By Sola OgundipeÂ & Chioma Obinna
The demise of re-nowned lawyer and frontline human rights activist, Chief Gani FawehinmiÂ to lung cancerÂ over the weekend, once again brings into sharp focus the growing burden of cancer in Nigeria on one hand, and the challenges ofÂ control and management options available on the other.
In Nigeria, essentially, the most common cancers documented are cancers of the uterus and breast for women and cancers of the liver and prostate for men.
However,lung cancer is fast becoming a common malignancy, more so as as cancer was recently listed by the World Health Organization (WHO) as one of the four major health problems confronting mankind in the 21st century.Â Â In the WHO Technical Report No. 804 of 1990, it was reported that over 50 per cent of cancer victims live inÂ poor nations like Nigeria, which have less than 10 per cent of the resources for cancer care and control.
The dilemma faced by cancer patients in this setting is further brought into sharp focus with the realisation that treatment of the disorder in this environment would require just 5 per cent of the life-saving cytotoxic drugs, which the manufacturers prefer to market in the richer nations which account for only 39 per cent of cancer cases.
In recent times, cancer has emerged as a major public health problem in many developing countries, matching its effect in industrialised nations. Already, the WHO notes in the 2008 World Cancer ReportÂ that only the adoption of healthy lifestyles by the populace, andÂ concerted public health action could stem this tide. Except urgent action is taken, cancer rates are set to increaseÂ more alarmingly.
ForÂ Nigeria in particular,Â Â it is expected that by 2020, cancer incidence forÂ the males and females may rise to 90.7/100,000 and 100.9/100,000 respectively.Â It is also anticipated that by 2020, death rates from cancer in Nigerian males and females may reach 72.7/100,000 and 76/100,000 respectively.
The WHO estimates there are 100,000 new cancer cases in Nigeria each year although observers believe the figure could become as high as 500,000 new cases annually by 2010.
So there is no doubt that cancer is a major health problem in Nigeria, unfortunately, the importance of cancer as aÂ has been seriously underplayed. It is disheartening to note that with a population of over 140 million people, there are fewer than 200 practicing oncologists and just a handful of centers exclusively focused on cancer treatment and research.
This apparent neglect and consequent lack of emphasis on the problem on the part of successive Nigerian governments, have resulted in a lack of development of cancer treatment and research facilities and cancer therapists.
Investigations by Good Health Weekly reveal that in terms of cancer diagnosis and treatmentÂ much is to be desired in the country.Â Facilities, equipment and manpower are grossly inadequate in scope and spread.
Cancer is, for the most part, an incurable disease in Nigeria, but less because of the nature of cancer, and more because of the limited resources and lack of education of the population.Â In a nutshell, prospects for improvement in the short term are bleak.
Medical records indicate that cancer registration in the country officially began in 1960 but it was not until 1990 that a National Headquarters of Cancer Registries was established in Ibadan.
Only very few hospitals operate screening programmes for cervical cancer, even then, they are poorly funded, unsystematic, and incomprehensive. The country lacks an established national mammographic screening programme and available mammographic services are hard to come by.
Problems of impeded access to health care, ignorance, poverty and a general lack of coordination of issues of health education complicate matters. There are no definite figures, but the number of active radiotherapy centers across the Federation are few and far between giving a ratio of roughly one machine to overÂ 30 million people, as against the recommendation of one machine to 250,000 persons.
Worse still, the available spectrum of anti-cancer drugs is very limited and such drugs are not readily available. Imaging facilities for staging patients with cancer, such as computerized tomography (CT) and Magnetic Resonance Imaging (MRI), are difficult to come by, and when available the cost of such studies are prohibitive – putting them out of reach of the average citizen.
Another worry is the inability to properly classify the various types of hematological cancers owing to lack of immunophenotypic, immunocytochemical and cytogenetic diagnostic facilities is of great concern to hemato-oncologists practicing in this part of the world.
Even of more concern is fact thatÂ clinical services for cancer are grossly inadequate and poorly distributed. Only a few centers have functioning radiotherapy equipment. Radiologic services are generally available, but access is seriously limited by high cost.
The same argument of high cost applies to chemotherapy. While pathology services are generally available, the scope of services is limited. Molecular diagnostic methods are not widely available and surgery is often performed by surgeons whose primary clinical practice is not oncology, and there is a very limited scope for multidisciplinary cancer care.
Essentially, complex diseases such as cancer are fast emerging as an important health care priority for the future. Ironically, while improvements in public health and increased funding for health care initiatives are leading to a decrease in incidence of communicable diseases, attendant increase in life expectancy is precipitating an increase in the incidence of all cancers, as a higher proportion of the population reaches the complex diseases-bearing age.
Factors likely to change the pattern and prevalence of cancer in Nigeria in the coming decades include greater awareness of cancer and improved access to health care
Admittedly, there is increasing awareness of modern palliative care and pain management in Nigeria. This is particularly useful as patients often present with advanced disease, and physicians have limited access to treatments that offer the prospect of prolonged survival.
However, it is not all gloom. But even with existence several local and international bodies actively promoting cancer control and prevention, the incidence of cancer has continued is bound to escalate.