- We are working to purchase more -- FG
- Every state in Nigeria should have one -- Expert
Nigerians suffering from cancer and medical experts have lamented the lack of an important machine for cancer care called Positron Emission Tomography computer tomography (PET-CT) scan machine across health facilities in the country.
They said the availability and affordability of the machine in the country will not only help ensure effective diagnosis and treatment of cancer, but also further enhance the survival rate.
Findings revealed that only one PET CT scan machine is available in the whole of Nigeria. No government facility in the country has the machine. The only one available is at a private facility in Lagos. It also serves the whole of West Africa, as no country in the sub-region has the machine.
This is happening when a number of countries in North, East and Southern Africa can boast of a number of PET CT scan machines.
According to Runcie C.W. Chidebe, a cancer advocate, and executive director of Project PINK BLUE, countries in North Africa have an extensive number of PET-CT scanners and a well-developed nuclear medicine system compared to other regions in Africa.
He said, "Multiple peer-reviewed data have shown that PET-CT scanners available in Algeria are two, Egypt are 15, Libya is one, Morocco is one, and Tunisia is five. In sub-Saharan Africa, South Africa alone has 14, Kenya has four, and Nigeria has one."
Daily Trust learnt that some cities in India have more than 20 PET-CT scan machines.
Nigeria records about 79,542 of cancer deaths annually, according to the International Agency for the Research on Cancer (IARC).
IARC said 127,763 new cases of cancer were also recorded in the country in 2022. Experts said this further underscores the need to improve survival and reduce death in the country.
Also some Nigerians have embarked on medical tourism to other countries just to access a PET CT scan.
What is a PET CT scan machine?
A PET CT Scan allows accurate identification of the location, size and shape of tumors through identifying abnormal cellular activity (the chemical processes that occur within a cell.)
Several studies have shown the superiority of PET-CT over using CT alone in certain cancers for diagnosis, staging, evaluating cancer spread, optimizing and monitoring treatment, and assessing prognosis.
The introduction of PET-CT scan in cancer imaging in the early 2000s resulted in a substantial increase in its quantity worldwide due to the significant time efficiency and cost-efficient advantages.
According to Prof Adamu Danladi Bojude, a professor of Community Oncology and Chief Consultant Clinical and Radiation Oncologist at Gombe State University and Federal Teaching Hospital Gombe, a PET CT scan combines the functions of a PET machine and CT scanner.
While saying it gives better and more vivid pictures than other imaging machines such as ultrasound, MRI (magnetic resonance imaging) and CT, he said a PET CT Scan machine checks the whole body unlike the CT machine that checks parts of the body.
He said it involves the injection of radioactive glucose into the body and it gives "A much broader picture, or a truer picture, of what is happening in the body. It gives additional information about what is happening. So if a CT for instance gives a two centimetres radius of information, the PET CT scan gives like six centimeters or five centimeter".
Importance of PET CT scan in cancer care
Prof Bojude, who is also the National Secretary-General, Nigerian Cancer Society (NCS) said ideally every cancer patient that is going to be treated, needs a PET CT scan.
He explained that it is a baseline investigation in developed countries.
"In developed countries where they have all the resources. It is actually baseline, just like you do X- ray and scan or blood test. It's a very important one," he said.
However, he said because it is very costly, medical experts in Nigeria use it for follow up care to check if cancer treatments such as chemotherapy and radiotherapy have killed, reduced the cancer or if it has spread to other parts of the body.
Mrs Abigail Simon-Hart, a cancer survivor and CEO/ co -Founder of the Bricon Foundation said, PET scans are incredibly valuable machines in cancer care as they allow you to see if the cancer has spread or not, and if it has, how far it has spread. It's also very useful to see if the treatment is working, she said.
She said, "They are a lot more advanced than regular CT scans as they are able to give a more detailed picture of what is happening in the body.
"In PET scans radioactive material is taken up by the cells which are very active (usually indicating cancer) so they show suspicious activity and not just where the cancer is; whilst CT scans show different slices of the body's organs and tissues from different angles and even though they can show cancerous areas it's not to the same level of detail as the PET scan.
"The PET scan is able to "see" at a more minuscule level what's going on in clusters of cells of the patient's organs and tissues, sometimes before symptoms even appear."
Abigail, who is also the Director of Centrepoint Medical said, "So it's fantastic for accurate staging of disease and seeing if your treatment is effective or not. Which is as important as most chemotherapy drugs used to kill cancer cells are so hard on the immune system and the patient's organs."
How unavailability, affordability of PET CT Scan machine impedes comprehensive cancer, survival
Prof Bojude, the clinical and radiation oncologist said the main impact of the unavailability of a PET- CT scan machine in the country is that it hampers quality care.
