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“Cancer prevention is very important. This is because if caught early, outcomes are usually very good. Cancer of the cervix is a very good example of this. If detected early during screening and treated appropriately, cancer of the cervix can be cured. Nigeria, most of the patients comprising 75% to 80% present late with an advanced and incurable disease. (Afolayan,2008) Increased awareness, early detection, advances in treatment and adequate follow up are factors that can improve survival rates”
*Dr. Popoola Margaret Owoloyi MBBS, MPH
PEGASUS REPORTERS, LAGOS | FEBRUARY 18, 2022
Cindy just came out of the surgeon’s consulting room where she had a clinical breast examination. She is yet to get over the fear that enveloped her two days ago when she discovered a suspicious-looking swelling on her right breast.
She concluded right away that it was cancer and called up almost every family member and friend, in her state of panic, to tell them about her fears. She was in a state of near hysteria and wondered how one as young as she was ( she was 32), as poor as she was (she was an applicant) and unmarried, could have cancer. She was terrified beyond measure and non of the people she called had any reassuring answers for her.
She thought of the radio programme she had listened to, a few weeks ago, to mark the World Cancer Day celebration, and she recalled the guest speaker saying that cancer was no respecter of persons and could affect anyone regardless of background or status. That fuelled her fear further. Then she remembered the same guest saying, we must go to the health facilities for prompt diagnosis and intervention as all efforts are being made to CLOSE THE CARE GAP. It was that statement that galvanised her into seeking help at the hospital and fortunately for her, the clinical breast examination done by the doctor put all her fears to rest as it was found not to be cancer at all.
WHAT IS CANCER?
Cancer is a disease or a malignant growth or tumour caused by an uncontrolled division of abnormal cells in a part of the body. In other words, cancer is a type of disease where cells grow out of control, divide and invade other tissues. Normally, the cells in the body grow and die in a controlled way. Cancer cells keep growing without control.
WHY MUST WE PAY ATTENTION TO CANCER? (EPIDEMIOLOGY)
The risk of developing cancer increases as a person gets older. Cancer presently is a major cause of death globally. According to World Health Organization, in 2008, over 12 million cases occurred with over 7 million deaths while in 2012, over 14 million cases occurred with over 8.4 million deaths. About 56% of all these deaths occurred in the developing world as of 2012.(Ferlay et al, 2008;Globocan 2012). It is projected that by 2030, 70% of the new cases will be in the developing world, therefore the expected death toll from cancer in the developing world will be overwhelming. (Boyle, P. Levin, B. 2008; Globocan 2012).
Nigeria produces about 100,000 new cases of cancer annually. This is associated with a high fatality ratio. The country was responsible for an estimated 15%(681,000) of the new cancer cases seen in Africa in 2008(Sylla and Wild, 2011).
CAUSE
The main cause of cancer is not known however there are a number of factors that may be implicated in its formation and they are referred to as risk factors. They are as follows:
1. Aging
2. Tobacco
3. Sun and Ultra Violet(UV) Exposure
4. Radiation exposure
5. Chemicals and other substances
6. Some Viruses and Bacteria
7. Certain hormones
8. Family history of cancer. Some cancers run in certain families.
9. Alcohol
10. Poor diet
11. Lack of physical activity or being overweight. Being overweight or obese after menopause increases breast cancer risk. Before menopause, the ovaries produce most of the estrogen, and fat tissue produces just a small amount of estrogen. After menopause (when the ovaries stop making estrogen), most of a woman’s estrogen comes from fat tissue.
12. Refined Sugar is also implicated by some studies.
TYPES
There are over 200 types of cancer however many of them are rare and may not pose much threat. Those that pose a lot of threats are those commonly diagnosed.
The top 5 most-diagnosed cancers in men are LUNG, PROSTATE, COLORECTAL, STOMACH and LIVER Cancers.
The top 5 most-diagnosed cancers in women are BREAST, COLORECTAL, LUNG, CERVIX and STOMACH Cancers.
The commonest cancers in Nigeria are Breast, Cervix, Prostate, Colorectal, Liver and Non-Hodgkins’s Lymphoma (Abdulkareem 2010). In Northern Nigeria however, there is a reversal in the pattern with Cervical cancers found to be commoner than Breast cancer (Adewuyi SA 2016). It is important to also know that there are childhood cancers that occur in children, for example, Retinoblastomas, soft tissue sarcomas like Rhabdomyosarcoma and Nephroblastoma (Wilm’sTumour). Other types of cancers may be bone tumours (Osteosarcoma) and blood cancers (Leukaemia).
