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‘How to reduce cancer deaths in Nigeria’

By Chukwuma Muanya
03 February 2015   |   8:28 pm
•Scientists advance treatments for disease WEDNESDAY is World Cancer Day. It is a day that unites the world in the fight against cancer. Activities to mark the day are being spearheaded  by the Union for International Cancer Control (UICC), the World Health Organisation (WHO) and the Committee Encouraging Corporate Philanthropy (CECP-Nigeria). The 2015 World Cancer…

Ado-Bayero-adn-Dora-Akunyili

•Scientists advance treatments for disease

WEDNESDAY is World Cancer Day. It is a day that unites the world in the fight against cancer. Activities to mark the day are being spearheaded  by the Union for International Cancer Control (UICC), the World Health Organisation (WHO) and the Committee Encouraging Corporate Philanthropy (CECP-Nigeria). The 2015 World Cancer Day aims to save millions of preventable deaths yearly by raising awareness and education about the disease and pressing governments and individuals across the world to take action. 

   Cancer has become a leading ‘silent’ killer in Nigeria. Most Nigerians are dying needlessly from the disease due to late presentation. Most victims either wish  the disease away or blame it on witchcraft. The hospital is always the last port of call. They first prefer spiritual help and only turn up in a clinic when their state has become irredeemable. 

   However, some cancer patients who have the resources prefer to seek medical attention in India, Germany, South Africa, United Kingdom (UK) and United States(U.S.) but oftentimes never return alive. The reasons for this sad scenario border on   ignorance, poor state of health facilities, poor funding of cancer care, late diagnosis and detection, and high cost of treatment.

    Former Super Eagles goalkeeper, Wilfred Agbonavbare, on January 26, 2015, lost his battle against cancer at a Spanish hospital. Sadly, Agbonavbare’s wife died of breast cancer three years ago after gulping all their earnings.

     The list of notable Nigerians who recently fell to cancer is endless. From former Director General of the National Agency for Food Drug Administration and Control (NAFDAC) and Minister of Information, Prof. Dora Akunyili, to the 13th Emir of Kano, Alhaji Ado Bayero, and to the Aare Musulumi of Yorubaland, Alhaji Abdul-Azeez Arisekola-Alao, who just died of colon cancer.

    However, experts insist that early detection and treatment in order to improve outcome and survival remains the cornerstone of cancer control. 

     The Union for International Cancer Control (UICC) and the World Health Organisation (WHO) warn that the global cancer epidemic is huge and is set to rise. 

     According to recent statistics released by UICC and WHO ahead of the World Cancer Day, currently, cancers figure among the leading causes of morbidity and mortality worldwide, with approximately 14 million new cases and 8.2 million cancer related deaths in 2012 out of which, four million people died prematurely, aged 30 to 69 years.

     The number of new cases is expected to rise by about 70 per cent over the next two decades.

     Among men, the five most common sites of cancer diagnosed in 2012 were lung, prostate, colorectum, stomach, and liver cancer.

    Among women, the five most common sites diagnosed were breast, colorectum, lung, cervix, and stomach cancer.

    According to the UICC and WHO, about 30 per cent of cancer deaths are due to the five leading behavioural and dietary risks: high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use, alcohol use.

     It has shown that tobacco use is the most important risk factor for cancer, causing over 20 per cent of global cancer deaths and about 70 per cent of global lung cancer deaths.

      Cancer causing viral infections such as Hepatitis B Virus (HBV)/Hepatitis C Virus (HCV) and Human Papilloma Virus (HPV) are responsible for up to 20 per cent of cancer deaths in low-and middle-income countries.

     According to UICC and WHO report, more than 60 per cent of world’s total new annual cases occur in Africa, Asia and Central and South America. These regions account for 70 per cent of the world’s cancer deaths and it is expected that annual cancer cases will rise from 14 million in 2012 to 22 within the next two decades.

   New research shows that cancer is causing unprecedented levels of premature mortality in Australians compared with all other causes of death, highlighting the urgent need for the whole community to do more to prevent cancer and improve patient outcomes.

    A new Australian Institute of Health and Welfare Report, Australian Burden of Disease Study: Fatal burden of disease 2010, showed that cancer caused 35 per cent of the years of life lost to Australians in 2010, a significantly higher proportion than any other cause.

    Director of Public Policy at Cancer Council Australia, Paul Grogan, said the main reason we are seeing more people lose their lives to cancers is that we are living longer and more of us are getting cancer in older age.

     To a Professor of Radiotherapy and Oncology at the College of Medicine, University of Lagos (CMUL)/Lagos University Teaching Hospital (LUTH), Aderemi Ajekigbe, Nigeria records 100,000 new cases of cancer yearly  and at the moment had about two million recorded cases.

