As Nigeria joins the international community to mark World Cancer Day today, a clinical fellow in Obstetrics and Gynaecology, Darent Valley Hospital, United Kingdom and the Medical Director of Optimal Cancer Care Foundation, Dr. Olufemi Olaleye, has called for the establishment of cancer registries in the country. He also spoke on other national issues. Rebecca Ejifoma brings excerpts
Where is Nigeria today on the world cancer list?
World cancer study done and published in 2010 has actually given us some relevant data with regards to Nigeria's cancer body. They have identified that cervical cancer is the deadliest of all the cancers affecting Nigerian women.
Breast cancer is the commonest, but it takes time before it kills the woman. On the other hand, cervical cancer kills a woman every hour in Nigeria - according to their story. That is about 10, 000 death yearly.
We also recognised that breast cancer is the commonest occurring cancer among women generally. It affects about one or two in 25 Nigerian women. That is one in 25 who are not at risk - no family history and no smoking. Two in 25 for those with family history like mother, sister and aunt with breast cancer. And, the study shows that prostate cancer is number one killer in men.
Is the number of deaths from cancer decreasing since the level of awareness is said to be high now? I don't see how the increase in awareness leads to more death of cancer patients. Awareness of disease does not increase or decrease the outcome. What will influence the outcome is intervention such as; prevention, screening, vaccination, availability of treatment, availability of treatment centres and most importantly, the post-operative care, palliative care and radiotherapy care.
It is not just doing the operation to remove the breast (in the case of breast cancer). There is still load of post-operative; post-surgical management like radiotherapy, chemotherapy and pay management that we need to give to these women.
However, one thing is of essence before we can even say something is rising or falling. We need to get the correct data. We don't have a cancer register in Nigeria. We are only using anecdotal evidence. There is no statistical evidence to backup whether we are seeing more people dying or surviving this disease.
What about the cancer Registry?
We have talked about this. And we have argued that it is possible to have a register. The way you set up a marriage register, birth or death register, you can set it up. Once you have a diagnosis of cancer, it bills on the private, public or whoever the practitioner is to fill a form and have that form sent to a national database registry.
People like me can use it for research. Younger doctors coming behind can have data. Policy makers, too, can use that data to, obviously, influence planning of care for cancer patients.
So, the figures of morbidity and mortality with regards to cancer are really not reliable because we don't have a proper cancer registry.
And I recommended that this can be done. Every hospital should have a cancer register form sent to it. We have a database of how many hospitals there are in Nigeria. We have teaching hospitals. We have laboratory centres, all places where diagnoses are done. Details of the patients should be entered into National database.
At least, a percentage of women, as you said, are coming out now because of increased awareness. There will still be a large percentage of people on the grassroots, who don't turn up for medical care. Rather they use herbs and agboto to cure their cancer or "attempt to cure". We will still lose some of those people to data gathering. But let us start gathering data with those turning up.
Of what benefit will the data be to Nigerians?
It's important on three levels. Epidemiologically, I quoted a set of figures from global cancer study. It was done in 2010 by a foreign epidemiologist. And I have a feeling they just extrapolated the figures for Nigeria. They didn't use proper cancer data registry.
But the figures from the United Kingdom and the United State will be based on their cancer registries and that's so key because once you have those kind of data you can say the rate or risk of cancer death is one in 10. This is because they have got a register of a number of people - in their population based on their census figure - that are having cancer.
We don't have such rate in Nigeria. So we use world rate of one in three. Now, if we are in a very reasonable and sensible economy - killing your people one in three - then it makes sense for you to offer cancer treatment centres. Because we don't have cancer registry, epidemiologists cannot make a case that this thing is of national interest. Therefore, the Ministry of Health cannot attack the matter as appropriately.
And because we do not have this registry, we cannot plan for the teaming population of Nigerians that are afflicted and will be afflicted. We cannot plan a prevention strategy for them. We cannot plan a cancer control. A cancer control for Nigeria is just a desk in Abuja - Federal Ministry of Health Cancer Control Desk. No budget to that desk.
If you fly through one airport in America and you don't see anything from the cancer society, you will be amazed. There are always messages, same for the NHIS cancer screening centres. We don't know the importance of preventing these diseases. But because we are not interested in carrying the cost of the cure, there are incentives to carrying the cost for prevention.
More importantly, the registry helps us as individuals to modify our health seeking behaviour. Take Ebola virus as an example. The information about Ebola helped everybody to know his health seeking behavior, the same thing with the current Lassa fever.
But nobody talks about cancer. They say it cannot happen to them until it happens to their daughters. The sad part is that it happens every year. There is no figure in Lagos. I run a cancer foundation. I have the data of only the people who come here.
Is Nigeria lagging behind in control of this disease?
Yes, Nigeria is lagging behind. Just like any other healthcare indices - Maternal mortality, child care, the government says it is trying. But the average Nigerian is still not feeling the impact. We ought to have seen the reason for that; it's corruption. The Nigerian Army never got arms. So, you can imagine, our doctors are suffering.
