Cancer upsurge: The chicken comes home to roost for Nigeria

Decades ago, Nigerians saw cancer as a kind of ‘white man’s disease’ to which black men, especially Nigerians, were naturally immune. The few incidents ever heard of were either misdiagnosed as some mysterious disease caused by witches or the wicked or they happened to ‘someone’ too far away for it to be taken seriously.

Today, the story has changed. Cancer, due to a combination of factors, now ranks third on the list of Nigeria’s most prevalent killer diseases behind only malaria and HIV/AIDS, according to the Nigeria Medical Association, accounting for death of millions of Nigerians that include top society figures and celebrities, of which Olufunmilayo Olayinka, the Ekiti state deputy governor, is the most recent, following her two-year-old battle against the dreaded terminal disease.

While it is accepted that cancer is caused by a number of factors that include genetic factors; lifestyle factors like tobacco use, wrong diet, excessive weight, physical inactivity and some types of infections as well as environmental exposures to chemicals, fumes and radiation, it is important not to overlook, like we have done for so long now, the role that exposure to fumes has played in raising Nigeria’s cancer population.

The failure of Nigerians, government and the governed, to make a connection between the rise in cancer cases and the air pollution we have lived and worked in for so long is no doubt a part of the problem we are now faced with. In fact, very few have made the connection between a generator dependent country and the rise in cases of cancer across the country.

Generator-dependent economy

Due to corruption and bad governance, Nigeria’s power supply over the years, has dropped to an abysmal level where Africa’s leading oil producing state with an estimated 160million population and the continent’s third largest economy has become generator-dependent.

According to GBI, a global firm, Nigeria’s generator importation occasioned by its epileptic and non-existent power supply hit N71.55 billion ($450 million) in 2011 and may reach N151.16 billion ($950.7 million) by 2020. With generators of all types and sizes pumping poisonous fumes into the atmosphere day and night, year after year, in our homes, offices and industries, in rural and urban centres, little wonder that Nigeria’s cancer figure continues to rise while the nation sleep on.

Fumes of death

Anthony Chukwu, a resident of Idi-Araba, Lagos, said that “Despite the noise and pollution from generators, they have become necessary nuisance in many homes, providing emergency power for lights, fans and fridges. Fumes emitted by generators and smoking vehicles are fatal, often without people realising the danger. It also has long-term hazards as a possible cause of lung cancer, medical reports say.”

The nation have been greeted with the sad news of other notable personalities apart from the recent case of the Ekiti state deputy governor. They include Gani Fawehinmi, legal icon; Beko Ransome-Kuti, radical medical practitioner; Maryam Babangida, former first lady, Sunny Okosun, musical ace and a countless but growing number of thousands of men and women across Nigeria, who were either knocked down at their prime by cancer or are currently battling for survival.

Unlike in other climes where data gathering and medium and long-term research findings are carried to connect living habits and factors with the rising cases of a particular disease, Nigeria’s lack of reliable and updated data may mean a continuation of the rise in cancer deaths brought about by years of exposure to and adverse effects of generator and vehicle fumes, to mention but a few factors responsible for the rise of the deadly disease.

Experts view

In an interview with BusinessDay, Osahon Enabulele, national president, Nigerian Medical Association (NMA) said that cancer has become a major public health concern with some hospitals and medical centres in the country lacking appropriate diagnostic facility and/or capacity to quickly detect and treat cancer.

Enabulele explained that cancer occurs when abnormal cells within any part of the human body continuously grow out of control with chances of developing most cancers related to risk factors such as tobacco use, unhealthy diet, harmful use of alcohol, physical inactivity, urban air pollution and indoor smoke from household use of solid fuels.

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Lending her view, Betty Anyanwu-Akeredolu, founder/president, Breast Cancer Association of Nigeria (BRECAN), noted that whereas the deaths of prominent Nigerians make news headlines, countless unknown Nigerian women are dying needlessly due to this disease that the advances in medical research is proving survivable even curable.