     Ajekigbe said the global incidence of cancer is soaring but the cases are worse and death rates are higher in Nigeria because cancer patients are usually poor and they have little access to treatment in the country.

     Ajekigbe in his inaugural lecture penultimate week at the University of Lagos (UNILAG) said: “At every time, there are only four functioning radiotherapy machines in the country, others may have broken down due to the high patient load on it.

      “Patients who can afford it will travel out when they can no longer wait for the machines to start working while the poor patients suffer in silence.

    “Even most of the patients who can afford to treat their cancer abroad come back in body bags. That is why we need to have our own facilities that will enable us screen, detect and treat cancer cases early.”

 In the lecture  titled, “Cancer: The Unwanted Guest That May Visit, ” Ajekigbe called on the Federal Government to address the increasing number of Nigerians dying from cancer due to poor access to treatment and funds needed to manage the disease.

     The radiologist added: “We cannot afford to lose more Nigerians to cancer. Government should dedicate the proceeds from an oil block to the provision of cancer equipment and treatment. It is a need.” 

     The oncologist, who defined cancer as an abnormal and uncontrolled growth that persists in the body, said women had a higher risk of being diagnosed with cancer when compared to men.

     “More than 40 per cent of cancer occurs in women. Breast and cervical cancer are the commonest forms and they occur in women. That is why every woman should examine her breast regularly. Cancer can happen to anyone but it does not have to be a death sentence if it is detected early.”

     According to the Committee Encouraging Corporate Philanthropy (CECP- Nigeria), 30 Nigerian women die every day of breast cancer (a cancer that can be cured if detected early); one Nigerian woman dies every hour of cervical cancer (a cancer that is virtually 100 per cent preventable); 14 Nigerian men die daily of prostate cancer (another cancer that can be cured if detected early); one Nigerian dies every hour of liver cancer (a cancer that is preventable through vaccination); and one Nigerian dies every two hours of colon cancer (another cancer that is virtually 100 per cent preventable). 

     National Coordinator CECP, Dr. Abia Nzelu, said, out of every five Nigerians with cancer, only one survives. 

     Nzelu further stressed: “ln the specific case of blood cancer, out of every 30 Nigerians (often young adults and children), only one survives.  Meanwhile, at the Tata Cancer Centre in India, the survival rate for blood cancer is 99 per cent. Behold the future generation of Nigeria wasting away from conditions that could be controlled medically. Alas, Nigeria is a nation where wealth accumulates and men decay.”

     She argued that 10 Nigerians die of cancer every hour, yet, according to the WHO, one-third of cancers is preventable, another one-third is curable and the last third can have good quality of life with appropriate care. 

     She continued: “For instance, in the U.S, cancer used to be a death sentence just like it is now in Nigeria. But today the survival rate  there has improved to two in three cases. Furthermore, she  stated target of the American Cancer Society is to improve the survival rate of cancer to 100 per cent, thus making this the last century for cancer in the U.S.

    “To drive the point home, let’s look at some well-known cancer survivors. Nelson Mandela was diagnosed in 2001 with early-stage prostate cancer at the age of 83. He underwent treatment, made a full recovery, and lived until the age of 95 years, remaining cancer-free until the end. Mandela was diagnosed and received all his treatment in South Africa. Queen Elizabeth, the Queen’s Mother, developed colon cancer at  66 and breast cancer at 83, but had full recovery from both ailments. She died from old age in 2002, aged 101. 

  Ronald Reagan survived colon, skin and prostate cancers sequentially; after he was treated for the prostate cancer, he declared that he had never felt better in his life. Ruth Ginsburg, the only female judge on the bench of the U.S. Supreme Court, survived pancreatic and colon cancer; during her treatment, she never missed a day on the bench.”

     Why is the situation different in Nigeria? Why do Nigerians seek treatment abroad and still end up dying from preventable cancers? Nzelu said: “The truth is that we do not have adequate infrastructure and system for early diagnosis, so cases end up being detected at a time when they are beyond help. Many other countries have invested a lot of funds in cancer research, screening programmes and treatment. In such countries, every sector of the society is involved in the fight against cancer.”

World Cancer Day

World Cancer Day, organised by the UICC, is an opportunity to highlight the wide range of actions needed to effectively prevent, treat and control the many forms of cancer.

     The day, the theme of which in 2015 is “Not beyond we,” offers the WHO an opportunity to demonstrate the Organization’s policies and programmes for countries to reduce their cancer burden. The Global Action Plan for the prevention and control of Non Communicable Diseases (NCDs) 2013-2020 offers the overall framework for country action.

   The Global action plan calls for national, international and multi-sectoral action across multiple areas to reduce cancer risks in populations, and to strengthen health care delivery systems for people with cancer. Environmental and infectious causes are important for cancer prevention so that WHO’s guidance in those areas is part of the comprehensive approach.

