15 February 2014

Nigeria: More Young People Now At Risk of Cancer - Experts

The tidal wave of cancer is sweeping across the globe. Recent findings suggest that cases will increase worldwide by 75 per cent in the next 20 years. The statistics show that more young people between ages of 30 and 40 years are being infected by the disease every day.

Cancer overtook heart disease as the number one cause of deaths in the world in 2011 and new cancer cases are expected to rise by half by 2030 and will reach 21.6million annually compared to 14million in 2012. This is the UN global analysis of the scourge.

Meanwhile, cancer deaths are expected to rise from 8.2million to 13million per year with the growth in world population, and as more people adopt risky lifestyle habits. This is according to a report compiled by more than 250 scientists from over 40 countries, which the International Agency for Research on Cancer (IARC), released on the eve of the World Cancer Day. It is the first such overview in six years.

The World Health Organisation (WHO) which oversees the IARC said the overall impact from cancer will 'unquestionably hit developing countries the hardest.

There were an estimated 14.1 million cancer cases around the world in 2012, of these 7.4 million cases were in men and 6.7 million in women. This number is expected to increase to 24 million by 2035, says the World Cancer Research Fund.

According to the World Cancer Report, more than 60 per cent of the world's cancer cases and 70 per cent of deaths recorded in 2012 occurred in Africa, Asia and Central and South America.

Dr. Samuel Otene, a consultant oncologist at the Federal Medical Centre, Makurdi, Benue State said the incidence of cancer in the developing world is alarming.

"It has been generally observed that cancer cases are on the increase and those which were said to be rare in Africa are now being commonly seen," Otene told Weekly Trust.

"Journals written about 30 years ago describing cancer as a rare disease in Africa no longer hold because we're dealing with these issues almost on a daily basis," he added.

This raises the question of whether decades ago there were no oncologists and people didn't report the illnesses which therefore made only hospital reported cases the basis for analysis.

"The increase in recorded cases today may be as a result of the availability of more cancer centres and the confidence on the part of individuals to be more open when they are affected," Otene said.

Analysing the situation more as it ravages young Africans, David Makumi, vice chairman of the Kenya Cancer Association and also the Regional Manager of Cancer Program, for all Aga Khan Hospitals in East Africa, told CCTV that the situation in Africa is very grim.

"The disease pattern in terms of seeing younger people with more aggressive and advanced diseases as a result of later diagnosis makes the WHO report not surprising."

He said across Africa, breast and cervical cancers compete for top position. There are others like head and mouth cancers as a result of tobacco chewing.

"We have a lot of problems in many parts of Africa with cancer of the esophagus (food pipe) as well as colorectal cancer. Tobacco and alcohol are the main causes for this. In men there are more prostrate, head and neck cancers as well as liver cancer because of Hepatitis B infection, also cancer of the bladder because of bilharzias," Makumi said.

He however emphasized that children also get cancer which are usually bone, kidney and blood cancers.

In Nigeria, specialists put the affected age bracket at 30 to 40 years.

Mrs. Belinda Philips (not real name) is a 35 year-old Abuja-based mother of two who first felt the lump in her breast for about a week before she realised she was pregnant for her second child. Doctors told her it wasn't malignant and she had no cause for worry.

By the time she gave birth, her left breast was twice the size of the right one and very hard. It had to be cut off. She is now undergoing chemotherapy, praying that the cancer hasn't spread to other parts of her body.

There is also the case of 28 year-old James Adam (not real name) from Jos who was diagnosed with colon cancer after it had advanced to a grade four disease.

But 39 year-old John Benson (not real name) from Lagos died after battling unsuccessfully with colorectal cancer for 10 years.Before his death, he was treated for everything else except cancer until an endoscopy revealed he had cancer and he had shrunken to a mere 35 kilograms. He died last November.

Dr. OlutoyeOgunnorin, a consultant oncologist at the University College Hospital Ibadan, described the prevalence as 'a rising increase.'

"It is a continuous stem among the younger group than before. A reason readily attributed to this is genetic predisposition, where there is a history of cancer in a first degree relative; like a mother, sister, aunt or grandmother," Ogunnorin told Weekly Trust.

Although there is no oncologist at the Aminu Kano Teaching Hospital (AKTH), Dr. Usman Mohammed Bello, a surgeon who has carried out numerous cancer surgeries, acknowledges that: "there are quite a lot of cancer cases amongst the younger generation."

Like his colleagues in other parts of Nigeria, he says, "the men suffer from colonic, stomach and liver cancer; women, breast and cervical cancer. In my area of specialty; colon, stomach and liver, I see a lot of these amongst young people. But also, we often see cancer amongst the younger generation in almost all organs of the body."

