Why there is cancer ‘explosion’ in Nigeria, by Durosinmi-Etti
Francis Abayomi Durosinmi-Etti is a professor of radiation therapy and oncology at the Lagos University Teaching Hospital (LUTH). Durosinmi-Etti served as the pioneer Chief Medical Director and Chief Executive Officer of the National Hospital, Abuja. He worked at the United Nations, International Atomic Energy Agency (IAEA) in Vienna, Austria between 1988 and 1995. Durosinmi-Etti, is now the Chief Executive Officer (CEO) of NSIA-LUTH Cancer Centre, a multi-billion-cancer centre established as a joint-venture partnership between the Nigeria Sovereign Investment Authority (NSIA) and LUTH. The oncologist in an exclusive interview with The Guardian ahead of the World Cancer Day, February 4, 2020, said there is an explosion of cancer cases and deaths in Nigeria. He gave reasons for the menace and proffered solutions on how to stem the tide. CHUKWUMA MUANYA writes.
Several reports indicate that most cancer centres in the country are not working due to malfunctioning equipment. Until now, this centre was having such issues. What barriers would you say that you have broken in terms of establishing this centre? Or rather what have been the challenges?
The challenge is the fact that cancer is on the increase all over the world but much more in Nigeria. So much so that it will not be out of place if we say there is an explosion or whatever; it is of that proportion now. Virtually every day you see new cases or even somebody with cancer. Hardly is there any family now that does not have somebody or know somebody who has cancer.
Number two; facilities for managing cancer are very few in the country. So this service we have in here is of very good advantage. Number three, even where the facilities are available, cost of treating cancer is very expensive. It is not a child’s play. You are talking of curative treatment from radiotherapy to chemotherapy or even for radiotherapy alone, you will be thinking around N1 million.
Is it for one month or one week?
For the course of treatment, which is everyday for about three to five weeks except Saturdays and Sundays. If you say waoh, everybody will say waoh because not many of us including me can afford that type of money. But you find Nigerians when they go abroad they have to pay 15,000 or 20,000 pounds just as deposit and you pay for others like for consulting, 3,000 pounds, and some more money for follow up. So at the end of the day you would have ended up spending up to 30,000 pounds or some people went to America that came back in here. They charged them $125,000. But what we are offering here now can range with that quality of what they are getting in America and even people from America attested to that. Many Nigerians in the diaspora do come home and they are always here to help us and they commend the efforts we are making. We are not there yet but we are training and retraining. As I am talking to you, two of our staff are in Switzerland, two just came back, others are going. As I am talking to you, right in front of me is a letter for four specialists coming from America. This is their letter of invitation visa section to come to Nigeria. They are coming to help us for six days. That is two radiation-oncologists from America, medical physicist, a nurse and another professional. They are coming to help us, in this same place, in starting up our three-dimension high dose brachytherapy. That is the latest anywhere in the world and most accurate brachytherapy for treating cancers of the cervix that is the neck of the womb in women which is very common even aspects of breast cancer and even people with cancer of the oesophagus, instead of cutting off the neck of the oesophagus, and prostate cancer in men. So all these things are possible now and we need to train people on them and they cost money.
You said there is rise in cancer cases in Nigeria more than anywhere in the world, why?
Well a number of possibilities. Maybe people are becoming more aware. You know there are so many Non Governmental Organisations (NGOs) and everybody becoming involved. February 4 is World Cancer Day, it is going to be celebrated all over the world including Nigeria and we are going to be preaching, counseling people on how to prevent cancer, early detection, early treatment to achieve cure but more importantly prevention. So people are more aware, so they report earlier or they try to report earlier for treatment. The environment itself has not been very helpful.
Our environment itself has not been of help because there is so much pollution with carbon fumes all over the place- generators, car exhaust, fires here and there, all sort of things, people smoking all over the place. So those things exposes people to risks of having cancer. Some of our diets are to be blamed- people who eat moldy rice or eba. They think it sweeter when it is cold and moldy. It can cause cancer of the liver.
Our albinos, we have about four million albinos in Nigeria at the moment. The sun is their worst enemy. You can be sure surprised that an albino that is not exposed to the sun will not have cancer. But when he or she goes about selling akara or is in school or a farmer working under the sun, I can tell you 80 to 90 per cent that he or she is going to have skin cancer and those skin cancer can be very terrible especially on their faces and exposed part of the body; huge terrible lesions. So those things are things we can prevent.
