Even though she is in the throes of a life-altering experience, Yetunde Agboola has refused to be defined by her predicament. A dedicated banker, the mother of two worked her way to a comfortable position in her organisation. But all that achievement has been replaced with pain and agony.
Now a ghost of her former self, Yetunde has faded physically as cancer of the breast continues to ravage her body. Now out of job due to months spent in and out of the hospital, she lives on the benevolence of people as her savings have been depleted through paying for mastectomy (surgical removal of the breast, usually as a treatment for breast cancer) as well as other treatments.
Today, that woman with steely disposition lives in fear of losing the fight against cancer and leaving her children without a mother.
Like her, several Nigerians are being ravaged by this deadly scourge. While many have died, many others are still battling with it, desperately holding on to life.
The enormity of cancer was recently brought to the fore during the 2019 commemoration of World Cancer Day. According to the World Health Organisation (WHO), more new cases of cancer and cancer-related deaths were recorded in 2018. The WHO Emergency Team head, Dr. Clement Peter, disclosed that 41,000 people died of cancer last year in Nigeria, just as 116,000 new cases were recorded. He noted that, on the average, 240 Nigerians die daily, or 10 Nigerians every hour, from cancer. Despite the staggering statistics from the global health body, observers believe the figure could become as high as 500,000 new cases annually.
The organisation is scared that, if nothing is done to nip the monster in the bud, the cancer burden in Africa might rise from 1,055,172 new cases in 2018 to 2,123,245 by 2040.
It also forecasts that, by 2020, cancer incidence for Nigerian males and females may rise to 91/100,000 and 101/100,000, respectively. Also, it is anticipated that, by 2019, death ratio from cancer in males and females might rise to 73/100,000 and 76/100,000, respectively.
This distressing statistics was further validated by medical experts who averred that cancer cases would rise in Africa mainly because of continued exposure to cancer-risk factors that include high alcohol and tobacco use, unhealthy habits, wrong diet choices, sedentary lifestyle, environmental pollution and carcinogenic materials, among others.
WHO noted that cancer remains one of the leading causes of death, particularly in developing countries. For many, this fact becomes even more worrisome, especially in Nigeria where cancer is usually detected very late.
According to consultant radiation oncologist with the Lagos University Teaching Hospital (LUTH), Dr. Habeebu Muhammad Yaqub, the Radiation and Oncology Department attend to about 40 new cases of cancer per month. He described cancer as a deadly but silent killer disease, noting that most patients don’t know they have it until it has spread.
“Over 80 per cent of these cancer cases are detected at an advanced stage, when only palliative treatment is possible. This is what actually makes it a silent killer because, at the stage of detection, it would have virtually sunk its fangs into vital body organs. If cancer is detected early, it improves the chances of cure,” he said.
He explained that cancer was an abnormal proliferation of cells in the body, which continues even after the removal of the stimulus. The cells have an ability to invade the surrounding structures and spread to other parts of the body, and can eventually result in the death of the host.
According to medical reports, cancer can easily attack tissues or organs of the body, like the brain, eye, throat, stomach, liver, lungs, colon, prostate, cervix, uterus, ovaries or blood.
Why cancer is on the increase in Nigeria
According to WHO, high poverty rate and lack of medical cover are among factors that may contribute to rising cancer cases in the country. The high cost of treatment and funding cancer treatments is a major setback in Nigeria and Africa in general, especially when it comes to cancer detection, treatment, and management. Even when diagnosed, the paucity of facilities to treat the ailment is a major contributing factor to its high mortality.
According to Dr. Peter, when a positive outcome of cancer is likely, only 26 per cent of low-income countries in the world reported having public sector pathology services, and only 30 per cent of these countries had cancer treatment services. He noted that, depending on the type of cancer, a woman might need between N21.1 million and N29.2 million for the treatment of breast cancer.
Corroborating this, Yaqub said cancer treatment requires huge financing, as equipment for treatment is capital-intensive.
He spoke further: “Some drugs cost up to a million naira and a patient might have to take up to six packs of such. Cheap cancer drugs might cost between N15,000 to N20,000 per month and they are expected to take it for a six month-stretch. This excludes all investigations that must be done before then. An average person undergoing chemotherapy might have to pay between N100,000 and N250,000.”
According to the World Poverty Clock, 86.9 million Nigerians live in extreme poverty and represents nearly 50 per cent of its estimated 180 million population. Similarly, the Special Adviser to the President on Social Protection, Mrs. Maryam Uwais, said 67 per cent of Nigerians live below the poverty line. And this impacts negatively on cancer treatment.
This is also compounded by the fact that the National Health Insurance Scheme (NHIS), which currently covers about seven million Nigerians, does not fund cancer treatment. It only covers cancer screening as well as mastectomies and prostatectomy for breast and prostate cancers.
Daily Sun’s investigation revealed that a mammogram (an X-ray for breast cancer) costs N4,000 to N5,000 in public hospitals in Nigeria. Cancer patients are expected to undergo CT scan or a magnetic resonance imaging to detect organs that have been affected by the ailment. And it costs between N34,000 and N40,000. An MRI, an advanced form of a CT scan, costs about N90,000 for just a part (chest for example). And a patient may be required to do an MRI of three parts (the head, chest and abdomen).
