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The World Cancer Day, celebrated on February 4 of every year, is an initiative of the Union for International Cancer Control (UICC) and is marked by countries all around the world. The day aims to bring awareness to this serious non-communicable disease that the World Health Organisation (WHO) has branded the second leading cause of death worldwide. The theme: ‘I Am and I Will’ urges every global citizen to take personal steps against the disease.

Cancer in Nigeria is widespread. This is per IARC’s (International Agency for Research on Cancer) most recent statistics. We recall in 2018, prevalence stood at approximately at 115,950 new cases of cancer in Nigeria. What was most shocking, however, was the disparity of cancer-associated deaths across gender. Even now, stats reveal over 71,022 death cases in women and 44,928 in men.

Women and cancer
Nigerian women were also more likely to die of cancer than men. Of the total 70,237 cancer deaths that occurred in Nigeria, 41,913 were women with the remaining 28,414 accounted for male deaths. It is thus vital that we examine the high disease burden of cancer in Nigerian women on this day.

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Granted, breast cancer and cervical cancer are the two major types of cancer that affect Nigerian women, with the latter ranked as the second most occurring and deadly cancer. Yet, cervical cancer is still notorious for claiming lives as the former, albeit less prevalent.

The IARC data shows that 14,943 new cases of cervical cancer occurred in 2018 with nearly all resulting in death as mortality rate was 10,403. We seek to explore why.

Cervical cancer
Cervical cancer is a type of cancer that develops in a woman’s cervix (the part of a woman’s body that connects the uterus or womb and vagina). Cervical cancer is characterised by uncontrollable cell growth in this region of the body.

“All women are susceptible to developing cervical cancer. However, this is more so for women in third world countries like Nigeria,” said Stephen Ohize, a medical doctor and public health expert.

In particular, there are also high-risk groups that are even more susceptible to cervical cancer. They include:

  • Women living with HIV
  • Women with immune disorders
  • Women in the lower socioeconomic group
  • Women who have partners that have multiple sexual partners/polygamous setting.

The cause of cervical cancer and a major culprit in the rise of the condition is a sexually transmitted disease – Human Papillomavirus or HPV. There are direct causal links that numerous scientific studies have identified with cervical cancer. These links, however, are viewed positively by scientists because it means that cervical cancer can be completely prevented as effective vaccines currently exist and are available for women within an eligible age group. And yet still, the WHO reported in 2018, that more than half a million new cases of cervical cancer were responsible for 84 per cent of the total new cancer incidence in the world. 311,00 women died of the disease in 2018.

Mr Ohize remarked on the link too: “most sexually active women will come in contact with the Human papillomavirus at some point in their lifetime; however, only very few (about one in 20) will result in changes that can lead to cancer. This means some factors make some people predisposed to having the HPV cancerous changes. They include:

  • HIV infection
  • Multiple sexual partners
  • Women with partners who have multiple sexual partners
  • Previous histories of recurrent sexually transmitted diseases. ”

Mr Ohize highlighted that the prospects of a woman diagnosed with cancer in Nigeria is not hopeful and this explains the high mortality rates associated with every diagnosis of the condition. This, he explained is attributed to “factors like location and nearness to appropriate health facility, socioeconomic status, educational status and cancer awareness level and the extent of disease at presentation/diagnosis”.

Symptoms
According to Cancer Research UK, the main symptom for cervical cancer is unusual bleeding (between periods, during or after sex and after menopause) from the vagina. Other symptoms include vaginal discharge or pain in the pelvis (hipbone). Once one identifies these symptoms or indeed general sickness, screenings are the next widely-recommended course of action.

Mr Ohize said “cancer screenings are investigative procedures that are directed towards an otherwise ‘healthy’ population to detect disease conditions early and treat them while the prognosis is still good. It is usually directed at diseases that are common with early treatment resulting in a better outcome”. This is consistent with advice from most health experts. The consensus is that early screenings and detection significantly improve the chances of a successful diagnosis, effective treatment, and subsequent survival and quality of life.

Challenges
Nigeria does not currently have a national screening programme like most developed countries. This has made screening services difficult to access in most parts of the country. However, most cities with access to tertiary (and some secondary) health centres have cancer screening services. Examples include the Pap’s smear, Visual Inspection with Acetic Acid (VIA), Colposcopy and HPV DNA testing.

Yet, this screening comes at some financial cost, depending on the screening modality. Not to mention, most health insurance schemes do not cover cancer screening services. Notwithstanding, we now have NGOs and other civil society organisations involved in providing free or subsidised screening services; as well as outreaches to rural and hard-to-reach areas.

Mr Ohize said in Abuja, women can get screened at “the Tertiary centres (National Hospital and Abuja University Teaching Hospital) which have screening facilities as well as several secondary health facilities. But these are supposed to be referral centres, and screening should ordinarily start from the Primary Health Care (PHC) centres. Some private laboratories also offer Pap’s smear and other screening modalities. NGOs are also present like the MEDICAID Foundation’s laboratory.”

Recommendations
Mr Ohize recommended an “increase in the number of registries and the quality of data.” The suggestion was addressed to the Nigerian National System of Cancer Registries who are tasked with the responsibility of keeping cancer-related medical records. He also noted the absence of a national screening programme “like most developed countries” and thus the need for this. More importantly, he remarked on the need for accessible and readily available treatment options. He said, “even for those who can afford care, it is usually fragmented as women often have to travel between cities to access different treatment modality like radiotherapy”.

At this juncture, the significance of raising awareness for cervical cancer is apparent. And while there are not as many incidents as breast cancer, it is just as deadly. Also, while the government has its part to play with regards to the recommendations highlighted, every day folk have a responsibility- to raise awareness. This was the sentiment expressed by Mr Ohize who noted that things can improve “as more awareness and attention is gained.”

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