Anyanwu-Akeredolu pointed that late presentation of cancer in hospitals was due to ignorance, situation the association is trying to change through awareness and enlightenment.

Echoing the sentiment of Anyanwu-Akeredolu, Remi Ajekigbe, consultant radiotherapist and oncologist, Lagos University Teaching Hospital, (LUTH) Idi-Araba, revealed that not less than 15 new cases are seen on a daily basis out of which nine are breast cancer with breast cancer still the leading cancer in the country.

Ajekigbe observed that Nigeria’s mortality and morbidity statistics for cancer are high due to late presentation syndrome involving 83-87 percent of cancer patients, running up bills of N150,000 to N350,000 every three weeks as long as the patient survives. He added that some items added to foods that make them sweeter are chemicals as they are all carcinogenic.

Statistics on cancer

A cursory look at cancer management in the country shows that Nigeria is ill equipped to deal with the complexities of cancer care with dearth in healthcare infrastructure which clinical services hard to come by and inadequately distributed. Only a few health centres have functioning radiotherapy equipment and the cost of care remains out of reach for most Nigerians who have received a cancer diagnosis.

Data collected from 11 cancer registries showed 7,000 new documented cases of cancer which corresponds with an estimated 100,000 new cases of cancer reported in Nigeria annually. From the data, 60 percent of cancers occur in women and 39.8 percent in men.

Some cancer registries include University College Hospital, Ibadan, Lagos University Teaching Hospital, Jos University Teaching Hospital, Ahmadu Bello University Teaching Hospital, Zaria, Obafemi Awolowo Teaching Hospital Complex, Ile-Ife, University of Nigeria Teaching Hospital, Enugu, University of Ilorin Teaching Hospital, Ilorin, University of Maiduguri Teaching Hospital, University of Benin Teaching Hospital, Aminu Kano University Teaching Hospital, Kano and Nnamdi Azikwe University Teaching Hospital, Nnewi).

Lius Sambo, WHO Regional director for Africa, stated that about 12.4 percent of African Region’s 804 million inhabitants are projected to develop cancer before the age of 75. While the risk increases with age, Sambo explained that about 90 percent of cancer cases will occur after the age of 40. If we act now we can save about 100,000 lives annually by 2020.

“Many people in the region do not know that they have cancer until it is at advanced stages due to the lack of awareness and the weakness of early diagnostic capacities in our countries. There is growing evidence that about 40 percent of all cancer deaths can be prevented if diagnosed early. Indeed a vast majority of patients survive the disease because of early diagnosis and available advanced treatment methods,” Sambo explained in his message for World Cancer Day 2013.

It is predicted that by 2020, number of cancer patients in Nigeria is projected to rise from 24 million to 42 million. It is also feared that by same 2020, death rates from cancer in Nigerian males and females may reach 72.7/100,000 and 76/100,000 respectively.

According to World Health Organisation (WHO) data reveal that lung, stomach, liver, colon and breast cancer cause the most cancer deaths annually. The data show that cancer causing viral infections such as HBV/HCV and HPV are responsible for up to 20 percent of cancer deaths in low-and middle-income countries with deaths from cancer projected to continue rising, with an estimated 13.1 million deaths in 2030.

Solving this impasse

Public health experts believe that reductions in cancers should come from a complete Government approach to adopting population-wide interventions that address risk factors, sustained primary healthcare measures, palliative and long-term care should be implemented for those who already have cancers.

“Planning integrated, evidence-based and cost effective interventions throughout the cancer continuum (from research to prevention, early detection, treatment, palliative care) is the most effective way to tackle the cancer problem and reduce the suffering caused to patients and their families. Until government at all levels deploy resources to raise awareness and create access to affordable treatment and care, Nigerian women will continue to die untimely due to breast cancer,” Anyanwu-Akeredolu explained.