Cervical Cancer: Every sexually active woman is at risk

- Sola Ogundipe & Chioma Obinna

In recent times, statistics available have shown that in Nigeria, cervical cancer accounts for 15 per cent of female cancers as compared to just about 3.6 percent in the developed countries. Shockingly, less than 0.1 per cent of Nigerian women have ever had cervical cancer screening in their lifetime and less than 1 per cent is aware of the existence of this silent killer. Consequently, cervical cancer kills a woman every hour in the country. Although 100 percent preventable, the cancer kills more women aged 24 to 35 years old women in developing countries than any other cancer in other parts of the world.

The World Health Organisation (WHO) projects a 25 per cent increase over the next decade in the absence of widespread interventions. This is a sharp contrast to what obtains in countries like Britain which have national screening programmes. There, deaths from cervical cancer have reduced by 75 per cent and reducing by further 7 percent annually.

Unfortunately, according to WHO estimates, Nigeria has a population of 40.43 million women aged 15 years and older who are at risk of developing cervical cancer. Current estimates indicate that every year 14,550 women are diagnosed with cervical cancer and 9659 die from the disease.

Worse still, Cervical cancer ranks as the 2nd most frequent cancer among women in Nigeria, and the 2nd most frequent cancer among women between 15 and 44 years of age. About 23.7 per cent of women in the general population are estimated to harbour cervical HPV infection at a given time and percentage of invasive cervical cancers are attributed to HPV s 16 or 18.

Cervical cancer is one of the most common cancers that affect a woman’s reproductive organs and various strains of the human papillomavirus (HPV), a sexually transmitted infection, playa role in causing most cases of cervical cancer.

When exposed to HPV, a woman’s immune system typically prevents the virus from doing harm. Thanks largely to Pap test screening, the death rate from cervical cancer has decreased greatly over the last 50 years. Today, most cases of cervical cancer can be prevented with a vaccine for young women
In a study, Senior Lecturer/ Consultant at the Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, Dr. Marliyya Zayyan noted that all Nigerian sexually active women are at risk of cervical cancer but the risk of cancer of the cervix is reduced with male circumcision.

She says cancer of the cervix is the commonest malignancy among women in northern Nigeria. Three to four new cases are diagnosed every week in ABUTH, Zaria

“We had 203 cases of cervical cancer in 2007. This number represents 75 percent of the total cases of confirmed gynecologic cancers presenting to the unit. The age distribution was very wide and youngest age of presentation was 28 years and the oldest was a 90year old with very advanced disease.

The median age of presentation is 35 years. Maj ority of the women were married however 3 per cent were single women who have never married and 20 per cent were divorced or widowed. It affected family women with an average of 5 children.”

Stating in Nigeria cervical cancer patients present late, she said only four cases (1.9 per cent) out of 203 presented early enough for cure to be achieved. “For 98.5 per cent of cases the disease could best be palliated.

“The early symptom of bleeding after intercourse is often ignored by the patients. Two hundred cases were not possible to treat surgically. These cases were treated by heat treatment (radiotherapy).

A quarter of the patients presented with complications of very late disease like leaking urine or faeces, or blockage of their intestines or urinary flow”

Challenges of management, includes deaths from cervical cancer on poverty. “The cost per cycle of heat treatment is N25,000 and six to seven cycles are normally required. Special drugs required to melt out the cancer are very expensive and toxic. Could be unavailable. Follow up of discharged patients is difficult. Many specialists are required to effect treatment in the advanced stages patients present.”

On the way forward, “Cancer of the cervix is about the only human cancer that is almost entirely preventable. “It is also 100 per cent curable if picked at very early stage. Treatment is cheap and simple in early stages requiring minimal manpower to achieve the high cure rate. Cancer of the cervix has an established screening method that works. Today vaccines are available for primary prevention of cervical cancer. Theses vaccines are already in use in other places and technology for their production is known.

