At this time of the year when breast cancer organizations in Nigeria join their counterparts worldwide in rolling out “pink” drums to mark the breast cancer month, it is about time we took a critical look at cancer burden in our environment and identify the challenges responsible for the low impact of available cancer control mechanisms. We have been told time and time again that cancer burden is rising in both developed and developing countries with 7 million people dying of cancer, each year worldwide and close to 11 million new cases diagnosed annually, a figure estimated to rise to a staggering 16 million by 2020. Going by this data, cancer claims twice as many lives as AIDS accounting for more than 12% of all deaths every year. That’s more than AIDS, tuberculosis and malaria put together!
“Cancer in the developing world is a disaster waiting to happen” a former UICC’s President, Franco Cavalli once said. He continued that “ by 2020, 70% of cancer deaths will be in developing countries where incidence is rising rapidly but resources for prevention and treatment are severely limited”. While the picture may appear bleak, it is a wake-up call for these countries to act now before it is too late. Nigeria , like other developing countries is witnessing a rising incidence of cancers with its problems of ignorance, poverty and communicable diseases yet unsolved. Whereas some countries in this league seek to confront the situation by at least recognizing cancer as a health priority and deploying some resources, Nigeria appears indifferent as cancer never appears on the radar screen of health priorities of the government. Consequently, there is a lack of development of cancer treatment facilities, cancer professionals, public education and patient support services. This apparent neglect is responsible for the unabated late presentation, wrong diagnosis ( for example, incompetent Nigerian doctors who diagnose a breast lump as a “boil”), mutilating surgery, lack of accurate, supporting databases such as cancer registries, insensitivity of doctors and other care givers to the plight of patients, and exploitation of patients by over billing. What do we have? Needless deaths of unknown figure. To a Nigerian, cancer is “that condition which cannot be cured”. Some have reasoned that this stigma may be responsible for an undue sense of fatalism that could adversely impact on the commitment of the government, health agencies and private institutions in the fight against cancer. But what about elsewhere? Cancer research is constantly improving diagnosis, early detection and treatment . Many cancers are now picked up at an early stage when treatments can be more effective. Mammography for early breast cancer detection is a good example. Emerging targeted therapies are increasingly showing the possibility that even late-stage cancers can be controlled and in some cases cured. The effect of these scientific and technological developments is that mortality from cancer will decrease and survival rates improve, despite the increasing incidence. With the unprecedented progress in cancer research in the last 25 years (in the Western world, of course), we now have the opportunity to tap from these advances in a cost-effective way in order to tackle our cancer burden .
The way forward? In my opinion, is to admit that Nigeria has a cancer burden, assess it and set out to control and reduce the burden. Cancer control being a public health approach aimed at reducing the burden of cancer in a population must be taken seriously by the government. Enough of the fire brigade approach where projects are executed without adequate information and planning. It must be emphasized that planning integrated, evidence- based and cost effective interventions throughout the cancer continuum (from research to prevention, early detection, treatment, palliative care) is the most effective way to tackle the cancer problem and reduce the suffering caused to patients and their families. In poor resourced country like Nigeria , a plan should identify its limitations followed by the priorities and specific actions it should take to reduce its cancer burden. For example, in the absence of mammography machines, Clinical Breast Examination (CBE) can be used as a primary screening modality. It has become a cliché to say “government cannot do it alone” but it is true. I submit that where government is giving disproportionate attention to other health priorities such as HIV/AIDS and malaria ( because donor agencies say so), NGOs can play a critical leadership role in increasing public awareness of the cancer problem and in developing effective partnership that can take on the responsibility of cancer planning for effective interventions.