Another big one is breast cancer but it runs in some families but can easily be prevented by people examining their breasts. When you get to certain age you can do some tests- go for annual check up. Another big one is cancer of the cervix- neck of the womb. It is second to breast. If you add the incidence to breast cancer, which is about 26.3 per cent to that from the cervix which is about 24.2 per cent that is almost about 50.5 per cent, that is over 50 per cent, of all the cancers in men and women. Then you talk about prostate in men, there seems to be an explosion of prostate cancer followed by cancer of the colon and rectum. These are things that we do not usually see in this part of the world but now we see them virtually everyday in people coming for treatment or for diagnosis.
Cancer of the lungs used to be uncommon. In my whole career, I have been in this field for 50 years; I have been in charge of cancer treatment for the United Nations International Atomic Agency, for the whole world for years. I trained in England at one of the best universities in Manchester, Christie Hospital in Manchester. In a week I will treat about ten cases of cancer of the lungs there, but in Nigeria in my entire career, about 40 to 50 years now, I don’t think I have seen more than 20 cases. But now we are seeing them almost every week, so something is wrong. Just like we are seeing rise in prostate cancer, something is wrong somewhere. It is either there is something we are taking because prostate cancer is hormone dependent. It either that we are taking something that increases the quantity of the hormone that exposes us to prostate cancer or something that we need to further investigate. Again we need to prevent prostate cancer by doing simple tests. You do your Prostate-Specific Antigen (PSA). We advise people to do it regularly especially people above 40 years. Anybody above 40 should do the test. It does not mean the person has cancer if the value is up but the person needs to do more tests. So cancer of the head and neck region is common. We have a child with cancer of the eye that we treated and the thing has virtually disappeared.
There are many more like that. We have cancer of the bone, cancer of the kidney. In fact you have cancer virtually everywhere in the body.
But what is important are those ones we say are common, we are seeing them so much now that it is getting to frightening level. But thank God a centre like this has come up. But a centre like this is like a drop in the ocean. We have about 200 million Nigerians and we have only one centre here with the best quality nationwide and whole of West Africa now, followed by National Hospital. But then we are not on the same level. I used to be the medical director of National Hospital Abuja, but they are very good there too. We have the latest technology. The other centres too where they have cancer facility are trying their best. It is not the fault of the doctors or the staff there, but it is what is available to them. So we need more facilities, we need to spend more and more on training the medics, which are the doctors, nurses, medical staff, radiographers, pathologist and all the whole team because cancer treatment is a multimodal and multidisciplinary form of treatment.
You don’t say because you are a clinical oncologist, then you know all the things. No it doesn’t work that way any more. People who are in separate fields, the physician, surgeons, gynaecologist, depending on where the cancer is, we all come together, work together, review the patients and the treatment we give to them and how the treatment would begin. We time and brand it sequentially and properly, this makes the thing smoother, or we start with chemotherapy drugs to kill the tumour. We think of how we can give the treatment.
Like that small girl with huge tumour on her eyes, it is gone and it was only chemotherapy that did that. But we know that is not enough because after sometime, if we are not careful it might just reoccur. So that girl still needs radiotherapy, which we will give.
But these things cost money, how many Nigerians can afford this money?
Everyday we see people here and there crying that they need this and that, they need treatment, you see some on television, which can be heart breaking. You wonder, what is going on in this country? Can we not look after our own patients?
So all those things are the problems, not only for us as doctors, or for someone like me as a cancer specialist, but for every Nigerian because no one knows who is the next. Whether you are rich or poor, a child or an adult, male or female, cancer does not know that one.
What are the solutions?
For me, the first is to identify the problem, which we have done, the cheapest thing is to prevent this from even coming and that is why public education is very vital.
Next you can preempt it. For instance, cancer of the cervix account for about 24.2 percent of all cancers and can be preeminently prevented and it is been done in developed countries because children under about nine years old, before they become sexually active, they get this injection called Human Papilloma Virus (HPV), which gives them immunity against cervix cancer.
Countries that have the means have mass vaccination of girls. The injection is expensive, it costs about $100 for one dose. But either we do it or we don’t do it, maybe it can be cheaper. But we need to prevent that sort of thing.
Other countries that have the means even give their young boys because this HPV is transmitted and we carry it all over our body and we give it to those women when we have sexual intercourse. That is why you find that women who have multiple sexual partners are much more prone to having cancer of the cervix and this is why we advise that women stay with their partners as much as possible to avoid more dangers.
Women should present for annual examination. They should do Pap smear, particularly when you are about 30 years old. There is what we call Visual inspection of cervix with acetic acid (VIA). It is currently more popular method of cervical cancer of screening test in low resource countries. So VIA can be done in low-resource countries for screening of cervical cancer as an alternative to Pap smear cytology. If you look in there, it doesn’t take 10 minutes. If you look in there, you get your cotton wool with acetic acid that is all over, you sprinkle it on the pelvis, on the neck of the womb, you are seeing through your speculums, within a few seconds or minutes, if you see acetowhite lesions, it looks whitish, that is any whitish area; that region is suspicious and can become cancerous, in another 10 to 15 years. But if you treat it right there and then, with what we call cryotherapy, just freeze it, you can cure that patient. All these things are there. Except people are aware, they are not going to put themselves forward.