  The 2015 campaign will be articulated around four key areas : choosing healthy lives; delivering early detection; achieving treatment for all; and maximising quality of life.

How can the burden of cancer be reduced?

Knowledge about the causes of cancer, and interventions to prevent and manage the disease is extensive. 

  According to the WHO, cancer can be reduced and controlled by implementing evidence-based strategies for prevention, early detection and management of patients. Many cancers have a high chance of cure if detected early and treated adequately.

Modifying and avoiding risk factors

It has been demonstrated that more than 30 per cent of cancer deaths could be prevented by modifying or avoiding key risk factors, including: tobacco use; being overweight or obese; unhealthy diet with low fruit and vegetable intake; lack of physical activity; alcohol use; sexually transmitted HPV-infection; infection by HBV; ionizing and non-ionizing radiation; urban air pollution; and indoor smoke from household use of solid fuels.

Early detection

Cancer mortality can be reduced if cases are detected and treated early. According to the WHO, there are two components of early detection efforts:

Early diagnosis

It has been shown that the awareness of early signs and symptoms for cancer types such as skin, cervical, breast, colorectal and oral is critical in order to get them diagnosed and treated at early stage. 

According to the WHO, early diagnosis is particularly relevant when there is no effective screening methods or – as in many low-resource settings – no screening and treatment interventions implemented. In absence of any early detection or screening and treatment intervention, patients are diagnosed at very late stages when curative treatment is not any more an option.

Screening

Screening is defined as the systematic application of a test in an asymptomatic in a target population. It aims to identify individuals with abnormalities suggestive of a specific cancer or pre-cancer and refer them promptly for treatment or when feasible for diagnosis and treatment. Screening programmes are especially effective for frequent cancer types for which cost-effective, affordable, acceptable and accessible screening tests are available to the majority of the population at risk.

     Examples of screening methods, according to the WHO, are: visual inspection with acetic acid (VIA) for cervical cancer in low-resource settings; HPV testing for cervical cancer; PAP cytology test for cervical cancer in middle-and high-income settings; and mammography screening for breast cancer in high-income settings.

Treatment

Several studies have shown that a correct cancer diagnosis is essential for adequate and effective treatment because every cancer type requires a specific treatment regimen, which encompasses one or more modalities such as surgery, and/or radiotherapy, and/or chemotherapy. 

  According to the WHO, the primary goal is to cure cancer or to considerably prolong life. Improving the patient’s quality of life is also an important goal. It can be achieved by supportive or palliative care and psychological support.

Green tea ingredient may target protein to kill oral cancer cells

A compound found in green tea may trigger a cycle that kills oral cancer cells while leaving healthy cells alone, according to Pennsylvania State food scientists. The research could lead to treatments for oral cancer, as well as other types of cancer.

     Earlier studies had shown that epigallocatechin-3-gallate (EGCG) a compound found in green tea, killed oral cancer cells without harming normal cells, but researchers did not understand the reasons for its ability to target the cancer cells, said Joshua Lambert, Associate Professor of Food Science and co-director of Penn State’s Center for Plant and Mushroom Foods for Health. The current study shows that EGCG may trigger a process in the mitochondria that leads to cell death.

Researchers find potential anti-cancer use for anti-epilepsy drug

Scientists at the University of York have discovered that a drug used widely to combat epilepsy has the potential to reduce the growth and spread of breast cancer.

     Researchers in the Department of Biology at York studied phenytoin, a drug, which inhibits epilepsy by targeting sodium channels.

     These channels, known as VGSCs, exist in the membranes of excitable cells, such as neurons, where they are involved in transmission of electrical impulses. They are also present in breast cancer cells where they are thought to help the spread of tumours.

 In research published in Molecular Cancer, the York team found that “repurposing” antiepileptic drugs, such as phenytoin, that effectively block the sodium channels, could provide a novel therapy for cancer.

    Despite extensive work to define the molecular mechanisms underlying the expression of VGSCs and their pro-invasive role in cancer cells, there is little clinically relevant in vivo data exploring their value as potential therapeutic targets.

     The researchers found that treatment with phenytoin, at doses equivalent to those used to treat epilepsy significantly reduced tumour growth in a preclinical model. Phenytoin also reduced cancer cell proliferation in vivo and invasion into surrounding mammary tissue.

Potential for cure among early detectable cancers

According to the WHO, some of the most common cancer types, such as breast cancer, cervical cancer, oral cancer and colorectal cancer have high cure rates when detected early and treated according to best practices.

     Some cancer types, even though disseminated, such as leukaemias and lymphomas in children, and testicular seminoma, have high cure rates if appropriate treatment is provided.

