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• Doctors blame systemic flaws, poor environment, knock government, proffer solutions ν Advise men to constantly examine breasts of their wives to detect scourge early
By Enyeribe Ejiogu, Cosmas Omegoh, Agatha Emeadi and Chibuike Okafor
When in 2005, Mrs Regina Alice Adedeji, a primary school teacher in Ondo State, was diagnosed with early-stage breast cancer at the Lagos University Teaching Hospital, Idi Araba, Lagos, she felt like one who received the pronouncement of a death sentence.
Her world literally collapsed. Merely hearing the words roll off the tongue of the Consultant Oncologist killed her inner person, when cancer had not even started to take her health downhill as undetected and untreated cancer usually does.
It took the calm, confident disposition of the male doctor who explained the situation in minute details, to reassure the 46-year-old woman who in every way was quite delectable that made her husband swoon over her.
Before that moment, the lump found in her left breast had been removed in a simple surgical process called biopsy. The excised lump was then sent for medical laboratory investigation, and the result showed it to be cancerous and malignant, meaning that cells from it could break away and invade other tissues far from the primary site.
To give Regina a good fighting chance to defeat the cancer, the doctor said that she would have to undergo immediate radical mastectomy, which is a surgery done to remove a breast. In her particular case, the doctor said that her lymph nodes which are near the breast would also be removed to ensure an abundance of caution as break-away cancerous cells may easily be transported through the lymph to other sites.
In some cases, a mastectomy is done to help prevent breast cancer from forming at all in women who have a high risk for it. For instance, Angelina Jolie, the successful American actress, underwent a mastectomy when she had not even shown any symptoms of breast cancer because it runs in the family, and she wanted to completely neutralize the possibility of her having it too.
For Regina, it was very thought of losing the full, firm ‘squeezies’ her husband loved to touch so much and which made their bond even after 21 years of marriage, that made her feel crushed. But wisdom and good reason prevailed. She had the double mastectomy though the cancerous lump was found only in one breast. After the surgical wounds healed, she began to wear prosthetic breasts, both at home and whenever she went out.
“Each time I step out in my elegant lace blouse, wrapper and Damask head-tie, (you know that type of skyscraper head-tie made popular by Madam Kofo) you would never suspect I am wearing prosthetic breasts under blouse,” she confided in Sunday Sun, adding, “just looking at me now will you think I don’t have natural breasts?”
According to the World Health Organization, (WHO) in 2020, 685,000 women died from breast cancer with no specific risk factors other than sex and age. Again, that research posits that approximately 0.5-1 per cent of breast cancers occur in men.
Globally, about 10 million people die from cancer every year. One in six people die every year. It is one of the largest health problems in the world. Annually, in Nigeria, more than 70,000 people die as a result of cancer (41,913 females and 28,414 males.) The estimated incidence of the five most common types of cancer are breast cancer (25.7 per cent), cervical uterus (14.6 per cent), prostate (12.8 per cent), non-Hodgkin lymphoma (5.3 per cent) liver (5.0). The estimated mortality proportions are breast cancer (18.6 per cent), cervical uterus (16.8 per cent), prostate (9.4 per cent), liver (8.3 per cent), and non-Hodgkin lymphoma (6.0nper cent). Breast cancer is currently the deadliest cancer type in Nigeria, while cervical cancer is second and prostate cancer is third.
As doctors have affirmed, several cancers are curable when detected early. Among them are: thyroid cancer, prostate cancer (most prostate cancers are slow-growing), testicular cancer, skin cancer, breast cancer, uterine cancer, Hodgkin’s lymphoma, and kidney and renal pelvis cancer.
What is cancer you may ask? Medical Director, Hoarse Memorial Methodist Hospital, Yaba, Lagos, Chairman, Christian Health Association of Nigeria (CHAN), Lagos State Chapter, Dr Abayomi Ogunbekun, answered: “Cancer is a disease that can affect any part of the body from the head to the toe. The cause of cancer generally is unknown.”
Ogunmekun also explained: “There are some risk factors which can lead to one having cancer in some parts of the body. We call them predisposing factors. If one is taking too much of alcohol, too much of drugs or chemicals, they can damage the liver. This may cause what we call liver cirrhosis which may lead to liver cancer. This may affect the kidney also.
“If one is smoking, that may lead to cancer of the lungs. Or if one is involved in a profession where one would inhale lead or tar dust entering into their lungs, one would be predisposed to cancer. If one has repeated infections that affect the urinary system, that also may lead to cancer of the bladder and the prostate too might be affected.
“In some instances, as we age, some cells might begin to metamorphose, begin to perforate and become abnormal. That is a natural factor which might cause cancer. If one is bleaching the skin, the natural colour will be eroded. That might lead to cancer. The factors earlier mentioned compel one to develop cancer earlier than necessary.
“Now, one thing that should be noted about cancer is it forces the cells to grow rapidly in an abnormal and deformed manner. At that point, it will start giving symptoms. If it is cancer of the skin, the skin starts changing colour. The skin becomes abnormal; it will no longer be like normal skin.