Being a teaching hospital located in the North, most of the patients at AKTH are from around the region; Kano, Jigawa, Katsina, Bauchi and other neighbouring states. "These are the states which usually refer patients to us," Bello said.

With junk food, smoking and alcohol being the most culpable items in the cause of cancer, Ogunnorin further explained that the nicotine component of cigarette is a known carcinogen to a mirade of malignancies including bladder and colon cancers.

"It has been established that there is a 90 percent relationship between lung cancer and smoking. For cervical cancer, it may be a case of young girls having more and more multiple sex partners and also cigarette,"Ogunnorin said.

He added that, alcohol can be metabolized into other harmful compounds. "It also has a chain that links it to cholesterol which predisposes to all kinds of malignancies as well."

Although various factors are attributed as causes, Bello explained that the main cause of cancer cannot be exactly pinpointed.

"But what we see with younger people who are infected are environmental factors and change in lifestyle and diet. Although alcoholism isn't prevalent in this part, we believe that genetic makeup and diet are largely responsible, especially now with our eating a lot of Western foods, a lot of which are carcinogenic," Bello told Weekly Trust.

Notwithstanding that individuals willingly report cases; the awareness of cancer is something that still poses a great challenge.

"The illiteracy level and the general belief that cancer is incurable in hospitals, patients instead go for traditional healing. It's when it's gone out of hand that they come to the hospital," Bello added.

In some cases patients refuse treatment options proposed. Bello explained that.

"With breast cancer, when they are told the breast will be cut off, they refuse. They feel something else can be done to preserve it and go elsewhere," he said.

Going by the Ibadan Cancer Registry, one of Nigeria's recognised cancer registries, Ogunnorin said if there will be variations in say 150 cancer cases in Ibadan there may be 120 in some other centres.

"This is because we are a referral centre and people from other parts of the country are sent here. Also, UCH is established. Not all centres have cancer registries. So it is safe to say it reflects what obtains in the country," he explained.

Another issue is the cost of cancer treatment as well as its unavailability, experts said.

To manage the cases, Bello said, "We educate them and their relatives and assure them that it's curable in hospitals. We encourage them to come early when they detect anything they are unsure of. We carry out necessary treatments and follow up thereafter. In cases where the drugs are expensive, we involve our social welfare department in the hospital and other voluntary organisations."

The story isn't different from Adam's whose relatives insisted he be discharged after being told he would need to pay up to N30, 000 for his first course of medication. Their reason: "he's a farmer and can't afford it. We need to hold a family meeting and decide."

It's been three weeks since then; his doctors are yet to see him as at the time of compiling this report.

Makumi described the fight against cancer in Africa as complex. "Poverty is not a risk factor, but the poor are affected. They can't afford treatment and have no access to medical services."

He added that:"The economic demographics of cervical cancer show that more poor people suffer as against the rich who can do an occasional pap smear or vaccine."

Makumisaid poverty was a challengebecause our governments tend to have too many conflicting priorities.

In an interview with CCTV, renowned oncologist, Prof. RemiAjekigbe, said Nigeria has not been able to tackle cancer as other parts of the civilized world, especially with the lack of facilities.

The Lagos University Teaching Hospital (LUTH) has only one radiotherapy machine which only started working again after it broke down last July. The hospital, according to the Head, Oncology and Radiotherapy, Department, didn't treat anybody between then and now.

Apart from this, there are only five other functional machines in Nigeria; thus making access a big issue.

"There are 2 million cancer patients in Nigeria and only 100,000 of them have access to radiotherapy machines," said Ajekigbe.

He has been in service for over 30 years and retirement ought to be around the corner, but such an exit will further leave a dearth in the number of oncologists in Nigeria.

According to the don there are only about 30 radiation oncologists in Nigeria.

"Thirty to 160 million people; there should be some encouragement to those on the field now to encourage younger ones to come," he said helplessly.

A 2010 report estimates the total annual economic cost of cancer to the world is $1.16 trillion. Yet about half of all cancers could be avoided through prevention, early detection and treatment, experts say. They emphasise that cancer can be prevented by at least 60 percent if people follow a healthy lifestyle.

"The chances for survival are very high when the disease is detected and treated early. Late presentation reduces the chances of survival,"Ajekigbe said.

Experts advise that more high-fiber foods should be taken and a reduced use of tobacco and alcohol and processed food as well as indulging in more exercise. Cancer isn't a death sentence, they submit.

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