March 29, 2023

Celebrating Excellence & Integrity


Cancer: Dealing with high incidence, cost of containment

• How to reduce rise in cancer cases,deaths
• Saving 10m lives, $1.16trn lost yearly to cancer
• Radiotherapy costs N1 million, N20 million needed for chemotherapy, experts say

Every February 4, the World Health Organisation (WHO) celebrates the World Cancer Day. In her message to commemorate the 2023 event, the WHO Regional Director for Africa, Dr. Matshidiso Moeti, said approximately 1.1 million new cancer cases occur every year in the continent, with about 700,000 deaths.

Experts say about 10 million lives and estimated $1.16 trillion lost worldwide to cancer could be saved by implementing resource-appropriate strategies for prevention, early detection and treatment.

According to Global Cancer Observatory: Cancer Today (GLOBOCAN), of the 9.6 million deaths worldwide, 50.6 per cent come from lung, colorectal, stomach, liver and breast cancers. Out of the 18.1 million cases reported in 2018, lungs, breast, colorectal, prostate and stomach cancers accounted for 46.1 per cent
fewer than 78,000 Nigerians and 125,000 new persons are infected.

Cancers of the breast, cervix uteri, prostate, non-Hodgkin lymphoma, liver, colon, ovary, rectum, leukemia and stomach are reported to be the top 10 commonest cancers in Nigeria.

GLOBOCAN is an online database, which provides detailed statistics and estimates of incidence and mortality in 185 countries for 36 types of cancer. It helps to provide a comprehensive assessment of the cancer burden worldwide.

Also, recent figures showed high cancer related mortality in Nigeria compared to most nations. For example, cervical cancer mortality ratio is about 51 per cent compared to less than 20 per cent in North America.

According to WHO, cancer is the second leading cause of death worldwide. About 70 per cent of cancer death occurs in low to middle-income countries like Nigeria.

Medical experts, who spoke to The Guardian, decried high cost of cancer treatment in the country, saying there is need to make its treatment affordable and accessible.

The medical experts said Nigeria has just four functional radiotherapy machines serving over 200 million persons across the 36 states of the federation and the Federal Capital Territory (FCT) Abuja, an evidence of low investments in cancer care. They said this is basically out of pocket for individual as the insurance coverage is still less than five per cent.

The medical experts, who spoke, include Professor of Gynaecology and Obstetrics and former Minister of Health, Isaac Folorunso Adewole; a Global Health Consultant/Chief Technical Advisor of E4HDI, Dr. Nnenna Ezeigwe; former Commissioner for Health in Ondo State, Dr. Dayo Adeyanju and Director of Research, Nigerian Institute of Medical Research (NIMR) Yaba, Lagos, Prof. Oliver Chukwujekwu Ezechi.
Reasons for high incidence, mortality.
MR) Yaba, Lagos, Prof. Oliver Chukwujekwu Ezechi.
Reasons for high incidence, mortality.

ADEYANJU said the celebration this year’s brings to the fore, issues of cancer management in Nigeria. He said, each year, cancer claims 72,000, with an estimated 250,000 new cases.

Adeyanju, citing the WHO cancer statistics, said by the disease was responsible for over 78,800 deaths in 2020 and 44,699 in 2021, with women more affected as a result of breast and cervical cancers. It projected that an estimated 28.4 million new global cancer cases would occur in 2040, a 47 per cent rise from 2020.

Adeyanju said 19 per cent of all breast cancer cases in the United States result in mortality; this ratio is 51 per cent in Nigeria. “This is due to late diagnosis, limited treatment options, and poor treatment outcomes. Access to treatment is delayed in 80-90 per cent of patients, resulting in late stages of cancer at the time of presentation and leading to poor prognosis.”

“Nigeria has four functional radiotherapy machines serving over 200 million persons across the 36 states and the Federal Capital Territory, FCT Abuja, which is evidence of low investments as regard cancer care. I remember visiting the radiotherapy unit of National Hospital, Abuja. There are two radiotherapy machines but only one is functional.”

Ezeigwe said the rising cases of cancer in Nigeria are a result of demographic transition and increase in attributable risk factors. According to her, as a non-communicable disease, no single cause has been established for most cancers.
She said, in addition to genetic predisposition, the other risk factors include use of tobacco and tobacco products, unhealthy diet, physical inactivity, harmful use of alcohol and air pollution.

The global health consultant said these factors are closely related to social determinants of health such as education, health system, occupation, income, as well as living and working conditions.

The lady said the level of air pollution, worsened by a frenzy of generator fumes due to power outage, is particularly worrisome, because citizens cannot protect themselves from the menace.
The physician said governance and socio-economic policies of several government sectors shape and determine these factors.

For former health minister, Adewole, there are about 12,000 new cases, yearly, and the fatality is about 8,000. He said the cost depends on type and stage and extent of treatment, and could run into millions of naira.

Ezechi added the rise in cancers in Nigeria forms part of a larger epidemiological transition in which the burden of chronic, non-communicable disease — once limited to developing countries — is now increasing in developing countries.

He said Nigeria is burdened by cancers attributable to infectious diseases like Human Immuno-deficiency Virus (HIV), Human Papilloma Virus and Hepatitis B. In addition to the risks associated with the adoption of western diet, tobacco use and alcohol intake, lack of exercise from sedentary lifestyle and pollution from hydrocarbon and industrial effluents also lead to cancer.
The clinical scientist also said the high fatality rate in Nigeria and other developing countries owes mainly to poor access to epidemiological data, research, treatment, and cancer control and prevention.

The NIMR boss believes lack of awareness, poor health system, inadequate equipment and infrastructure, inadequate health workers especially oncology team, poor remuneration and brain drain are some of the reasons cancer cases are growing in the country.

“Finally late presentation and detection of the early forms of cancer due to poor health-seeking behaviour and poorly organised cancer prevention and control programmes,” he said.

Policy implementation
FOR Adeyanju, poor funding, poor policy implementation, lack of political will and commitment on the part of government are also responsible for the rising case
He said in 2018, the Federal Government developed a Cancer Control Plan — a four-year programme with a vision to reduce the incidence and prevalence of cancer over the next five years and beyond. But as usual with successive governments, the document has not got the required attention. This, he said, would have taken care of prevention and control of carcinogens,” Adeyanju stressed.

Guardian online

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