Deadly death

•Cancer leads the pack

By Doris Obinna

Tomorrow, Friday, February 4, 2022, the global cancer community will commemorate World Cancer Day (WCD) to inspire greater awareness of cancer and action to better prevent, detect and treat the disease.

WCD 2022 marks the first year of a new three-year campaign centred on equity, with the campaign theme “Close the care gap.” This year’s campaign raises awareness about the lack of equity in cancer care.

The executive secretary, GivingTide International, Dr. Abia Nzelu, said that cancer remains a major cause of geographic, racial, social and gender inequality: “According to the World Health Organisation (WHO), cancer ranks as a leading cause of death and an important barrier to increasing life expectancy in every nation.”

Nzelu disclosed that a 2019 study found cancer to be the first or second leading cause of death before the age of 70 years in 112 of 183 countries.

“In 2020, there were about 19.3 million new cases and 10 million cancer deaths worldwide. Sadly, 70 per cent of cancer deaths occur in developing nations like Nigeria, due to lack of access to optimal care. Nigeria is estimated to have 233,911 cancer cases, with 124,815 new cases and 78,899 cancer deaths, yearly,” the doctor said.

Causes

She stated that: “Without bold action, an estimated 28.4 million new global cancer cases would occur by 2040, a 47 per cent rise from 2020. The relative magnitude of the projected increase is highest in low human development index (HDI) nations (95 per cent), including Nigeria. This projected increase in cancer incidence will be paralleled by increases in mortality rates, unless resources are placed within health services to appropriately treat and manage the growing cancer cases.”

The GivingTide lead explained that, “Cancer arises from the transformation of normal cells into tumour cells in a multi-stage process that generally progresses from a pre-cancerous lesion to a malignant tumour. These changes are the result of the interaction between a person’s genetic factors and three categories of external agents, including physical carcinogens, such as ultraviolet and ionizing radiation, chemical carcinogens, such as asbestos, components of tobacco smoke, aflatoxin (a food contaminant), and arsenic (a drinking water contaminant), and biological carcinogens, such as infections from certain viruses, bacteria or parasites.

“WHO, through its cancer research agency, the International Agency for Research on Cancer (IARC), maintains a classification of cancer-causing agents. The incidence of cancer rises dramatically with age, most likely due to a build-up of risks for specific cancers that increase with age. The overall risk accumulation is combined with the tendency for cellular repair mechanisms to be less effective as a person grows older.”

Care and treatment

Nzelu hinted that a comprehensive cancer centre (CCC) was the only institution that could optimally tackle all stages and types of cancer. The CCC is not a hospital with a radiotherapy machine. Rather, it is a world-class, stand-alone tertiary health institution, with all its units focused solely on cancer care. The CCC houses first-class cancer research, preventive, curative and palliative care in one place, resulting in better outcomes across a range of measures, including, most importantly, cancer survival.

“Sadly, while India has over 200 CCCs, most of which are philanthropy-funded non-profit/non-governmental institutions, Nigeria has none. Some African nations that have CCCs include Egypt, Uganda, Tanzania, South Africa, Kenya and Sudan.

“Instead, Nigerians now spend over $1 billion on foreign treatment annually, an amount sufficient to establish 20 CCCs every year. Unfortunately, most Nigerians who go abroad for treatment end up dying because of late diagnosis and delay in intervention. Moreover, unforeseen situations (such as the COVID-19 restriction) may make it impossible to go on medical tourism, even if one could afford it.”

“Again, a correct cancer diagnosis is essential for appropriate and effective treatment because every cancer type requires a specific treatment regimen. Treatment usually includes radiotherapy, chemotherapy and/or surgery.  Determining the goals of treatment is an important first step. The primary goal is generally to cure cancer or to considerably prolong life. Improving the patient’s quality of life is also an important goal.

“This can be achieved by support for the patient’s physical, psychosocial and spiritual well-being and palliative care in terminal stages of cancer. Some of the most common cancer types, such as breast cancer, cervical cancer, oral cancer, and colorectal cancer, have high cure rates when detected early and treated according to best practices.

“Some cancer types, such as testicular seminoma and different types of leukaemia and lymphoma in children also have high cure rates, if appropriate treatment is provided, even when cancerous cells are present in other areas of the body.”

Reducing cancer

burden

“Between 30 and 50 per cent of cancers can currently be prevented by avoiding risk factors and implementing existing evidence-based prevention strategies. The cancer burden can also be reduced through early detection of cancer and appropriate treatment and care of patients who develop cancer. Many cancers have a high chance of cure, if diagnosed early and treated appropriately,” said WHO.

Early detection/diagnosis

Director of the United States National Cancer Institute (NCI), Dr. Ned Sharpless, stated: “We can’t leave huge portions of society behind and expect meaningful progress. The bottom line is that we want fewer cancer diagnoses and more survivors.”

According to the American Cancer Society (ACS), efforts to build sustainable infrastructure for cancer prevention and care in developing countries are critical for global cancer control.

“Cancer mortality can be reduced, if cases are detected and treated early. There are two components of early detection: When identified early, cancer is more likely to respond to treatment and can result in a greater probability of survival and less morbidity, as well as less expensive treatment. Significant improvements can be made in the lives of cancer patients by detecting cancer early and avoiding delays in care.”