‘Why cancers have become so common in Nigeria’

• Identifies environmental pollution from rapid industrialization, growing Western lifestyle as major reasons for increasing cases of tumours

Cancer has become so common in Nigeria and more and more people are being diagnosed with the condition and even more are dying. Why?

A study published in 2009 showed that the main reason for increasing cancer cases is pollution and copying of Western culture by Nigerians. So what are the Western cultures that we are talking about? If you look at the fact that industrialisation has increased. Industrialisation means greater air pollution. You look at industrial waste pollution and environmental pollution. We are not organized and we do not even regulate these things and do the right environmental impact assessment before these industries are cited.
We are totally unable to manage the magnitude of the problem. Some analysts have said that the cost of handling the level environmental pollution that we have is totally monumental. But beyond this is lack of awareness of what people are exposed to and what to do.

Even the employers and employees are totally unaware of some of the dangers.
You know it is not only big companies that are producing hazardous waste. There was a situation where someone was producing paint in his house and was not aware he was exposing himself and he died of cancer. So in most cases industrial workers inhale the poisonous fumes that are coming out from the production lines. In some instances the workers take of the protective equipment because they are not aware of how important it is to wear them.

If their employers give them the protective material but they are not using it. We live on an era where industrial waste is contributing to industrial pollution. Even the issue of road-worthiness of vehicles is taken very seriously abroad. You see most cars here emitting dangerous fumes. Nobody pays attention to these cars that are polluting the whole environment. Another thing that has contribution to air pollution is generators. All these are part of the problem of air pollution.

But another issue is concerning our food. In the area of animal husbandry, so many things are injected into these animals like the poultry and fishes. Some are imported into the country and preserved with chemicals.

Even those that are alive, what are the farmers giving them?

The whole idea in the production of food is that they are cutting corners. The corner is that they are no longer allowing the things to take the natural time. They give hormones in order to hasten the growth that also contributes to the problem that we are having after ingesting them later. The farmers give a lot of antibiotics in poultry even to fishes. You know that fish is very good; everybody is building a fishpond. What are they giving to the fishes? Are they running it properly? So we need to have increased regulation and monitoring of food production.

Let us look at other things concerning food, our diet. We have complex carbohydrates like cassava root that is our akpu or fufu that contains lots of fibres. But today the processed foods have little or no fibre. If you eat less fibre, I mean eating more of processed food and they stay longer in the stomach and the gastrointestinal tract generally. So they have long transit time, they have more time to cause troubles in the bowels. We are also looking at a lot of preservatives that are put on these processed foods. We are no longer eating fresh foods, fresh vegetables, fresh fish and fruits. We are eating more of energy dense foods. I am sure you are seeing more pregnant men? Is it not true? There are lots of pregnant men because people are living sedentary lifestyles both children and adults. Even now there is higher incidence of childhood cancers not really been associated with lifestyle-associated factors. We need watch what our children eat because cancer is preventable. Cancer is associated with other non-communicable diseases (NCDS) like diabetes, obesity, high blood pressure and so on. And all these NCDs are escalating. More and more people are beginning to get old at very early stage that is degenerative diseases. People are becoming more sedentary, sitting from dusk to dawn without any exercise. This leads to obesity.

We are also consuming a lot of alcohol and cigarettes. Cigarette smoking is one of the highest contributions to cancers. It is not only lung cancer that is causes; it can cause all sorts of cancer. Then alcohol ingestion is associated with breast cancer and liver cancer. The consumption of alcohol has really escalated. People do not actually understand what they are consuming. In place of water people are taking soda and soft drinks that are laden with sugar. You are loading yourself with ten cubes of sugar drinking a bottle of carbonated soft drink.

So we need to go more natural, we need to eat more vegetables and fruits. For instance all these environmental pollution contributes to free radicals. Free radicals are produced in the body but the only way to fight the deleterious effects of these free radicals is to take a lot of vegetables and fruits. In the body the only antioxidant that is produced within the body is glutathione and that by the age of 21 begins to reduce. But if you take vegetables and fruits it will go a long way. Nutritionists have calculated that we need to take three to five servings of vegetables and fruits to get enough antioxidants that will be able to nullify the free radicals the body have accumulated. Not only for the metabolic processes but fruits and vegetables offers protection from the free radicals from all these environmental pollution.

So because of the environmental pollution you now have an imbalance of free radicals, which cause inflammatory processes in the body even some changes like cancer, diabetes, hypertension and generative changes.
Who gets cancer? Is it only adults or for all age groups?

Every age group even from birth has what is called congenital. Some are born with a cancer, with a malignancy and every part of the body can have cancer except the ones that are already dead that is they don’t have any blood supply like the hair, teeth and nails. You know the teeth still have supply of blood but it is only the enamel part that does not have supply. Otherwise any other part of the body that is living can turn cancerous.

What is the prevalence of cancer in Nigeria?

In terms of prevalence various figures are being put forward. About 200,000 cancer cases are being diagnosed every year in Nigeria. Some people are giving figures of up to 500,000 cases. 10,000 people die every year and about 10 people every hour. But globally you have up to 61,000 people die everyday from cancer.

In Nigeria, what are the common types of cancer?

Breast cancer is the commonest followed by cervical cancer, which is most prevalent in Africa. But in Nigeria, breast cancer is the commonest. Human Papilloma Virus (HPV) causes almost 100 per cent of cervical cancer. 70 per cent of cervical cancer deaths occur in Africa and yet it is absolutely preventable. Apart from vaccination, we also have early detection method that can detect it before it changes and becomes cancer. There is prostate cancer and colorectal cancer. There are also cancers associated with Human Immuno-deficiency Virus (HIV).

