THE  inspiration for writing this article comes from a recent report indicating that the Federal Government has set aside the sum of $90 million to purchase high level radiotherapy equipment to fight the rising cases of cancer deaths in the country.

To some, this may be extremely heart-warming, but it is my candid opinion that this will not reduce the number of cancer deaths in the country.  If appropriately implemented, this policy may prolong the lives of some cancer patients, but at an aggregate level, it will not reduce the number of cancer deaths, overall.

Firstly, advanced radiotherapy and other forms of sophisticated treatments are only needed for late stage cases of cancer.  Cancer comes in various forms – early stage or late stage.  It is the late stage form of the disease that kills, when cancer cells have disseminated to remote and hard to reach parts of the body.  Any treatment given at that stage is only palliative and cannot cure the disease.

If radiotherapy was so effective in treating late stage cancers, some of our most prominent citizens who recently died from various forms of the disease, who evidently received such sophisticated treatments overseas, would still have been alive today.

The key strategy that has been effective in preventing cancer deaths all over the world is one based on early detection of cancers, so that simple treatments that can result in 100 per cent cure rate can be applied.  Using this approach, significant progress has been made in many parts of the world in reducing death rates from cancers such as breast, cervical, colon and prostate cancers.

Secondly, experience has shown that when sophisticated medical equipment are purchased in Nigeria, there is often failure to build the human capacity to use the equipment resourcefully and effectively.  Many such interventions have failed in the past because equipment are simply purchased and dumped on ill-prepared medical personnel who lack the skill and experience to use or maintain the equipment.

So, within a short period of time, we are often told that the equipment have broken down or that the results we are getting are not commiserate with the efforts we have put in place.

For example, a lot of money was spent not too long ago to purchase high-level radiotherapy equipment at the National Hospital, Abuja, but what we hear repeatedly from colleagues and patients alike is that there are challenges in using and maintaining them. Thus, unless this recent announcement by government comes with a comprehensive package that includes staff training and re-training, equipment maintenance and health systems strengthening that will ensure its sustainability, it is unlikely to meet the outcomes that are being envisaged.

Thirdly, and most importantly, I worry that in announcing the plan to purchase high level equipment for cancer treatment, government has not provided a comprehensive plan for the prevention of cancers.  It would appear that this equipment purchase is the sole plan, which would likely shift attention from the more compelling need to seek ways to prevent cancers.  Many cancers can be prevented, or at least can be recognised in their early stages and treated effectively, and government need to consider a comprehensive plan that encompasses prevention, early diagnosis and treatment, rather than that based on treatment alone.

In sum, I am not opposed to purchasing these equipment, as indeed, it would likely boost local training of medical staff in the use of sophisticated techniques in the management of cancers.  I also concede that radiotherapy may be essential in the management of early stage or intermediate stage cancer.  However, I strongly feel that we must step back a little and do a more comprehensive re-thinking of the strategy if our ultimate goal is to reduce deaths from cancers in the country.  Some people have posited that the incidence of cancers is increasing in the country just because many more people are being reported as dying from the disease.  I do not believe this is necessarily the case.  By contrast, more people are dying from the disease because many do not recognise that they had cancers until very late, when treatment becomes rather difficult and ineffective.  The deaths speak volumes of the lack of a comprehensive and purposeful cancer awareness programme in Nigeria. Most cancers do not have symptoms similar to those of malaria or other illnesses, and unless you look for them specifically you will not find them until very late. Indeed, when patients begin to come down with symptoms of cancer, the disease most probably is in its late form.

The results of several publications by medical scientists in Nigeria indicate that up to 90 percent of patients seeking cancer treatment come in late stages (stages 3 and 4), when treatment is hopelessly ineffective.  In more developed parts of the world, nearly two in three patients present early for cancer treatment, and this is because such countries have comprehensive policies and action plans on cancer prevention and treatment. To date, it is extremely worrisome that our country does not have a comprehensive cancer policy that seeks to explain the disease to citizens and that promotes routine medical examination, early diagnosis and treatment of cancers.

The armamentarium to treat most cancers in their early forms already exists in this country.  The challenge is how to bring patients to seek treatment when cancer is still in its early stage.

Indeed, the rising cases of cancer deaths in Nigeria is becoming a national embarrassment, It is my considered opinion that the government needs to develop a comprehensive policy on cancer prevention and treatment, and set up an emergency task force to implement the related plan of action.  Such a policy must be hinged on the tripod of the prevention of cancers, early recognition of the disease and prompt treatment.  We must go back to the days of Professor Olikoye Ransome-Kuti when he emphasized the importance of preventative health care.  I dare say, our failure to heed his advice has continued to plague our health care system and is the major reason for the continued under-performance of this country in key health indicators.

In conclusion, the central point being made in this article is that a policy anchored on primary and secondary prevention is more likely to significantly reduce the number of cancer deaths in this country, rather than that based on procurement of sophisticated medical equipments.

Indeed, my assessment of the possible benefits of the three types of prevention strategies suggest that primary prevention would yield up to 20 per cent effectiveness, secondary prevention up to 75 percent, and tertiary prevention (based on sophisticated medical care) only 5 percent.

In the best world where resources are infinitely available, the best policy would be to focus on the three types of prevention simultaneously, but in our country where resources are limited, my advice is that we should concentrate resources in implementing the secondary prevention of cancers. We need to emulate a country such as Canada whose cancer policy is simply: “look for cancer cells early and treat early”.

The entire health care policy of Sweden is a simple 8-page document, all anchored on prevention.  Nigeria must use the opportunity of the rising cases of cancer deaths to re-focus its national health policy on prevention and primary health care.

Mr. FRIDAY OKONOFUA, a professor of Obstetrics & Gynaecology, wrote from the University of Benin, Edo State.