The year 2024 marks the final year of the World Cancer Day campaign ‘Close the Care Gap’. This annual global call to action unites humanity to prioritise life-saving cancer care and to eliminate health inequities. The focus of the 2024 campaign is “Together, we challenge those in power” to shake the very foundations of injustice—to become lifelong advocates fully equipped to push for lasting change.
Cancer is a major public health priority and leading cause of death globally. It is a major cause of geographic, racial, social and gender inequality, causing one in every six deaths and affecting almost every household (one in five persons diagnosed globally).
WHO estimates that worldwide there will be 20 million new cases and 9.7 million deaths from cancer in 2022. The global cancer burden is projected to increase by about 77 per cent by 2050. Sadly, cancer places its heaviest burden on developing countries like Nigeria, where more than 60 per cent of the world’s total new annual cases and over 70 per cent of cancer deaths occur, yet only five per cent of global spending on cancer care takes place in these countries.
The cancer situation in Africa is disheartening. In 2022, 1,173,771 new cancer cases occurred on the continent, with 756 531 deaths. Cancer deaths in Africa are projected to reach about one million per year by 2030. This is so because cancer survival rates in Africa are currently only 12 per cent, compared to over 80 per cent in High-Income Nations. Nigeria is the number one contributor to these dismal statistics.
The major risk factors for cancer include tobacco use, obesity/overweight, physical inactivity, unhealthy diets, and air pollution. Some infections can also predispose to cancer, including hepatitis B and C (which affect the liver) and human papillomavirus – HPV (which affects several parts of the body including the cervix, throat, mouth, anus, and scrotum among others).
Although hepatitis B and HPV can be easily prevented via vaccination, these infections are still prevalent in Nigeria, which explains why cervical and liver cancers are among the top five (5) causes of cancer deaths in Nigeria.
Lung cancer was the most common cancer worldwide in 2022, with 2.5 million new cases (12.4 per cent of new cases). Breast cancer ranked second (2.3 million cases, 11.6 per cent), followed by colorectal (1.9 million cases, 9.6 per cent), prostate (1.5 million cases, 7.3 per cent), and stomach cancers (970,000 cases, 4.9 per cent).
There were about 127,763 new Nigerian cancer cases in 2022 (48,096 cases in men and 79,667 in women). The five most common cancers were breast (25 per cent), prostate (14 per cent), cervical (10 per cent), colorectal (6.4 per cent) and non-Hodgkin lymphoma (4.1 per cent) cancers.
These five account for over 60 per cent of Nigeria’s new cancer cases. In 2022, there were 79,542 cancer deaths in Nigeria, with more women (46,637 deaths) dying than men (32,905 deaths). The ‘Big Five’ cancers which cause the most death in Nigeria are Breast cancer which is the leading cause of cancer death in Nigeria (16 332 deaths, 20.5 per cent of the total cancer deaths) followed by prostate cancer (11,443 deaths, 14.4 per cent), cervical cancer (7,093 deaths, 8.9 per cent), colorectal cancer (5,912 deaths,7.1 per cent) and liver cancer (4,252 deaths, 5.3 per cent).
Cancer patients in developing countries have a much higher risk of dying due to late diagnosis and poor access to quality treatment. “WHO’s new global survey sheds light on major inequalities and lack of financial protection for cancer around the world, with populations, especially in lower-income countries, unable to access the basics of cancer care,” said Dr Bente Mikkelsen, WHO Director for Noncommunicable Diseases.
Despite the progress that has been made in the early detection of cancers and the treatment and care of cancer patients–significant disparities in cancer treatment outcomes exist not only between high and low-income regions of the world but also within countries. Where someone lives should not determine whether they live. Tools exist to enable governments to prioritize cancer care and to ensure that everyone has access to affordable, quality services
Nevertheless, each of us can make changes to reduce our risk of developing cancer, since 50 per cent of cancers can be prevented by lifestyle modifications such as: avoiding smoking, reducing the intake of processed foods and increasing the intake of fruits and vegetables, exercising regularly, and keeping up with recommended screenings and vaccinations.
