advocate for and create awareness of cancer screening available to Nigerian women. To assist in breaking down these barriers, we need to ensure primary prevention through lifestyle modification and secondary prevention through cancer screening. For both Breast and Cervical cancers, the screening tests are simple and relatively inexpensive and can easily be provided at primary health centres. The gold standard test for cervical cancer screening is testing for the Human papilloma Virus (HPV) that is currently inaccessible for majority of women in the country. And so there is need for the government to allocate funds specifically in order to make it available to women.
The screening program has to be comprehensive with provision made to assist the women navigate the healthcare system following any positive results from the screening exercise including the facilitation of referrals for further assessment and treatment. Having a National screening programme for cervical cancer will key into the recently launched WHO cervical cancer elimination strategy, which involves screening and treatment of cervical cancer as well as the prevention with HPV vaccination. The HPV vaccines are only available to those who can afford it, which brings the need to incorporate the vaccine into the National vaccination program, FLAC is collaborating with the Federal Ministry of Health, vaccine manufacturers and other partners to make the vaccines more accessible to young girls and women across the country. The partnership with Roche aims to serve this purpose and extends back to 2016. Roche has specifically paved the way to provide breast cancer treatment to women in some States across Nigeria as we work together in the joint creation of awareness amongst women about the importance of vaccination, screening and treatment.
We therefore call on government and other stakeholders alike to join us in meeting the objective of 90 per cent of girls to be vaccinated against HPV by 2030, 70 per cent of women screened for HPV by the age of 35 and then again at 45 years of age and lastly that 90 per cent of women diagnosed with cervical cancer are able to access treatment.
*Dr. Amina Abubakar Bello, a consultant Obstetrician and Gynaecologist, is the First Lady of Niger State and Chairperson of FLAC.