Cancer

Cancer is a  group  of diseases involving abnormal  and uncontrolled tissue growth characterized by the potential to spread to other tissues.

When cancer spreads, a process called metastasis, it results in life threatening situations. Tumours that does not spread to other tissue are regarded as benign. With the exception of benign brain tumours, most benign tumours are not life threatening.

 

Common signs & symptoms

Possible symptoms including;

1. A lump.

2. Abnormal bleeding.

3. Prolonged cough.

4. Weight loss.

5. Change in bowel movement and

6. Dizziness.

Because these symptoms are not specific to cancer, a proper diagnosis is required to ascertain the disease.

Cancer risk factors

Major risk factors for cancer include; tobacco use, obesity, poor diet, a sedentary lifestyle, exposure to radiation, environmental pollutants and excessive alcohol use.

In developing nations, about 15% of cancer cases are attributed to exposure to infectious agents such as Helicobacter pylori, Hepatitis B and C, Human papillomavirus (HPV) infections, Epstein-Barr virus and HIV/AIDS.

Cancer prevention

According to the WHO, between 30-50% of all cancer cases can be prevented. Prevention is the most cost-effective long-term strategy for the control of cancer. Nigeria needs to implement policies that will raise awareness, reduce exposure to cancer risk factors and ensure that people are provided with the information and support they need to adopt healthy lifestyles.

Examples of personal cancer prevention practices include:

1. Avoid smoking and tobacco use.

2. Exercise regularly and maintain a healthy weight.

3. Minimize alcohol use.

4. Take the HPV vaccine (for young girls).

5. Avoid exposure to radiation, environmental pollutants and carcinogenic substances.

Cancer incidence in Nigeria

The most recent comprehensive study of cancer incidence in Nigeria placed the total number of new cases at 115, 950 in 2018. Of this number, 44,928 (about 39%) cases are male and 71,022 (about 61%) cases are female. Collectively Breast, Cervical, Prostrate, Colorectal and Non-Hodgkin lymphoma are the top 5 cancer types in Nigeria.

The top 5 cancer types for  women include; Breast, Cervical, Colorectal, Ovarian and Non-Hodgkin lymphoma and the  top 5 cancer types for  men include; Prostate, Colorectal, Non-Hodgkin lymphoma, Liver and Stomach cancers.

Available data indicate that around 464,000 cancer cases have been reported in the last four years. 

Cancer mortality in nigeria

Cancer is quickly overtaking many infections diseases in Africa and indeed Nigeria as the leading cause of death. In 2018, 70,327 people died from cancer in Nigeria, Breast, Cervical, Prostate, Liver and Non-Hodgkin lymphoma were the top 5 cancer type with highest mortality reported. This alarmingly high fatalities can be attributed to a number of factors including; poor and inadequate healthcare facilities, chronic staff shortage, unaffordable cancer treatment costs and a general lack of adoption of cancer prevention practices. 

Available figures indicate that well over 280,000 Nigerians have lost their lives to cancer in the last four years. These numbers may be viewed as conservative since a significant number of cases are usually not reported for reason such as; a cultural attitudes that undermines regular medical visits, poor access to quality diagnostic facilities as well as financial difficulties.

Cancer Facilities and expertise in Nigeria

A resilient healthcare system is indispensable for Nigeria to successful manage her cancer burden, recent studies have indicated that the country needs between 170-200 fully equipped cancer treatment centres. With only 8 cancer treatment centres having a radiotherapy machine, her current capacity is indeed a far cry from expectations. 

Also, a 2020 WHO report showed several concerning figures on cancer workforce in Nigeria,  it was pointed that the federal ministry of health had no staff who dedicates a significant amount of time to cancer. The number of radiation oncologists, medical physicists, surgeons, radiologists, nuclear medicine physicians and medical laboratory pathologists per 10.,000 cancer patients were 6.0, 8.6, 157.6, 30.2, 0.3 and 1095.6 respectively.

Importantly, a study by Phillips Consulting (PCl) in 2018 rightly pointed that due the lack of adequate medical facilities and specialists, tens and thousands of Nigerians troop abroad to explore better and more affordable medical treatments and health care services. Destinations of Nigerian medical tourists include the Middle East, India, Turkey, the United States of America, and Europe. Cancer patients can spend up to $60,000 for treatment abroad.

Below is a list of the eight (8) cancer treatment centres with radiotherapy capacity:

1. Lagos University Teaching Hospital, Lagos.

2. University of Benin Teaching Hospital, Benin.

3. Usmanu Danfodiyo Teaching Hospital, Sokoto.

4. Federal University Teaching Hospital Gombe, Gombe.

5. National Hospital FCT, Abuja.

6. University College Hospital Ibadan, Ibadan.

7. University of Nigeria Teaching Hospital, Enugu.

8. Ahmadu Bello University Teaching Hospital, Kaduna.

It is important to note that the radiotherapy machines at some of these centres are either obsolete or not operational. 

Cancer treatment cost and the challenge of poverty

Nigeria's National Health Insurance Scheme (NHIS) does not cover cancer, neither do plans from several health management organizations. Usually, prescribed drugs determine the cost of cancer treatment in Nigeria, and the total cost is reliant on the number of drug cycles. Drugs are benchmarked at about N200,000 per dose of drugs. A patient can pay between N150,000 to N1,000,000 for a treatment cycle, and may need as many as fifteen cycles. Cancer patients can spend up to $60,000 for treatment abroad, and this excludes other associated financial costs such as visa fees, flight tickets, logistics, hotel accommodation, and upkeep for the patient and their caregivers. The high amount of capital expenditure by patients suggests opportunities for investment along the value chain of cancer management in Nigeria.

The cost implication of cancer in Nigeria can not be afforded by the low-income earners, who, unfortunately, are the most affected by cancer. For a country with a national minimum wage of 30,000 NGN and a poverty rate of over 40% of the population, these numbers clearly points to a sad reality that cancer treatment is a luxury for the majority of the nation. For these reasons and more, a national effort coordinated by the national health insurance scheme in collaboration with key stakeholder in the private and non-profit sectors needs to be urgently put in place.

 CANCER DATBases & Data management in nigeria

Understanding the cancer burden in Nigeria is limited by the incompleteness of cancer data. This is not unique to Nigeria as most African countries surfer the same plight. The lack of a complete epidemiological profile possibly contributes to the country's inability to adequately tackle many non-communicable diseases (NCDs) including cancer. Although the country has six population-based and 19 hospital-based cancer registries that the National System of Cancer Registries (set up in 2009) tries to coordinate, the country has no national, population-based cancer registry and thus no reliable national cancer statistics. The national cancer incidence statistics supplied for Cancer in Nigeria (2009 –2013) are based on figures derived from only two population-based cancer registries in Abuja and Enugu.