Chukwumere Nwogu, a Cancer Epidemiologist; Thoracic surgical oncologist and chief executive officer, Lakeshore Cancer Centre and Stephen Edge, a professor of Surgery and Oncology at Roswell Park Comprehensive Cancer Centre in Buffalo, New York, USA, recently spoke to BusinessDay’s Anthonia Obokoh, on cancer management, risk factors and cost effective ways of cancer control. Excerpts:
Basic ways to avoid cancer
Chukwumere:
Avoid smoking, because smoking causes a lot of cancers. Fortunately, smoking has a low prevalence in Nigeria and that is great.
Vaccinations can also help. Like HPV which is the virus that causes cervical cancer. We can vaccinate young people to prevent them from the infection. Vaccines against hepatitis B for instance, which cause liver cancer. Now there are some other cancers that you can detect before they become cancerous like cervical cancer. When there are some changes in the cervix, and they are detected early, one can treat it before it becomes cancerous, and that is a form of prevention.
Colon cancer, for example, if you are able to detect it at the early stage before they become cancerous, it be can be prevented.
There are also lifestyle changes that can help such as; a good diet, moderate alcohol consumption, and exercise can be beneficial.
There are several stages at the prevention level, but one of the biggest things that we can do is trying to detect cancers before they become advanced.
Screening can be very useful, and in Nigeria setting it up might be challenging, yet it is necessary to have mass screening available.
“Breast cancer is a big issue in Nigeria, It is important to teach all women from the very young age to practice self-breast examination, teaching all health workers to do what we call clinical breast exam once in a year to be able to examine their breast”.
So, if we can detect the cancer, when it is really small, we remove it and potentially cure the patient rather than waiting when it becomes advanced and might be very difficult to cure when it is too late.
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Cervical cancer can be eliminated in Nigeria
Edge:
Cervical cancer is known to be caused in almost all cases by a virus called Human papilloma virus (HPV) and scientists have discovered vaccines against the virus.
If all young boys and girls actually get the HPV vaccine when they are teenagers, 20 years from now, there will be probably almost no cervical cancer in Nigeria.
HPV vaccines are available in Nigeria and it is relatively inexpensive. I am sure that the Nigeria government is considering ways to make HPV vaccine available to all boys and girls.
What are the leading causes of cancer?
Chukwumere:
The leading causes of cancer depend on where you are in the world. In Nigeria, the four most common cancers based on the data that was just released this year by the World Health Organization (WHO) are breast, cervical, prostate and colorectal cancers.
Cancers arise from almost any part of the body, so a lot of these cancers arise from no known cause.
However, there are some specific things like virus that can also cause cancers, smoking cigarettes, someone getting too exposed to large number of radiation like atomic bomb. These things can cause cancer.
Beyond Chemotherapy, what are the alternatives treatments for cancer?
Edge:
It depends on how advanced the cancer is. For many women with breast cancer, if it is found when the tumour is very small, many of them do not need chemotherapy. We are also developing ways to find out who really needs chemotherapy and those that do not really need it. This will reduce people who get chemotherapy.
There have also been some exciting new findings based on the possibility of using the body’s immune system to fight cancers. They are very exciting changes and development in treatment particularly in lung cancer. Also, other things that we are able to do now are more and more person care system.
So, things are changing a lot and in a very quick way. Let us say in 20 years, cancer might have better treatment options than chemotherapy.
A big challenge is that the drugs (currently available) are quite expensive and there is a need for action to reduce the cost of the drugs.
Average cost of cancer treatment
Chukwumere:
It is difficult to say how much is spent on cancer treatment because every cancer is not the same and has different stages.
Typically for most cancers, they have four stages so it depends whether it is very early or it is at stage one or whether it began to spread a little bit of stage two or three or it has gone to a distance of the metastasis stage which is stage four.
Usually, it is a lot cheaper and easier to treat a patient at an early stage and it is more successful. When some have stage four cancers, it is very difficult to treat and sometimes impossible to cure, which is a lot more expensive.
For instance, when someone comes in with breast cancer very early that has not spread, the person can have a relatively cheap surgery, lumpectomy. This is because it was presented at the early stage, but when presented late, a patient has to add treatment like radiation and chemo therapy, which can get very expensive.
There are so many factors that go into cancer treatment, but there are international agencies that are working with the federal government of Nigeria, and some private entities like Lakeshore cancer centre to also get some other companies to provide discounted chemotherapy.
Also, there are a lot of efforts now to bring new radiotherapy machines into Nigeria to help have treatment more available. This might be able to also reduce the cost.
How do we attract more investment into cancer treatment?
Edge:
I think the international community recognises that cancer is becoming the leading cause of death in the world. Forty years ago, cancer was not the leading cause of death or sixty years ago. Some certain infectious diseases were much more common. Diseases such as yellow fever, cholera were the main causes of early death. But now people live longer and get cancer.
“Acquiring the very expensive radiation machines are a major challenge. This is why there are not enough radiotherapy services in the country”.
The need for investments is clear, but economic development could drive the investment needed in these areas.
How can government improve on cancer care in Nigeria?
Chukwumere:
According to the latest estimate on the global burden of cancer, in September 2018, by the International Agency for Research on Cancer (IARC), there will be an estimated 18.1million new cancer cases and 9.6 million cancer deaths in 2018. In Nigeria, 115,950 new cases and 70,327 deaths are predicted.
First of all, one of the most important things is to have the National Cancer Control Plan (NCCP). It will deal with all the different aspects of the prevention, early detection, acute diagnosis, treatment and palliative care that are important.
Yes, the federal government might be trying it’s best to increase the numbers of radiotherapy machines, but even at that it is inadequate.
It is estimated that every country or low middle income country like Nigeria, should have one radiotherapy machine for one hundred people. So there should be close to two million machines, since the country’s population is approaching 200 million people.
The machine itself might cost in the neighbourhood of about N3 million, but it is not just about the machine, we need to build special building or vault for the machine, which is also expensive.
Also another angle to be looked at is the cost-effective ways of dealing with cancer to reduce the burden of the disease, which constitutes the highest cause of medical tourism by Nigerians.
It has been documented that the burden of non- communicable diseases on the Nigerian population is growing at an alarming rate. Given the limited expenditure on healthcare in Nigeria, it is crucial to strive to maximize the impact of cancer control through less financially demanding alternatives that exist.
Lifestyle modifications, vaccination, screening, early/accurate diagnosis, appropriate treatment and palliative care are all critical components of effective cancer control.
There is a compelling opportunity to engage collaboratively with the public and private healthcare institutions. Physicians, nurses, pharmacist, allied healthcare workers, researchers, non-governmental organizations and the citizenry can work to stop the cancer challenge.