He said, "What this means is that most of our patients, quite a large number, will end up not getting better. For example, if it is available, when you finish treatment you ask the person to do PET CT scan after three months, six months or one year and any metastases (the spread of cancer cells from the place where they first formed to another part of the body) can be picked early. You could finish treatment here, rejoicing. Meanwhile the cancer has spread and is hiding in the lungs, brain or any other parts of the body."
He explained that in Western countries people survive three to six types of cancers because of comprehensive care. They may live to 89 years or even hundred. "But here people may not survive up to 60 or 70 years, and that is even for those that don't have hypertension, diabetes, by the time cancer comes."
Runcie C.W. Chidebe, of Project PINK BLUE, said the unavailability, inaccessibility, and unaffordability of PET-CT scan machine in Nigeria is a bigger issue impacting doctors' capacity to diagnose properly, find out if the cancer has spread to other vital organs, and plan the best treatment.
He said, "So, we are expecting a lot from cancer doctors. However, cancer doctors are not magicians; they cannot give the best and optimal treatment when they do not have the best and optimal diagnostic tool. Cancer doctors cannot give what they do not have.
"Nigeria cannot continue to be the giant of Africa based on population alone and then become a dwarf in many other human development indices. The government at all levels must begin to become a giant in the cancer health system. We cannot continue to claim to be a giant with just one PET-CT scan owned by a private company, whereas South Africa has 14 and Kenya has four."
Mrs Abigail Simon-Hart, said, "As a cancer survivor and advocate, to me, the problem of the PET scan is twofold. Availability is one and the next is affordability. They are really expensive machines to buy, maintain and man so access is not cheap and will never be "cheap". Don't get me wrong, Getting a PET CT scan done anywhere in the world is not cheap but in Nigeria, with just one machine, it's well out of the reach of the average Nigerian.
She also said that with only one machine in the country there is usually a waiting period to access the machine.
"Add to that the wear and tear on the machine, it has to be serviced etc... It's not rocket science that most people will not be able to get one done. And for those who can afford it... can it even be done in a reasonable time frame to be useful to the patient? So, not having more than one PET scan in a country is definitely hampering our ability to stage cancer cases and provide appropriate treatment for our cancer patients," she added.
Citing example of the impact of the dearth of the machine in Nigeria, she said, "We already know for example that many cancers such as breast cancer in black patients is more aggressive and in much younger populations than in Caucasian populations often resulting in late diagnosis because you don't expect to see breast cancer in young women (we even had one case of a 14 year old and several in their early twenties). I believe a PET CT scan would reveal so much in these kinds of cases and allow for earlier and appropriate staging and better treatment plans.
"In our foundation we see a lot of patients coming with "advanced " disease who would have benefited from a PET CT scan but due to cost and availability have had to "manage " with a CT scan or sometimes they are asked for a bone scan. Bone scan machines are another story in terms of availability!
"The patients that I know have families abroad , international insurance cover or can afford to travel will generally travel out for treatment, not just to get the scan because they don't want to wait or are scared , even though the machine is well maintained. Many are convinced that the machine and treatment abroad will be better and more modern.
Whether we want to accept it or not, the frank and blunt truth is cancer is a scary disease and with the mass exodus of medical personnel people are scared of being treated in Nigeria in spite of the fact we have some excellent cancer facilities here."
Danlami Mathias, who lost his brother a few years ago said "His brother was advised by his doctor to do a PET CT scan but the family couldn't afford the trip to India or the United Kingdom. He said they later settled for a bone scan at a tertiary public hospital in Abuja and his brother died shortly after that.
Affordability
Till date only Mecure Healthcare Ltd, a private facility in Lagos owns a PET CT scanner in Nigeria.
Even with one machine available, Prof. Bojude, said the cost of a PET CT scan in the country is beyond the reach of many Nigerians.
He said, "Just yesterday, I sent a patient to Lagos for the procedure. It cost him 1.2 million for a session. Imagine what that means for a patient to travel from the north, the east or to fly from any part of the country to do the scan.
"And someone has to go with the patient too. You don't let a cancer patient who has just undergone chemotherapy, or radiotherapy to go alone because you don't know what will happen, so they have to go with another person. And then at least they will spend two to three days there before coming back. That will cost another N1 million, because they will eat or book a hotel."
He said before the launch of a PET CT scan in a private facility in Lagos in 2022, patients who could afford it had to go to India, Egypt, UK, US etc, to access the scan.