Can cancer be inherited?

Yes! In talking about risk factors are the ones you can do something about. There are some you cannot do anything about. When you can do something about something you better do and leave those things you cannot do anything about. The closer the relationship with a person that has cancer the more likely you are to develop the condition. There is what we call first-degree relation like your mother or sister. If they had breast cancer, you have a more likelihood of having breast cancer. Cervical and prostate also have that kind of relationship. The distant the person is like a cousin or aunty, the chances get lower. Of course there are now genetic tests, which gives you the percentage likelihood of having that type of cancer and you are now told how to be more vigilant.

There are some myths surrounding cancer. Is it contagious?

Cancer is one of the non-communicable diseases. Non-communicable means it is not contagious like hypertension. The risk factor is the older you are, the incidence of cancer increases.

Can cancer really be prevented?

Yes cancer is preventable. For cervical cancer, there are two vaccines that could be used to prevent it. For liver cancer, you can also use vaccine to prevent it because of its association with hepatitis virus. Hepatitis vaccination is also advocated.

How can cancer be diagnosed?

It depends on which type. For breast cancer, a woman can diagnose herself every morning, and if you detect it early, it can actually be treated depending on the type.
But there are more virulent types but for those that are not very aggressive, if they are detected early at stage one and below, they can be cured. I know people that have breast cancer diagnoses that have lived forty years

Where do people get the services?

Apart from doing self-examination especially in breast cancer there are some tests that you need equipment like the ultra sound and x-ray. Then for prostate, you have a blood test called Prostate Specific Antigen (PSA) test. A surgeon can also use the finger to examine your prostate.

Where can people access these services?

At the moment these services could be obtained mostly in the hospitals. But that is not really ideal because when it is in the hospitals it gives the impression that it is only people that are really sick. Whereas you should go for screening when there is nothing wrong with you. So we need to have in place what we call the Pink Caravan that is taking the screening to the people, mobile screening service. Take it to the people on wheels. In that same caravan, let me use Enugu State as an example, if they have one caravan and they put in place equipment for breast check, for prostate check, for cervical check and then have the vaccination that is you can do the vaccination there and there are minor intervention that you can do immediately if you make diagnosis for cervical. Also for the prostate you can take biopsy at once. So we can do all that holistically within the van. You have 17 local governments and if start two weeks for one local government and then train on ground advocates for each local government who will be helping us to create awareness and pulling all the people that need to come at a certain time. So they pull all the people that are qualified age wise to have their testing and they come there and do their testing. The same van can come in and do awareness and get people to come forward and within the two weeks they should be able to finish one local government. They are proposing that if we do that per state, Enugu will have for instance 34 weeks to cover all the local government and you have 52 weeks in one year. So there is so many things that can be done, so many lives that can be saved, so many people that will be detected early that can be cured and then you reduce the cost on the treatment because when you are early, the treatment cost is less. It is when you are late that you have overwhelming cost that so many people cannot afford.

Is there any of such plans on ground? Have you started any such thing?

There is a nationwide campaign on this and we are going to sustain it and one of the things that we want to achieve is get people to utilize the facilities because some people are living in self denial, they are saying ‘it is not my portion.’ They are afraid of the word cancer. By telling people don’t we are trivializing the disease, we want to make it something they will not be afraid of and they are likely to come out and have their screening done. We are hoping that we hope that cooperate entities to come in and support the project.

What treatment options for cancer are available in Nigeria?

When you have a diagnosis, depending on that diagnosis determines the type of treatment you need to have. You may need to have the surgical removal of the mass depending on the size. After the surgery you may need to do radiotherapy. For radiotherapy we are totally ill equipped.

Radiotherapy equipment all over the country are not up to 12. The recommendation is that for one radiotherapy unit per one million population.

So if we go by the population of Nigeria we should have at least 174 radiotherapy units in the country and we have not more than ten in the country in which only one, two or three at a time may be working. So we need to work on it. But a lot of people may end up asking you, ‘is it only radiotherapy that we need for treatment?’ No! But it is the one that we are most deficient in and it is very needful and it definitely helps and compliments in treatment. There is also chemotherapy that is drug treatment, which is very effective but it is very expensive depending on the type of cancer that you have. The cost ranges from N40, 000 a month to N160, 000 every six weeks or up to N500, 000 every six weeks. In fact somebody was telling me two days ago that a 21-year-old that has breast cancer that they are spending 10,000 pounds every month to treat her. So it is not something you wish your worst enemy but if it is detected early the cost will reduce.

What advice do you have for Nigerians especially as regards to the issue of cancer?

My advice is that everybody should be committed and be empowered to reach the less privileged and under served one on one and spread the good news that most cancers are preventable when detected early. The private sector can help float this mobile cancer facility; they can also help to put together cancer centres with radiotherapy and other facilities and capacity building. There is so much to do but it is doable if we all join. Let us no wait for government, government can never take care of health care alone; it is not done anywhere, everybody needs to contribute. We also need to do more research and find out why we are having particular cancers in our own environment and how to take care of the situation. We have to improve and increase knowledge so that those who are wrong practices will stop them and do the right thing. We need to sensitise the population to know. We start from childhood in adopting healthy lifestyles and discouraging sedentary lifestyle.