“We can also have cervical, uterus cancer and ovarian cancer. This can occur in some instances when one is promiscuous or having multiple sex partners or having prolonged infections like sexually transmitted diseases. Also, repeated fungal infection can also affect the cells and cause them to start changing. If one is an albino and is exposed to the rays of the sun most of the time, they are likely to develop skin cancer with time.”
Also explaining how cancer diseases arise, General/Breast Cancer Surgeon at the University of Uyo Teaching Hospital (UUTH), Uyo, Akwa Ibom State, Dr Isaac Udoh said: “Cancers in general arise from a cell whose growth becomes uncontrolled, and it develops its own autonomy and grows at the expense of the organism (human).”
An albino’s cancer tale
Take the case of Tony (not his real name) who is an albino. He suffers visual impairment and high vulnerability to skin damage from ultraviolet rays which results in skin cancer.
Sunday Sun learnt that Tony’s skin cancer ordeal began when he was a teenager. At that time, he did not know that activities that exposed him to sunlight were going to have adverse effects on his skin later in life.
He recounted how his undue exposure to sunlight usually left his skin reddish resulting in skin burn.
He said: “In 2003, I once noticed a slight wound on the right side of my scalp that till now has refused to heal.
“Then, I visited a hospital in Surulere and told the doctor about the challenge alongside other ailments, but he only treated me for malaria and assured me that the wound would heal with time.
“After a long time, the wound refused to heal. So, one day, I decided to visit a dermatology hospital in Yaba. From there, I was referred to Lagos University Teaching Hospital (LUTH), Idi-Araba.
“The skin burn normally lasted for some days before my skin would repair itself.
“I have undergone multiple excisional biopsy Mohs Surgery and Skin Grafting procedures battling with a severe case of what doctors call squamous cell carcinoma, a type of skin cancer.
“My last pathology results showed I required corrective surgery to improve my condition.
“I had my first skin grafting surgery in 2008. I also had a second surgery in 2017 following an accidental cut on the same spot leading to an infection. Since May 9, 2018, I have been living with bandages on my head. This is changed at least two times a week. With each passing day, my health continues to deteriorate.
“I need corrective surgery on my head which has been bleeding since 2018, and also on my lips which is a very sensitive position I must say.”
Tony goes through excruciating pain in his head and lips. He usually fights off his struggles and prefers to replace them with a cheer.
“This is the most painful and difficult period in my life,” he said.
Tony’s case now compelled him to live indoors – just to reduce the impact of the sun on his skin.
At the moment, he said: “I have been visiting the National Cancer Centre at LUTH. They are the ones managing me for now. Before now, I was taking chemotherapy. But I have stopped that. I’m on anti-biotics and pain reliever right now until I go for a scheduled surgery.”
Reasons for rising cases of cancer
A germane question is: what can be attributed to the rising incidence of cancer? What could be the reason, why are we seeing more cases of cancer now?
Anambra State indigene and Consultant General Surgeon and Surgical Oncologist at the Federal Medical Centre, Umuahia, Abia State, Dr Theophilus Chukwuemeka Eze Onwumelu, who is also a senior lecturer at Gregory University Medical School and Rhema University Teaching Hospital, Aba, gives this simple answer: “Nobody knows. Nobody can categorically say this or that is the cause of this or that cancer. For that reason too, nobody can say this is the cause of the rising incidence of cancer in Nigeria. Globally, cancer incidence is rising. Yes, there is an increase in cancer cases. What you notice in Nigeria is that there is a rising incidence of breast cancer and prostate cancer. Again, there is a downward slide in the age of people presenting with cancer cases. Generally, it used to be believed to be a disease of the old, especially breast cancer seen in people in the age bracket 60, 70 or 80. But these days, a lot of the cancer cases in pre-menopausal women are within the 25-35 age bracket. Currently, I have a 25-year-old patient with advanced cancer of the breast.”
However, Onwumelu who also an adjunct consultant general surgeon and surgical oncologist at Abia State University Teaching Hospital, Aba and an adjunct senior lecturer at Abia State University, posited that the changing lifestyle as well as changes in dietary patterns have seen Nigerians eat more Western foods like noodles, junk or fast foods which are essentially based on over-processed wheat flour.
Moreover, a lot of people are not engaging in physical exercise such as jogging, cycling, among others, he said, adding that there is increased use of hormonal contraceptives among women, which have been implicated in the rising incidence of cancer.
“Some women present early stages of cancer even though the risk factors do not apply to them.
Similarly, another contributory factor is that patients present late at the hospitals. Late presentation is a major problem in Nigeria. Overseas there are a lot of screening programmes and diagnostic facilities that allow doctors to pick up the earliest signs of the disease. Their economy is good and the health delivery system is optimally equipped,” he noted, saying that “I recently returned from Saudi Arabia. There, you find that people just walk in and request a mammography or MRI. These tests are free. And so a lot of people come early and the various cancers are detected early and treated early. That is the first level of prevention so that they do not grow to an advanced stage.
“Unfortunately, in Nigeria, we do not have screening facilities. That is why we catch cancer diseases at the late advanced stage. Another major problem is this: how many men walk into a hospital and request for a PSA (prostate-specific antigen) test to be done? When a regular PSA test is done, cancer of the prostate can be detected early. When this is done, it can be treated and prevented from manifesting fully.
