What Every Nigerian Must Know About Cancer By Dr Idris Ola
Excerpts of Dr Idris Ola’s recent chat with Punch NG reporter Peter Dada about cancer control and prevention.
What should Nigerians know about cancer?
There is still so much that is not known about cancer. However, research has shown cancer to be a multi-factorial disease that often requires genetic predisposition and disruptive environmental factors. Genetic predisposition in the form of inherited and spontaneous new mutations have been shown to be involved in its development. Environmental factors implicated include lifestyle habits such as diet, tobacco use and excessive alcohol intake. Exposure to chemical pollutants, radiation and certain diseases has also been implicated in the development of cancer.
Prostate cancer is a common concern for men. What is the cause?
Like many other cancer types, there is still much to discover about the primary cause of prostate cancer. There is a genetic component to its cause in form of gene mutation, which may be inherited, or it could be a new spontaneous mutation. New mutations are more common and are not often transferred to offspring. Environmental factors also play roles in its eventual occurrence. Risk factors that have been identified include increasing age, usually age 50 and above, family history of prostate cancer and excessive weight gain.
What are the symptoms?
In the early stages of its development, there are usually no symptoms or signs. The earliest symptom can be nocturnal – that is, frequent urination at night. In advanced stages, men may begin to lose weight, have difficulty starting urination, poor urinary stream or forking of urine during urination. Others are urinary retention or pain during urination, pain in the bones, especially back and hip bones, passage of blood in semen or urine, and poor erection of the penis. At advanced stages when the cells invade other body parts, the symptoms might become more diverse depending on the other organs affected.
How can cancer it be prevented?
Cancer is a deadly disease and must be prevented at all cost when possible. Factors implicated in its development that are modifiable or avoidable are the focus of our prevention programmes since we do not have much control over the genetic changes.
We therefore focus on controlling the environmental factors. For instance, avoidance of known risk factors such as excessive weight gain, cigarette smoking, excessive alcohol intake, intake of high fat diets, and contacting of some infectious agents, among others. Also, immunisation is increasingly becoming a vital mechanism for cancer prevention. Hepatitis B and Hepatitis C vaccines can prevent infection with these viruses and subsequently prevent the development of cancer later in life.
Similarly, administering human papillomavirus vaccine for young boys and girls, ages 11 to 13, has also helped to prevent development of cervical cancer. For those not vaccinated at this age, they may still get vaccinated up to age 26. Studies have shown that there is up to 86 per cent reduction in HPV cancers among teenage girls who received this vaccine.
We also have family history. Genetic diseases can be transmitted along family lines, and in cases where they are linked to cancer development, members of such families are at risk. It is, therefore, imperative to pay attention to the cause of deaths among family members. For example, the daughter and siblings of a woman that had breast cancer have a higher tendency to develop the disease than those without such a family history. Another way to prevent it is by having regular checks for cancer and other diseases. This can help to detect it early and early detection can cure it easily before it becomes a full-blown cancer. This can save a lot of lives and money.
How can it be cured?
Early detection and treatment is the key. When it is detected when it is still confined to the prostate gland itself, the chance of a cure is high. Treatment options depend on how aggressive the cancer is, the stage at diagnosis, and the general health status of the person. Usual treatment options include surgical removal of the diseased prostate, using radiation to destroy the cancer cells, and hormonal therapy. Hormonal therapy involves starving the cancer cells by cutting off the hormone that feeds them. Prostate cells receive testosterone hormone from the testicles.
Therefore, surgical removal of the testes (orchidectomy) cuts off this supply and starves or shrinks the cells. Some medications can also be used to achieve this. This is quite commonly used in Nigeria because our men often present late or at older age when other treatment options might be more harmful to their health. Use of chemotherapy drugs is applicable, especially when the cancer cells have invaded other body parts. Modifying the immune system of the body called immunotherapy has also shown great promise of cure.
Is there any biological means of curing cancer?
The only proven biological means that have shown promise so far are the various forms of immunotherapy and the newer therapies focusing on modifying body’s natural system of fighting diseases. Most biological agents such as those used in herbal medicine have not shown any promise.
From my experience, it amounts to total waste of time, money and eventual loss of lives. Most people come to hospitals having tried all sorts of biological agents in various forms of healing system – faith healing, traditional healing, among others. But the results have always been the same: no improvement and, in most cases, worsening of symptoms. At this point, most people tend to return to hospitals for medical care even though it’s sometimes too late.
Treatment of cancer is expensive for many Nigerians. How can this be addressed?
This is very true and sad. I see this type of people very often in my line of work and no matter how hard we counsel them, they will find a way of absconding from clinic because they simply can’t afford basic treatment. I have always been an advocate for inclusion of cancer screening and treatment in the National Health Insurance Scheme. But even the NHIS is grossly inadequate and covers less than five per cent of the Nigerian population. There is a glimpse of hope, however. On Tuesday, October 29, 2019, the Federal Ministry of Health and its several partners launched the ‘Chemotherapy Access Partnership Program’ in Abuja.
This programme, aimed at making essential cancer medications available to all Nigerians at a very affordable cost, has been designed to run in seven centres, including the National Hospital, Abuja; University College Hospital, Ibadan; Obafemi Awolowo University Teaching Hospital, Ile-Ife; Ahmadu Bello University Teaching Hospital, Kaduna; Lagos University Teaching Hospital; University of Nigeria Teaching Hospital, Enugu; and Aminu Kano Teaching Hospital, Kano.
I believe this is a right step in the right direction and scaling and proliferation of this type of programme is necessary to address this critical problem. From a broader perspective, necessary efforts towards poverty eradication by all concerned stakeholders would boost the economic and financial power of Nigerians and, hence, would help improve their ability to pay for care.
Many Nigerians travel outside the country to treat cancer. Why is it difficult to treat it in Nigeria?
Irrespective of where treatment is sought, most important determinant factors are those I have mentioned earlier, especially early hospital presentation. In the United States, for example, the death rate from cancer is declining not just because the treatment is better, but because they are much more aware, attend regular screenings, and often present for treatment much earlier than we do in Nigeria.
People who have travelled abroad for treatment when cancer has reached advanced stages still have a guarded chance of survival. Some of the limitations we have in Nigeria are in terms of limited number of cancer specialists, diagnostic tools and a number of functioning treatment centres available in the country.
To access radiotherapy, for example, patients can be in a queue for an average of three to six months. In this situation, survival chances can rapidly decline. This does not happen in developed countries. Those who access cancer treatment early and go through all stages of their treatment in Nigeria also do very well. At least I know quite a number of them that are hale and hearty several years after treatment. The important thing is to present early, have resources to support treatment and go through treatment as advised by the specialist.
About Dr Idris Ola:
Ola, a co-founder and Executive Director of the Women’s Cancer Prevention and Support for African Society, a non-profit organisation offering cancer awareness and education