So we need to reassure people that not everybody that has lump in the breast would have breast cancer. They shouldn’t be afraid because 80 percent of the lumps in the breast are quite harmless. But we don’t want lumps in the breast. It is either you remove them and make sure they are not cancerous. But some benign lumps would disappear. However, there is one we call breast mouse because it might be in one part of the breast today and then go to another part tomorrow.
Women should not be afraid. They need to present themselves for examination. Men too should check their prostate. Like I said, they must do something about it, at least have a PSA done or get your doctor to do rectal examination.
Another big issue is that of cost, and the economic situation in Nigeria. How do we address it? How much does it cost to treat prostrate, breast, cervical cancer?
Certainly, here now, for curative and that is if you want to cure the patient because there are two types, you want to cure or palliate, that is just to relief the symptoms.
We cure those that are early. We palliate those that are late. Palliation just means, maybe someone cannot breath probably because something is obstructing it, you can stop that obstruction, or maybe somebody is bleeding away somewhere, you can stop that bleeding, maybe somebody is in terrible pain, you can stop that pain; all sort of palliation until eventually the person dies, but they die with dignity.
But the curative ones, at least at the moment, depending on the tumour, we will be thinking of about N800, 000 to N1 million, which is cheap compared with what is obtained abroad, that is about 20, 000 pounds, almost about N20 million.
For someone with cancer of the cervix, it might be a bit more if it is early. You have to give her high dose of brachytheraphy, which we have here, now and then. We are going to start using that maybe from next month. We know what we do but we also want to be guided so that we are very sure.
Everything is ready and it is just to go. That will also cost money, in addition to having the radiotherapy from the existing machines.
We have three linear accelerators; those are high-powered radiation machines and systems for computerised planning, everything is in place and people are being trained.
How do we address this issue of cost since the treatment of cancer is not in the National Health Insurance Scheme (NHIS) for the indigents and average Nigerians?
It is a big problem, I know the NHIS in fairness to them, they are trying to look into it now, but last year they paid for few cancer patients, but that is not significant enough. I don’t know what they are doing this year, but I know they are trying to help.
What they can do? There is no reason why the government cannot vote some money for this cadre of patients. I am the president of CEPAON, one of the top cancer organisations, Cancer Education, Prevention and Awareness Organisation of Nigeria.
We hold meetings annually and at one of our cancer summit about two years ago, one of our decisions, which is still being followed, and I think it is at the Senate now has to do with catastrophic cancer. I think they said they were going to give them I N4 billion. I don’t know how far it has gone, but if they can get something like that in the budget annually, that will be a great help and this fund is managed properly so that indigent people can benefit. People are really poor and I see them heart broken.
There are other private organisations and non-governmental organisations, like the very first cancer NGO registered in this country. It is the Cancer Aid Foundation, which I am one of the fellows that started it 31 years ago.
In those days, the organisation had been helping indigent patients. We are planning again now to see how we can reconstitute the board with eminent Nigerians. I am the executive secretary, I am prepared to step down and get eminent people. Some of the eminent people we had are dead, so we are trying to resuscitate this so that we have credible people, who would make sure – and vet these people that once they pass through some tests, we know that they are truly indigent, they can be assisted, instead of people suffering and dying.
But apart from that, I think even the government on its own, the easiest thing might be, maybe through the ministry of health, or somehow, get some funds and get credible people to administer those funds, making sure that people go through some tests and then they know that these people don’t have anybody to help them. At best they can subsidise the cost of treatment, but help is needed.
There is a myth that is going on now; they said Cannabis sativa that is marijuana could be used to manage cancer patients?
Yes it is true. Unfortunately I have not tasted marijuana so I don’t know, maybe there are some varieties.
But we actually use marijuana in treating some form of cancers. When you give cancer patients drugs, they become sick and vomit a lot and that helps a lot in controlling that. It also helps with their pain as well.
On a personal level, what should an average Nigerian do to prevent – basically, lifestyle issues, what do you recommend?
They should do everything in moderation. They shouldn’t smoke, but if they must smoke, they should moderate it. Alcohol causes cancer as well, but it must be in moderation.
Sex, particularly women, don’t change partners. Have only one partner, but if one is not enough for you, use condom so that you don’t get these diseases that cause cervical cancer passed on to you.
Check your breast also for any lump. Also the men, once you are 40 years old, a simple PSA test will do. All these things will really bring cancer rate down.