How Nigeria Is Winning War Against Cancer, By Adewole
Prof. Isaac Folorunsho Adewole is the former Minister of Health and former Vice Chancellor, University of Ibadan. The gl obal expert on cancer, ahead of his 70th birthday, which is due on May 5, spoke to SUNDAY AZUBUIKE on how Nigeria is winning the war against cancer. How many Nigerians are living with cancer?
THE total number of new cases in Nigeria in 2020 was 124,815, of which 51,398 occurred in males with prostate cancer as the commonest at 29.8 per cent and 73,417 occurred in females with breast cancer being the commonest at 38.7 per cent, followed by cancer of the cervix at 16.4 per cent. Number of prevalent cases ( five- year) 233911.
How many Nigerians die yearly of cancer?
An estimated 78,899- cancer deaths occur annually.
What are the commonest cancers and their virulence?
The most common are breast, lung, colon rectum and prostate cancers. The most common types of cancer in Nigeria are breast, cervix, prostate, and liver, with breast and cervical cancers recording the most deaths for women, and prostate cancer for men.
The most common in 2020 ( in terms of new cases of cancer) were: breast ( 2.26 million cases); lung ( 2.21 million cases); colon and rectum ( 1.93 million cases); prostate ( 1.41 million cases); skin ( non- melanoma) ( 1.20 million cases); and stomach ( 1.09 million cases).
The most common causes of cancer death in 2020 were: lung ( 1.80 million deaths); colon and rectum ( 916 000 deaths); liver ( 830 000 deaths); stomach ( 769 000 deaths); and breast ( 685 000 deaths).
Each year, approximately 400,000 children develop cancer. The most common cancers vary between countries. Cervical cancer is the most common in 23 countries.
What is the situation in Nigeria?
Nigeria has one of the highest cancer mortality rates in the world with an estimated cancer is responsible for 72,000 deaths in Nigeria annually, with an accounted 102,000 new cases of cancer annually.
As of 2023, about 72 per cent of people in Nigeria were not directly affected by cancer, neither were their family members. The other 28 per cent of people had either cancer or one of their family members did.
How many Nigerians have survived cancer? What is the survival rate?
With advancements in medicine and technology, more people are surviving cancers. However, in Nigeria, many cancer patients in the country could have survived but often present late to the hospital for treatment. There was an absence of data on this aspect of cancer in Nigeria.
What is the geographical spread of cancers in Nigeria and which cancers are more common in each region and why? Why are cancer cases and deaths rising in Nigeria?
A significant proportion of the increase in the incidence of cancer in Nigeria is due to increasing life expectancy, reduced risk of death from infectious diseases, increasing prevalence of smoking, physical inactivity, and obesity as well as changing dietary and lifestyle patterns
A common reason for the rising incidence of cancer morbidity and mortality is due to absence of effective services put in place by the Federal and state governments.
What are the common causes of cancer in Nigeria?
Tobacco - Tobacco smoke has more than 7000 chemicals, at least 250 are known to be harmful and at least 69 are known to cause cancer.
Alcohol - Alcohol, as classified by the International Agency for Research on Cancer, is a toxic, psychoactive, and dependence-producing substance and a Group 1 carcinogen that is causally linked to seven types of cancer, including oesophagus, liver, colorectal, and breast cancers. Alcohol consumption is associated with 740,000 new cancer cases each year.
Physical inactivity, dietary factors, obesity and being overweight- Overweight and obesity are linked to many types of cancer such as oesophagus, colorectal, breast, endometrial and kidney. Regular physical activity, and maintaining a healthy body weight, and a healthy diet can reduce the risk.
Infections - Cancer- causing infections, such as hepatitis and human papillomavirus ( HPV), are responsible for up to 25 per cent of cancer cases in low- and middle- income countries. Vaccines are available for hepatitis B virus and some types of HPV, and can reduce the risk of liver and cervical cancers, respectively.
Environmental pollution - It has been estimated that outdoor air pollution contributed to 4.2 million premature deaths worldwide in 2016, of which six per cent were lung cancer deaths. Additionally, close to four million people die prematurely from illness attributable to household air pollution from cooking with solid fuels and kerosene.
Occupational carcinogens - It is well documented that occupational carcinogens are causally related to lung cancer, mesothelioma, and bladder cancer. For example, mesothelioma ( cancer of the outer lining of the lung or chest cavity) is to a large extent caused by work- related exposure to asbestos.
Radiation - Exposure to all types of ionising radiation increases the risk of various types of malignancy including leukaemia and several solid tumours. Risks increase when the exposure occurs at a young age and also when the exposure amount is higher. Ultraviolet ( UV) radiation, and in particular solar radiation, is carcinogenic to humans, causing all major types of skin cancer, such as basal cell carcinoma ( BCC), squamous cell carcinoma ( SCC) and melanoma. Avoiding excessive exposure, and using sunscreen and protective clothing are effective preventive measures. UV- emitting tanning devices are now also classified as carcinogenic to humans based on their association with skin and ocular melanoma cancers.
What is the cost of treating cancer to a cancer patient daily, monthly and yearly depending on the common types?
Cancer treatment in Nigeria costs nearly N30 million per patient. Women in Nigeria needs about N2.1 million to N29.2 million to treat breast cancer depending on the type of breast cancer. The woman would have to go through different stages of diagnosis, chemotherapy, surgeries among others to get treated. This includes eight series of diagnosis that cost between
N232,000 to N311,000; three surgeries which cost N670,000 to N3.3 million; 10 sessions of chemotherapy that cost about N916,000 to N2.6 million and finally 10- 23 sessions of radiotherapy, which may cost N138,000 to N360,000.
Is cancer treatment included in the National Health Insurance Act ( NHIA)?
An evaluation of the National Health Insurance Scheme ( NHIS) benefits package from October 2020 revealed that cancer care is not listed as part of the benefits offered by the scheme. Additionally, Computed Tomography ( CT) scan and Magnetic Resonance Imaging ( MRI) scans - diagnostic tests that are crucial to identifying most cancers - are only partially covered by the NHIS.
But recently National Health Insurance Act ( NHIA), an upgrade of NHIS, now covers some percentage of cancer treatment.
The Health Federation of Nigeria lobbies for the legislatures to a cancer health fund ( CHF) now available to provide funding and healthcare services to indigent cancer patients in the country especially for breast, prostate and cervical cancers.
The CHF programme is an initiative of the Federal Ministry of Health that commenced in 2021 with six pilot hospitals.
Can cancers be prevented or cured? If yes or no, why?
YES: Between 30– 50 per cent of all cancer cases are preventable. Prevention offers the most cost- effective long- term strategy for the control of cancer. Strengthen national policies and programmes to raise awareness and, reduce exposure to cancer risk factors, and also ensure that people are provided with the information and support they need to adopt healthy lifestyles.
A person’s risk of cancer depends on many different things. Research shows that things like stopping smoking and keeping a h e a l t h y weight can reduce the risk of cancer.
Prophylactic vaccination against HPV and screening and treatment of pre- cancer lesions are effective ways to prevent cervical cancer and are very cost- effective.