Mastectomy, the removal of a cancerous breast through surgery, costs about N60,000 in the country. A breast cancer patient that requires radiotherapy through a linear accelerator should be prepared to pay about N100,000, while a cervical cancer patient would pay about N50,000 or more. Meanwhile, a breast cancer drug like Adriamycin, costs N5,000 per bottle, while Eprirubicin, meant for breast cancer patients with heart problem, costs about N15,000 per bottle.
More factors responsible for cancer
In Nigeria, a cancer diagnosis is as good as a death sentence. It is a fact that cancer patients undergo hardship in the cycle of the illness, from excruciating pain to loss of some organs or even their lives. Cancer treatment itself is painful, slow, extremely expensive and unreliable, especially in Nigeria.
And for most patients, cancer is a multiple tragedy. Apart from physical pain, they have to contend with social stigma and financial stress that goes with tackling cancer.
Most Nigerians have attributed the rise in cancer to late and wrong diagnosis, which results in complications. Dr. Yaqub, however, disagrees with this. He said most people, after being diagnosed with cancer, resort to denial and at the end of the day, they fall into the hands of quacks that exploit their situation.
“The average Nigerian doesn’t want to be tagged with cancer. Even when diagnosed correctly, they would still go to those who would tell them what they want to hear. In such cases, they push away the person that gave the right diagnosis.
“Also, Nigerians don’t present their cases early. Late presentation leads to no diagnosis. We don’t have personnel and there are quacks out there ready to milk cancer patients. So, they would give their own diagnosis to be able to retain the patient,” he said.
The oncologist also attributed the rise in cancer cases to ignorance and lack of medical check-ups, lamenting that most cancer cases have already advanced by the time they start giving symptoms.
Early menarche (first menstruation) and late menopause, he disclosed, are major factors associated with the rise of breast cancer in women.
He lamented that the age at which females experience their first menstruation is decreasing, as against that of the past when most girls attained puberty around 18 years and almost immediately commenced childbirth.
“Now, most start seeing their menses at about 12 years and start giving birth late. What we have is that the woman matures on time and the female hormone, oestrogen, would have already started circulating before childbirth. This is a prolonged oestrogen bombardment of the breast at early age. This prolongation we know predisposes women to breast cancer. So, this is one factor among many factors. Childbirth and breastfeeding protects against breast cancer.”
Another factor, he said, is change in lifestyles brought about by westernisation. He posited that sedentary lifestyle has so much contributed to the rise in cancer cases, as people have abandoned farming, trekking and exercising to become more interested in white-collar jobs and eating processed food.
Healthcare in a shambles
The death by cancer of a number of prominent Nigerians has helped in drawing people’s attention to the severity of the scourge. Some top Nigerians who lost the fight to cancer include a former minister, Prof. Dora Akunyili, renowned human rights activist and social crusader, Gani Fawehinmi, wife of former military president, Maryam Babangida, music maestro, Sunny Okosuns, ace broadcaster, Yinka Craig and Clara Oshiomole..
Primary health care in Nigeria is expensive and in most cases unavailable. Thus, the country lacks the basic facilities for early detection is key to survival.
Nigeria has less than one radiotherapy machine per one million people compared to one machine to 250,000 people in the developed world.
An equity gap case study on access to radiotherapy in Nigeria conducted by the Directory of Radiotherapy Centres of the International Atomic Energy Agency (IAEA) showed that there are only three functional radiotherapy machines in the country.
Radiotherapy is only available in 21 countries in Africa, a far cry from what is obtainable in developed world. There are about 4 radiotherapy machines per million population in the United Kingdom, and 8.0 machines per million populations in the United States. Nigeria has 1 megavoltage radiotherapy machine per 20 million people. This to a great extent has fuelled medical tourism.
The cancer of the lung, which afflicted Craig and Fawehinmi, became critical because no Nigerian hospital could diagnose it. Both of them were diagnosed of the disease in the United States after complications had already set in.
Support for programmes for the care and treatment of cancer patients is still inadequate, especially from the federal government.
A dearth of trained manpower has equally added to this saddening trend. Treatment of cancer requires a multidisciplinary approach. Experts needed for treatment include surgeons, pathologists, physiotherapists, oncologists, radiation oncologists, therapy radiographers, medical physicists and oncology and palliative care nurses. Over the years, Nigeria has witnessed a mass exodus of these trained medical workers.
Speaking on this, Dr. Yakub said the country is ill prepared to tackle cancer.
He noted that although there are improvements now with the setting up of more cancer centres in the country, the training and facilities needed for treatment are not properly laid down.
“One major factor is lack of trained personnel to manage cancer treatment. To curb cancer, Nigeria needs to train its radiation oncologists and others involved in cancer treatment. We need to improve on training and increase the facilities we have for managing cancer in the country,” he stressed.
In April 2018, the federal government launched the National Cancer Control Plan (2018-2022), a five-year plan that defined strategies and roadmaps for cancer control. The plan stipulates that the country requires N93 billion (380 million dollars) to reduce the burden of cancer within the time frame. Yet, only N180,980,579, was allocated in the 2018 budget for the cancer control programme.
Not long ago, President Muhammadu Buhari unveiled a world-class Advanced Cancer Treatment Centre at the Lagos University Teaching Hospital (LUTH), Idi Araba. He also promised to have same replicated across the country
Despite this, most have described the efforts as insufficient and are calling for Universal Health Coverage and a mandatory health insurance for all, which will enable them access the highest possible quality healthcare service.