WHAT’S your view on wrong cancer diagnosis?
We have a cancer problem and we know that there are many factors responsiblr for it. It is one of the multi-sectoral response we apply to the cancer problem in Nigeria. One of them is that in our population. There is low level of awareness. People do not know much about cancer. When you talk among market people, teachers, etc, people do not know what cancer is and what causes it. They do not know what they should do about it even if they know they have it and what the usual result of the treatment is. So, we are doing now is to help somebody who has cancer to get better before whatever will happen happens. This way, we can respond to it through public awareness initiatives, and campaigns in the newspapers, but there is another problem.That problem is even among health care professionals, there is low of level awareness. Among doctors and nurses, there is not enough knowledge about cancer. In my clinical experience in teaching patients in Nigeria, there are many instanceswhere someone who has cancer goes to see a doctor and the doctor mis- diagnose. This delays the time the person gets correct diagnosis. The cancer would have become advanced at that time and the result of treatment will not be good. So, we decided that we can intervene at that level through health care professional awareness, to provide continuing education for health care professionals who are interested in cancer care and to give them the opportunity to meet each other. For instance, if you are treating breast cancer in Ibadan, you are the one treating in Sokoto and in Owerri, everybody knows each other and by this networking, they can improve the communication between them. If a patient comes to you from Sokoto and you have treated the patient and he is to go back to Sokoto, you tell him, do not worry, when you get to Sokoto, go to this person. He is also a specialist in this area.
Lastly, the conference we had was to promote research. So, the meeting is for professional development, capacity building and networking. Although, there are roles in improving cancer care for advocacy group and lay people who gather themselves together to organise walks, raffle draws that bring the cancer problem to the population. The role of SOCRON is to find excellent teachers internationally and in the country to teach people the latest information in specific areas and the people meet themselves, discuss their challenges and learn how to overcome them
Who are the Oncologists and what is their figure in Nigeria today?
The figure is so bad that you will be ashamed if I mention it. Let us focus on solution.
During the conference, we did a special training for nurse oncologists because throughout Nigeria, may be there are four or five people who can call themselves nurse oncologists. (Oncologists are physician who specialise in the diagnosis and treatment of cancer). We know that nurses have a major role to play in providing care for cancer patients. Also, we had a training programme in palliative care because specialists in palliative care also have a role to play. We also had a training for doctors where we taught them how to improve their ability to diagnose cancers.
In Nigeria today, majority of cancer patients are treated by non specialists. So, the result is usually a bit of a problem. So, we have focused on identifying who these people are. Let them come forward and identify their interest to treat cancer patients. We are working to create curriculums for training the specialists. It is expensive to train an oncologist. If a person trains abroad, the likelihood of coming back to practice to Nigeria is very low because they make so much money abroad. We cannot expect that international person will come back home and stay.
What are the main causative factors of cancer in Nigeria ?
We call the things that cause cancer risk factors because each individual cancer has multiple causes. Cancers have multiple causes. Unlike malaria, where you are bitten by a mosquito, it transmits plasmodium into your blood and you have malaria.Same cannot be said of most cancers, except a few. That is why we usually talk about risk factors.
So, if you look at the risk factors for cancer, number one is the fact that people are living longer. They are not dying of typhoid or malaria, snake bite, trauma on the farm, tetanus, and other diseases, as they used to 200 years ago. They now live to be 50, 60 years and more. When we talk about longer life being a risk factor, some people will say, oh!, but my uncle lived to be 80 years. Of course, there will always be an exception to the rule, but the general experience of the population is what we refer to because just as you have an uncle who lived to be 80 years, your grand mother may have had like 10 pregnancies delivered successfully and only two survived. Those are the reality that people are dealing with. So, in a developing country like Nigeria, that is number one reason why you now see more cases of cancer. Second reason is changing lifestyle characteristics. We are all getting obese. We do not engage in much physical activity as we should. We eat more calories. Increasingly, it looks as if it is just a matter of people eating too much. A long time ago, we were worried whether the too much eating was as a result of eating too much rice, but if you look at recent United States (U.S.) Government Dietary Guidelines, the central focus is eat in moderation.
However, as people move out of poverty and get more money, the tendency is to increase calorie intake, particularly animal protein – they eat more meat and take more dairy product. So, the other lifestyle that is changing is reproductive, particularly when you are talking about breast cancer. Our great grand mothers would start their period between 18 to 19 years. Nowadays, children start their period at 10, 11 and some even at nine years. There are several reasons why that is so, but once people start having menstrual period, they will start having children and it is almost a continuous exercise until they can no longer have children because there were no such thing as birth control or spacing their children because you want to go to school. The only thing you do is wake up, go and look for food and come back to sleep. People therefore used to have in their live time 12 to 15 pregnancies. Some of the pregnancies get to full time and are born and when they are born, the children are breast fed because that is what people knew. So, they were breast fed for two year or three years until the next baby comes along and ready to take the breast. So, it is a perpetual pregnancy-lactation cycle. And that appears to be what the body is designed for, which is evolutionary. But changing modern lifestyle, including fewer pregnancies, late onset of pregnancy, none pregnancy, lack of breast-feeding, are driving breast cancer incidence.
What about cervical cancer?
Sexual networking is a very important risk factor for cervical cancer. In a low resource environment like Nigeria, you have a lot of cervival cancer, a lot of hepatitis and a number of gastric cancer. All these are cancers that are commonly linked to infections. Cervical cancer is linked to human papilloma virus (HPV). While liver cancer is linked to hepatitis B, gastric cancer is linked to helicobacter pylory infection. Helicobacter pylori (H. pylori) is the bacteria responsible for most ulcers and many cases of stomach inflammation (chronic gastritis).
What are the possible measures to prevent cancer?
Cigarette and other tobacco are the only legally available products that if used according to the prescription of their producers, will certainly kill, so one of the most important preventive measure is to stop smoking. Then, we have to look at lifestyle issue: Avoid obesity by all means, try to keep a healthy weight and it is good to eat good diet.
The advice is that when you put your food in front of you, it should be a multi-coloured rainbow a little bit of green, a little bit of white, a little bit of brown and a little bit of yellow. The white may be rice. The brown may be meat and green may be salad, as well as pepper. Another advice is do not eat what your grandmother will not recognize. That is to say be careful of a lot of over processed food items.
That is not to say that you should not have the occasional candy, but eat it all in moderation. Also, get to engage in a lot of physical activities. People should get at least 30 minutes of physical activity everyday and 30 minutes is not a lot. A very simple strategy to get physical activity is to park your car somewhere that will enable you walk 30 minutes to your office. In Nigeria, we do not have a culture of recreational activity. For instance, if getting home from work, you tell your husband that you are going to the gym, he will ask you: ‘To meet you?’ We do not have the culture of exercise. Even in Boston in America and other western countries, where you see a lot of white people walking out including swimming, walking, jogging, etc, you still do not find a lot Africans doing the same. Our people will need to develop the habit of going to the gym, and engaging in various forms of physical activities. People must prevent infections including HIV/AIDS. Everybody should be immunized against Hepatitis B virus. It will be very helpful in reducing the risk of liver cancer.Another important thing to note is that if you do not drink alcohol, do not start. If you drink, then drink in moderation.