“A lot of women, when they detect a lump in the breast, would rather go to the miracle healing centres instead of going to the hospital. By the time they eventually come to the hospital, the cancer is advanced.
“Usually, when a woman has pain in her breast because of a lump, she will go to see a doctor and say that she has breast pain. But most breast cancers do not cause pain and that is another reason most women do not present to the doctor early.
“A woman should do breast self-examination at least once every two weeks when she is taking her bath, especially one week after the menstrual cycle. By palpating her breast regularly, she will be able to notice if a lump has formed in the breast mass and then go to see a doctor
“Then again, and unfortunately too, many men do not even check their wives’ breasts. When you examine a woman’s breast find a lump in it and ask the woman whether her husband ever touches her breast, you will be shocked by the answers they give.”
Speaking in the same vein, Consultant Obstetric Surgeon Laparoscopic Surgeon and Medical Director of Dayspring Hospital Group, Dr Sam Adebayo, noted that there is low awareness of cancer early symptoms which also cause late diagnosis.
“Early diagnosis is hampered by the fact Nigerians do not exhibit good health-seeking practices and, therefore, do not go to see doctors in time. As a result, many cancer cases are diagnosed at advanced stages, when the chances of survival and cure are extremely low.
“Again, there is an inadequacy of facilities, equipment, and personnel for cancer diagnosis and treatment. There are only a few functional radiotherapy machines and chemotherapy drugs are very expensive. Also, many cancer patients have to travel long distances, pay high costs, or face long waiting times to access care. All these factors tend to drive the victims in the middle-to-lower income groups to the healing centres in the hope of a cure.”
Systemic challenges doctors face
Increasingly, the systemic challenges in the Nigeria public healthcare system, whereby doctors are not well demonstrated and there is a severe lack of equipment, as well as a bad economy, these factors have combined to make cancer treatment and management very difficult and surviving it even more so a dearth of doctors caused by the Japa syndrome further worsens the already parlous situation, particularly considering the availability of specialist cancer doctor.
Onwemelu explained: “Oncology is a very specialised speciality. The training is cost-intensive. You have to attend regular conferences and refresher courses and subscribe to journals. So, most doctors with lean pockets do not just go into oncology. That is why we have a very small number of oncology specialists. The Japa syndrome has also made the bad situation worse.
“Again, cancer drugs are extremely expensive and most patients cannot afford them. And the drugs are not covered under the National Health Insurance Scheme. Even many people are not covered under health insurance. And they cannot afford the high cost of radiotherapy. For instance, completing one session of radiotherapy with a linear acceleration machine can cost up to N1 million.
“So, you see patients that struggle to do chemotherapy and are not able to do radiotherapy cycles. Chemotherapy is very costly. The price of drugs is huge.”
What can be done
Today, a lot of big banks and large corporate bodies spend huge sums of money budgeted for Corporate Social Responsibility (CSR) or Corporate Social Investment as some of them prefer to call it. For instance, MTN Nigeria has specially-built mobile diagnostic laboratories on wheels which provide PSA tests, and mammography scanning of women, and have 3D and 4D Ultrasound machines which are used to conduct medical outreach and health education programmes, to enlighten people as a first step preventive measure.
But Onwumelu strongly argued that a much better, more impactful and beneficial way to confront and stem the tide of the ravaging tide of cancer in the country is for the government to go into properly organised public-private partnerships driven by special tax waivers that would enable groups of suitable large corporates to sponsor
three radiotherapy centres in each of the six geopolitical zones in the country and equip them with linear accelerator radiotherapy machines. The centres would offer radiotherapy services that will be relatively free or affordable.
The reason he painfully revealed was that the country has severe deficiencies in the area of radiotherapy.
“Currently, it is only the University of Nigeria Teaching Hospital, UNTH, Enugu, that has one linear accelerator radiotherapy machine.
“The demand on it for radiotherapy is huge. Every state in the country should have at least one radiotherapy centre,” he said.
Incidentally, Onwumelu had a brief stint in Saudi Arabia before returning to Nigeria, to contribute to the health sector.
Asked what informed his decision, he said: “Patriotism. I have a lot of cancer survivors who kept on calling me and crying. I found out that I was not happy even though I was making money in Saudi Arabia. So, I listened to my patients and returned, to help my people.”
Advice on ways to prevent cancer
Just like the other cancers, colorectal cancer is also ticking up. In this regard, people have to adopt lifestyle modifications to help the person avoid colorectal cancer. This is very important as this cancer used to be associated with men who are 50 years and above.
Rather, the age of manifestation has reduced as the oncologist explained: “Incidentally, we are finding colorectal cancer in a lot of young men. Right now, I have a 36-year-old man who came with complete intestinal obstruction. When we went into the theatre we found out it was an advanced case of colorectal cancer.
“I urge everyone to adopt lifestyle modifications; you should watch what you eat. Eat less flour-based stuff like shawarma, biscuits, etc. Eat less carbohydrates and more vegetables and natural foods, which have fibre.”