CECP recommends mobile cancer units and comprehensive treatment centres

 Nzelu said: “In the U.S., there are over 2000 mobile health units in addition to 1500 Comprehensive Cancer Centres (CCCs )(a CCC is a tertiary health institution focused exclusively on cancer care). The American cancer society, a voluntary health organization, which played a pioneering role in the fight against cancer in America , has three million passionate volunteers, and an annual budget of $1 billion, raised mainly through these volunteers and private philanthropists. No wonder then that there has been a significant improvement in the U.S. cancer survival rate, with nearly 14 million cancer survivors currently in the U.S.  alone and more than 400 lives being saved daily from cancer.

      “Even developing countries like India, Egypt, Zambia, Mauritania, Tanzania, Pakistan, South Africa among others have CCC. In addition to having a world-class National Cancer Institute, as well as mobile cancer units, the Arab Republic of Egypt also has the largest children cancer centre in the world, which was built and is still being sustained solely by donations. India has over 120 CCCs, mostly established with the support of the private sector. Bangalore, an Indian city with a population of eight million has four CCCs whilst Nigeria, with a population of 170 million has no single Comprehensive Cancer Centre. Moreover, there is no full-fledged Mobile Cancer Centre (MCC) in Nigeria.”

     Nzelu said CECP is mobilising Nigerians to contribute towards the acquisition of 37 MCCs, one for each state and the Federal Capital Territory (FCT), Abuja. The MCC will facilitate the on-going life-saving campaigns of the National Cancer Prevention Programme (NCPP), a non-governmental initiative of mass medical mission (MMM), the first major national effort towards the control of cancer in Nigeria. 

     She further explained: “In spite of its limited resources, the NCPP has been carrying out nation-wide awareness/screening/treatment campaigns since 2007. Over 100,000 Nigerians have been directly screened/ treated so far, and through the awareness being created, the NCPP is helping to protect millions of Nigerians from the cancer scourge. There is an urgent need to scale up this effort.

    “We must note that a MCC is not the same as a mobile mammogram. Rather, an MCC is a clinic on wheels, in which screening, follow-up and several forms of treatment (including surgeries), can take place. It is equipped with facilities for mammography, sonology, colonoscopy, colposcopy and cryotherapy, as well as a surgical theatre. It also has an in-built laboratory for preventive screening against certain cancers like prostate, colon and bladder cancer and other common diseases, which are known to increase the risk of cancer. These include malaria, diabetes, hepatitis, kidney disease, hypertension and Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS).  Thus the MCC would tackle the double burden of disease that is communicable and non-communicable diseases.”

     Nzelu said anyone may contribute towards the MCC  project by sending the word ‘CANCER’ as an sms to ‘44777’ at N100 per SMS through any of the mobile networks; this SMS can be sent as many times and as frequently as desired. Higher amounts could be given via ATM or online at www.quickteller.com using the code ‘777526’. 

    She said individuals, families or organisations who donate a unit, could have them branded in their honour. 

Palliative care

Palliative care is treatment to relieve, rather than cure, symptoms caused by cancer. Palliative care can help people live more comfortably; it is an urgent humanitarian need for people worldwide with cancer and other chronic fatal diseases. It is particularly needed in places with a high proportion of patients in advanced stages where there is little chance of cure.

    According to the WHO, relief from physical, psychosocial and spiritual problems can be achieved in over 90 per cent of advanced cancer patients through palliative care.

Palliative care strategies

    Effective public health strategies, comprising   community- and home-based care are essential to provide pain relief and palliative care for patients and their families in low-resource settings.

      Improved access to oral morphine is mandatory for the treatment of moderate to severe cancer pain, suffered by over 80 per cent of  patients in terminal phase.

WHO response

     In 2013, WHO launched the Global Action Plan for the Prevention and Control of Non-communicable Diseases 2013-2030 that aims at  reducing  by 25 per cent premature mortality from cancer, cardiovascular diseases, diabetes and chronic respiratory diseases. Some of the voluntary targets are most relevant for cancer prevention such as the target about reducing tobacco consumption by 30 per cent within the period 2014-2025.

    WHO and the International Agency for Research on Cancer (IARC), collaborate with other United Nations Organisations within the United Nations (UN) Non-communicable Diseases Interagency taskforce (2014) and partners to: increase political commitment for cancer prevention and control; coordinate and conduct research on the causes of human cancer and the mechanisms of carcinogenesis; monitor the cancer burden (as part of the work of the Global Initiative on Cancer Registries (GICR); develop scientific strategies for cancer prevention and control; generate new knowledge, and disseminate existing knowledge to facilitate the delivery of evidence-based approaches to cancer control.

      Others are to: develop standards and tools to guide the planning and implementation of interventions for prevention, early detection, treatment and care; facilitate broad networks of cancer control partners and experts at global, regional and national levels; strengthen health systems at national and local levels to deliver cure and care for cancer patients; and provide technical assistance for rapid, effective transfer of best practice interventions to developing countries.