We were at a cancer summit in Abuja last October. It was the same thing. Everybody talked and talked. Professors gave their keynote speeches. But by and large everybody asked, "Where is the money?" It is the money we are interested in to build a cancer centre. There is no point to tell the people that cancer will kill them as a government you do not provide cancer screening services.
Mammograms are not cheap. Radiotherapy centres are not available. There are only two. Cobalt60 is a radiotherapy machine. There are only about two. There are only five Linear accelerators to generate the x-rays to go for chemotherapy.
We have only one in the whole of Lagos State and it is in a private hospital, where they charge about 600, 000 naira. So, how many people are going to use it? Meanwhile, if you get to a country like India, just one city has about 20 of these machines. Truly, we are lagging behind.
Nobody talks about cancer killing men. Why is it like that?
It is because we have more cases of the female cancer. Women carry more of the burden of the disease of cancer generally. For example, HPV, the sexually transmitted virus that causes cancer causes seven other kinds of cancer in women than men. Women carry more burden of cancer.
Moreover, there are more women than men anyway in population. That also affects it. Most importantly, women have the two organs called the breast. If it's not the right, it will be the left that has the cancer.
Women have an extra organ that can form cancer that men do not have. That is the ovaries. Although we have our testicles, ovarian cancer is more common than testicular cancer. Of course, we have prostate and testicular cancers; they are not as common as those in women.
Another reason is that women tend to respond more to awareness messages. The men won't unless it stops us from eating, going to the toilet or having sex. Rather, men would wait until it affects those three before you see a man coming to the hospital.
Unlike women, they are used to coming to the hospital - when they are pregnant, have period problems. So, coming to hospital is no longer a big deal. The uptake for men is not as high during their awareness we had as women do.
How can Nigerians, individually, fight against cancer?
Three things we must do. Improve our health and lifestyle (that is keep fit. Obesity is one of the root causes of cancer and non-communicable diseases. Therefore, we need to do away with it).
Lifestyle choices like smoking and eating diets that are devoid of fruits and vegetables - are all ways we can be inviting cancer.
Second thing is to attend screening. There are screening programmes for men and there are screening packages for women. Attend them. While women should screen in two to three years men above 40 should screen for prostate cancer annually. Women should take vaccination. From age 10, they can vaccinate girls against cervical cancer.
With this year's theme, ‘We can, I can!’ what is your foundation preparing for Nigerians?
World cancer day is just on February 4. What we have decided to do on that day is ‘you can dance, we can keep fit, we can prevent cancer.’ To make it really entertaining, we are going to have a dancing session then sensitise them more.
We have got some celebrities to come perform, too. They include topnotch actors and actresses alongside comedians like Desmond Elliot, Kate Henshaw and Princess, among others. While they will be having good time, there will be lectures educating them.
With a new government in place, what solution should it proffer?
I'm tired of advising the government. We have a new Minister for Health who incidentally is a cancer titan. But it's not about one person. It is a system. Nigerian economy is such that we have never voted as much priority to our healthcare budgets.
So, if we want to be serious about our healthcare, let us start from the budget. What percentage of this year's budget is healthcare? I can't remember. But it's not up to six per cent. And it should be 15 since Nigeria is a signatory to the Abuja accord signed in 1995.
Secondly, we need to finance healthcare differently from what we have been doing. Nothing new on capital expenditure; no new hospitals are being built; no new equipment is being bought. We are only using money on salaries and consumables.
Thirdly, we need to set a third-party structure. What we have now is a second party payment structure - where either you or a company pays for it. And most Nigerians are paying for it out of pockets because only 10 per cent of the entire population is employed. So, majority don't pay for their healthcare because they can't afford it.
We need a third party payment structure. England calls it the NHS. America now calls it the Obama Care. We need something like that in our country
WHO raises alarm as Zika virus spreads “explosively”, what is your thought on it?
The World Health Organisation (WHO) has warned that the Zika virus, linked to severe birth defects in thousands of babies in Brazil, is “spreading explosively” and can infect as many as four million people.
The WHO Director-General, Margaret Chan, said this at a meeting recently with the agency’s executive board in Geneva, adding that the spread of the mosquito-borne disease had gone from a mild threat to one of alarming proportions. She said that to help determine its response, WHO would convene an emergency meeting on Monday, because the level of alarm was extremely high. Chan told the Geneva gathering that in 2015, the virus was detected in the Americas, where it was now spreading explosively. She stressed that as of today, cases have been reported in 23 countries and territories in the region. She recalled that WHO was criticized in 2015 for reacting too slowly to West Africa’s Ebola epidemic, which killed more than 10,000 people, and it promised to cut its response time.
By: Olufemi Olaleye
This Day News
ABUJA: Training Schedule for Basic Life Support BLS, Pediatric Advanced Life Support (PALS), Advanced Cardiovascular Life Support ACLS, First Aid, CPR, AED
PORTHARCOURT: Training Schedule for Basic Life Support BLS, Pediatric Advanced Life Support (PALS), Advanced Cardiovascular Life Support ACLS, First Aid, CPR, AED
LAGOS: Training Schedule for Basic Life Support BLS, Pediatric Advanced Life Support (PALS), Advanced Cardiovascular Life Support ACLS, First Aid, CPR, AED
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