Prof Bojude summarized that the dearth and unaffordability of a PET CT scan takes "Nigeria one million years behind the rest of the world, including South Africa and North Africa. Secondly, it makes us not treat the patient very well. You can imagine getting a complete image of the patient from day one with PET CT scan to getting image of just the head , neck, the chest, the abdomen, or the hand with just CT
" PET CT Scan gives complete image, although it's expensive, and it gives two or three times better image, because it's a functional image"
He added that a patient's cancer may have spread to the lungs and the patient may not be manifesting any symptom for the physician to suspect, but that a PET CT scan helps to pick it early for treatment.
"And you see, if you miss the metastasis, that metastasis will be the source of another metastasis, while we are celebrating that a breast cancer patient has done surgery and other treatments and is now cancer free, the disease may be hiding somewhere; maybe in the brain. Maybe you're just having a headache. You say, Ah, maybe I'm hypertensive. Maybe I'm just tired from the therapy, or maybe from chemotherapy, not knowing that it's cancer in your brain. And until the patients are having headaches, lack of sleep, dizziness, and whatsoever that you now go and do maybe CT, and then, behold, one criminal is there. But with PET CT scan, it can be picked faster and earlier."
The way out
Patients and experts called on governments at the federal and state levels to make the machines available for early diagnosis, comprehensive and quality care.
Mrs Abigail, said the way out is greater investment in the health sector.
She said, "The government is trying ... but we need much more. Not just purchasing more PET CT scans and other machines but ensuring that we retain and train more medical personnel. We have to make our country conducive for people to want to stay. Things are tough and for medical personnel even tougher. Many are overworked, underpaid and not provided the tools to do their jobs. This has to be a priority. Equipment is only as good as the manpower using it."
She said there needs to be greater coverage by the national health insurance scheme, adding that people shouldn't be paying out of pocket for cancer treatment.
"They have added some level of cancer care to the scheme but this needs to be increased to cover advance treatment such as PET CT scans and radiotherapy even if it's to co -pay. We need to keep educating and screening, it's about prevention and early detection. That is the bottom line. Prevention is better and cheaper than cure. The breast cancer I had was detected early and I took immediate action, so it required less resources to treat. I'm alive today and cancer free thanks to early detection. I must say the National Institute for Cancer Research and Treatment (NICRAT) under the leadership of Dr Usman Malami Aliyu is doing a great job."
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She further said, "My message is cancer doesn't discriminate, it can affect anyone , irrespective of age, sex , religion or financial status, get yourself screened, get your loved ones screened so like myself you can share your own story of beating cancer! "
Runcie C.W. Chidebe, the cancer advocate and executive director of Project PINK BLUE, said the way out is that "Cancer control must be decentralised from federal to state and local governments."
According to him, leaving cancer control in the hands of the federal government alone is problematic. "Many state governments are building beautiful hospitals for cancer care and treatment, which is great; however, cancer building alone cannot treat cancer, bring about optimal cancer care or even increase patient outcomes. It is advanced cancer machines like PET-CT, radiotherapy, brachytherapy, well-equipped laboratories, access to medicines and a workforce that can reduce the burden of cancer. Also, there is a need for more budgetary allocation for cancer control in Nigeria. "
Prof Bojude said the way forward is for the government to increase the number of cancer centres and PET CT scan machines in the country.
He said the number of cancer treatment centres in the country is too few compared to the population when compared to other countries.
He said well to do Nigerians should also support the government in the provision of centres and equipment for cancer care.
While saying that the private sector needs to be more involved in supporting cancer care in the country, he said there is also a need for improved health insurance to increase access to care as the accessing care at private health facilities is expensive.
While saying that Lagos for instance should have at least three to four cancer treatment centres, he said it is important for every state in Nigeria to have a minimum of one PET CT scan machine.
He said, "So we will have like a minimum of 37 machines. That is every state must have a minimum of one well, equipped cancer center with a PET CT scan machine."
He added that the country should do more as South Africa and countries in North Africa have a number of CT scan machines.
Dr Uchechukwu Emmanuel Nwokwu, head National Cancer Control and Nuclear Medicine Program, of the Federal Ministry of Health said the federal government is planning to bring two PET CT scan machines into the country.
He said the machine country was part of the government's plan towards increasing cancer centres and radiotherapy machines in the country.
He said the government plans to bring them in by early 2026 with one in Lagos and another one in Katsina.
He said there are also proposals from two private facilities to set up two in Abuja.
He said, "So we are hoping that the country will have additional four PET CT machines in a very short time. The government is inaugurating a National Technical Working Group on nuclear medicine, to look at political directions, guidance for nuclear medicine services, including PET CT scan in the country."