SYMPTOMS AND SIGNS
Signs and symptoms are both signals that something is not right in the body. A sign is a signal that can be seen by someone else – maybe a loved one, a doctor, nurse or other health care professionals. A symptom is a signal that is felt or noticed by the person who has it but may not be easily seen by anyone else. Some General Signs and Symptoms of Cancer
• Unexplained Weight loss
• Fever
• Fatigue
• Pain
• Skin changes
Signs and Symptoms of Certain Cancers
• Thickening or Lump in the Breast or Other parts of the body
• Unusual bleeding or discharge from the vagina, in the stool or even coughing up blood.
• Indigestion or trouble swallowing
• Recent change in a wart or mole or any new skin change.
• Nagging cough or hoarseness
• White patches inside the mouth or white spots on the tongue
• Sores that do not heal
• Changes in bowel habits or bladder function
DIAGNOSIS
To make a diagnosis, the doctor will take a detailed history(that is asking questions to be able to know how the disease started and how it has progressed) examine the patient and carry out some investigations. However, to be able to treat the patient properly, a biopsy ( i.e a small part of the growth) has to be taken and the biopsied tissue subjected to histology.
It is the histology report that gives the definitive diagnosis. It helps the doctor to know for sure that the tumour in question is either benign (harmless growth) or malignant (harmful growth/cancer).
TREATMENT
A multi-disciplinary approach is best for the treatment of cancer. This may include surgery, chemotherapy, Radiotherapy, Hormonal therapy, Targeted therapies, physiotherapy where applicable, Psychotherapy, Pain management and Palliative care.
TREATMENT CENTERS IN NIGERIA
These are the centres that have radiotherapy machines in the country. Some have the Cobalt 60 machine, others have the Linear Accelerator Machine.
South-West: LUTH, Lagos; UCH, Ibadan; Eko Hospital, Lagos.
North-Central: National Hospital, Abuja.
North-West: ABUTH-Shika, Zaria; Usman Danfodio Uni. TH, Sokoto
South-East: UNTH, Enugu; UBTH, Benin.
PREVENTION
Cancer prevention is very important. This is because if caught early, outcomes are usually very good. Cancer of the cervix is a very good example of this. If detected early during screening and treated appropriately, cancer of the cervix can be cured. Nigeria, most of the patients comprising 75% to 80% present late with an advanced and incurable disease. (Afolayan,2008) Increased awareness, early detection, advances in treatment and adequate follow up are factors that can improve survival rates. In Nigeria, most of the patients comprising 75% to 80% present late with an advanced and incurable disease. (Afolayan,2008) Increased awareness, early detection, advances in treatment and adequate follow up are factors that can improve survival rates.
It is estimated that 1/3 of cancers can be prevented while another 1/3 can be effectively treated with early diagnosis. The remaining 1/3 will require improvement of quality of life with palliative care (WHO 2006). Screening tests are used to find cancer before a person has any symptoms. A number of screening methods have been recommended for some cancers; the commoner ones are:
Breast Cancer Screening Methods
1. Breast Self-Examination(BSE)
2. Clinical Breast Examination
3. Mammography
BREAST SELF EXAMINATION (BSE)
Of the three screening methods above, both Clinical Breast Examination and Mammography will require a visit to the hospital, expertise and specialized equipment. Breast Self-Examination however is inexpensive as it is done by the woman herself. It is best to perform it once every month after menstruation.
It confers two advantages on the woman.
1. Regular BSE helps the woman to become familiar with the normal contour, shape and size of her breasts.
2. It helps the woman to know, immediately there is a change from the normal. For instance, a woman that is used to her normal breast will immediately pick out a lump once it occurs or immediately notices a dimpling or nipple discharge etc.
In spite of the advantages of BSE, only a few women actually practice it regularly. In a recent study in Zaria, Nigeria, it was found that while 55.7% of the study population perform BSE, only 12.4% of them perform it monthly (Popoola and Popoola, 2016).
Fig 6: Direction of finger movement.
Mammography
Fig 7: Mammography
This screening test is not meant for younger women however over the years it has been noticed in our clime that breast cancer has been diagnosed even in women of younger age group, therefore;
• Women ages 40 to 44 should have the choice to start annual breast cancer screening with mammograms (x-rays of the breast) if they wish to do so.
• Women aged 45 to 54 should get mammograms every year.
• Women 55 and older should switch to mammograms every 2 years or can continue yearly screening.
• Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer.
• Note that for a younger woman a breast Ultra Sound Scan may be a more useful test and will usually be requested by the doctor.
• Some women – because of their family history, a genetic tendency, or certain other factors – should be screened with MRIs along with mammograms. (The number of women who fall into this category is very small.)