Furthermore, cancer is often totally curable when detected and treated early. Although most cancers have no symptoms in the early stages, some screening tests such as mammography (for breast cancer) and PSA test (for prostate cancer), can detect cancer even when it is not obvious. This both reduces the burden of dealing with late-stage cancers and increases the chances of successful treatment.
Indeed, cancer screening programmes have great potential to improve cancer outcomes. When organised effectively and quality-assured, they can reduce mortality and even prevent certain cancers like cervical and colorectal cancer – two major causes of needless cancer deaths in Nigeria.
To this end, the current focal cause of Giving Tide is the big war against cancer, which is operated by the National Cancer Prevention Programme (NCPP), a non-governmental initiative of mass medical mission. Since 2007, NCPP has spearheaded community-based cancer prevention across Nigeria. In 2017, a fleet of Mobile Cancer Centres (MCC) was acquired and deployed, to scale up the reach and impact of the programme. The ultimate goal of the project is to establish a Comprehensive Cancer Centre (CCC) in Nigeria. To achieve this goal, major investments in resources are urgently needed.
A CCC is the only institution that can optimally tackle all the spectrums of cancer care. The CCC is NOT a hospital with a radiotherapy machine. Rather, it is a world-class, stand-alone tertiary health institution, with all its units focused on cancer care. The CCC houses first-class cancer research, and preventive, curative and palliative care in one place resulting in better outcomes across a range of measures – including, most importantly, cancer survival. They serve as guiding institutions for all aspects of cancer control and are instrumental in operationalizing the cancer goals of countries.
In this regard, most nations are ahead of Nigeria. For instance, India has over 200 Cs – most of which are philanthropy-funded non-profits. African nations that have CCC include Egypt, Uganda, Tanzania, South Africa, Kenya and Sudan. Nigeria has no CCC, therefore while other nations work towards ‘closing the care gap’, our herculean task in Nigeria amounts to bridging an ever-widening chasm.
Cancer is the most expensive disease to treat. Therefore, the fact that Nigeria has no Comprehensive Cancer Centre is a major reason why Nigerians spend over one billion dollars on foreign treatment annually. This amount is sufficient to establish twenty (20) Cs every year! Unfortunately, most Nigerians who go abroad for treatment end up dying, often because of delays in diagnosis and even worse delays in treatment. Moreover, unforeseen situations (such as happened during the COVID-19 lockdown) may make it impossible to go on medical tourism, even if one could afford it.
Alicia Keys is the queen of songs with a message. Starting her music career in her teens, her songs always seemed wiser than her age. Alicia is the rarest kind of musical genius a classically trained pianist who has won 15 Grammys and been named Billboard’s number one R&B artist of the 2000s decade.
In 2014, Alicia released a rallying song titled ‘We Are Here’ in which she gave a striking (if unflattering) diagnosis of Nigeria’s systemic failure. Her diagnosis (mass hysteria) is in sync with the ‘Zombi’ or ‘Suffering & Smiling’ ethos which Fela sang about thirty years earlier.
Giving Tide believes that a few inspired, passionate, and dedicated heroes can help Nigerians to shake off the endemic ‘mass hysteria’ which has put the most populous black nation at the bottom of nearly all developmental sectors, including health and cancer care. Nigeria desperately needs heroes like Sir Dorab Tata and Mrs. Mazumdar Shaw (founders of India’s first and the largest Cancer Centers respectively); and heroes like the founders of Sloan Kettering Cancer Center in New York (the first Cancer Institute in USA). The best way to nudge Nigerians away from the indolence of ‘mass hysteria’ is to show them the still more excellent way. In line with the focus of WCD 2024, we can “challenge those in power” only if we lead by example. There is no alternative.
WCD 2024 is an opportunity for us to commit to supporting the innovative strategies of Giving Tide designed to confront the entrenched and recalcitrant inequities of Nigeria, including inequity in cancer care. Addressing the root causes of these inequities will ensure that everyone can have access to quality health services when, where and how they need them. Together, we can!