Cervical Cancer Screening
Cervical cancer testing should start at age 21. Sexually active young women below that age may be tested too. The recommended cervical screening methods are:
1. Pap (Papaoniculaou) Smear
2. HPV(Human Papilloma Virus) DNA test
• Women between the ages of 21 and 29 should have a pap test done every 3years. HPV testing should not be used in this age group unless needed after an abnormal Pap test result.
• Women between the ages of 30 and 65 should have a Pap test plus an HPV test (called ‘co-testing’) done every 5 years. This is the preferred approach, but it’s ok to have a Pap test alone every 3 years.
• Women over age 65 who have had regular cervical cancer testing in the past 10 years with normal results should not be tested for cervical cancer. Once testing is stopped it should not be started again. Women with a history of a serious cervical pre-cancer should continue to be tested for at least 20years after that diagnosis, even if testing goes past age 65.
• A woman who has had her uterus removed (a total hysterectomy) for reasons not related to cervical cancer and who has no history of cervical cancer or serious pre-cancer should not be tested.
• All women who have been vaccinated against HPV should still follow the screening recommendations for their age groups.
Prostate Cancer Screening in Men
1. PSA
Starting at age 50, men should consider having a PSA blood test. An African American/Nigerian or a man whose father or brother has had cancer of the prostate before age 65 should start considering having a PSA blood test from age 45.
If the decision to get tested is taken, then a PSA blood test with or without a rectal exam is done. How often a person is tested depends on the person’s PSA level.
Colon & Rectal Cancer and Polyps
Starting at age 50, both men and women should follow one of the testing plans available for this condition and get themselves screened.
CONCLUSION
The fight against cancer is a collective one. We must all create the much-needed awareness but most importantly, as an individual, determine to take control of your health, and help reduce your cancer risk. To do that effectively, do the following:
• Stay away from all forms of tobacco.
• Get to and stay at a healthy weight.
• Get moving with regular physical activity.
• Eat healthy with plenty of fruits and vegetables
• Limit how much alcohol you drink (if you drink at all)
• Protect your Skin
• Know yourself, your family history, and your risks.
• Get regular checkups and cancer screening tests.
REFERENCES
Adewuyi SA (2016) Clinical and Radiation Oncology Services in Nigeria: That there be quality life after Cancer Treatment. Inaugural Lecture Series No.3/16: 6 – 10
Afolayan EAO (2008) Cancer in North-Western region of Nigeria – an updated analysis of Zaria cancer registry data. Western Nig. Jour. Of Med. Sci. 1: 37 – 43.
Boyle P, Levin B (2008). International Agency for Research on Cancer. World Cancer Report; Lyon, France. 2008; 2008.
Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008; GLOBOCAN 2008. Int. J Cancer. 2010; 127: 2893 – 2917.
Globocan. Cancer Facts. 2012.
Popoola MO, Popoola OB (2016) Awareness of Breast Cancer and Breast Self-Examination
Practice Among Female Students of a Tertiary Institution in Zaria, Nigeria. Book of Abstracts, 2nd Cancer Summit, Abuja. CCS/2016/009:13.
Sylla DS, Wild CP. A million Africans a year dying from cancer by 2030: What can cancer research and control offer to the continent? Int. J.Cancer. 2011.
WHO. (2006a). Cancer. Factsheet No 297.
Dr. Popoola Margaret Owoloyi MBBS, MPH also known as Dr. Meg, is an Orthopedic Surgeon in training at the Ahmadu Bello University Teaching Hospital, Zaria. She’s a Reverse Medical Tourism advocate and a champion of the call for a better health system for Nigeria and Nigerians. She is the ED, C-HELP Nigeria, Coordinator, Irawo Book club and the Chief Navigator at WOW Consult, a Patient Navigation outfit that seeks to connect patients to the appropriate health facility for their medical condition locally, thereby encouraging Reversal of Medical Tourism. She is the author of the financial bestseller NAIRA BOSS and the amazing medical text, EVERY PREGNANT WOMAN ( with Hausa translation) amongst others.
Dr. Popoola Margaret is the Convener of the C-HELP’s HEALTH SUMMIT and ANNUAL CANCER AWARENESS ROAD WALK. She is also the Convener of the HEROES of HEALTH AWARDS. JMBSR – a medical and basic science journal, is also floated by her organisation, C-HELP. For more information, questions about cancer or other health concerns, you may reach the author Dr. Popoola Margaret Owoloyi via Email: chelpngo@gmail.com or 08067698538 (WhatsApp Only)
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