Control of Cervical cancer depends on increase in public awareness of the disease. Government should subsidise the treatment and incorporate screening programme into the primary health care as well as improve infrastructure and development of health facilities.

To reduce the burden, she posited that there should be constant training and re-training of personnel. She recommended that “We need a strategy to reduce the burden of disease in the community through education. We need to roll out a reliable screening plan to cover at least 80 per cent of our population.
The vaccine for cervical cancer should be part of our immunization plan. We should get rid of cervical cancer like other countries have done so we can direct attention on other cancers that have more complex biology.

Overview of Cervical Cancer
Cervical cancer is one of the most common cancers that affect a woman’s reproductive organs. Various strains of the human papillomavirus (HPV), a sexually transmitted infection, playa role in causing most cases of cervical cancer.

When exposed to HPV, a woman’s immune system typically prevents the virus from doing harm. In a small group of women, however, the virus survives for years before it eventually converts some cells on the surface of the cervix into cancer cells. Cervical cancer occurs most often in women over age 30. Thanks largely to Pap test screening, the death rate from cervical cancer has decreased greatly over the last 50 years. And today, most cases of cervical cancer can be prevented with a vaccine for young women.
At a glance

In Nigeria, cervical cancer is the second most common cancer in women after breast cancer
It accounts for 13 percent of all female cancers. Overall, the mortality: incidence ratio is 52 percent. There has been a steady rise in frequency of cancer over the years. Cancers of the cervix (30.1 percent) topped the list of the most frequent female cancers. Recent predictions of an increase in incidence of cervical cancer is manifesting. Findings at the Kano Cancer Registry, Ahmadu Bayero University, Kano, supports evidence for establishment of comprehensive cancer control programmes.

At a rough estimate, Nigeria records 10,000 cases of cervical cancer yearly,” notes Prof. Isaac Adewole, Consultant Obstetrician and gynaecologist at the College of Medicine, University of Ibadan. “The women with this ailment die in a painful, miserable and undignified manner.

At least 80 per cent of cases in Nigeria are at advanced stage where very little can be done. Measures including prevention, early detection and effective management of cervical are necessary to prevent an increase in incidence and deaths of women from the disease. He said there is need for stronger advocacy to ensure that cervical cancer vaccine becomes available in the public health sector. Adewole, also principal investigator Operation Stop Cervical Cancer Nigeria laments that cervical cancer fuels a cycle of poverty. Most of these women are low income earners and often located far from health institutions.
The disease which affects the poorest and most vulnerable women sends a ripple effect through families and communities that rely heavily on women’s role as both providers and care givers.”

Every 10 minutes, two women die from cervical cancer worldwide, affecting more of younger productive women between 20 years and mid 30s. Once a woman is affected, it can take between five and 30 years for the virus to develop into full cancer, but since it has no early symptoms, the woman feels very healthy while the virus continues to ravage her. By the time the symptoms begin to show, the situation becomes uncontrollable. Virtually nothing can be done to remedy the situation and the woman waits for death. Cervical cancer has been reduced drastically in the western world thanks to universal screening. “The rate of the cancer in Nigeria is 70 per cent and rising. If we can introduce universal screening, it would reduce drastically.”

Symptoms
Early cervical cancer generally produces no signs or symptoms. This is why regular screening is so important. As the cancer progresses, the following signs and symptoms of more advanced cervical cancer may appear:

* Vaginal bleeding after intercourse, between periods or after menopause
* Watery, bloody vaginal discharge that may be heavy and have a foul odor
* Pelvic pain or pain during intercourse
When to see a doctor: If you experience any unusual bleeding between periods or pain during intercourse, make an appointment with your doctor.
Risk factors
* The greater your number of sexual partners – and the greater your partner’s number of sexual partners – the greater your chance of acquiring HPV.
* Early sexual activity. Having sex before age 18 increases your risk of HPV.
* If you have other STDs – such as chlamydia, gonorrhea, syphilis or HIV / AIDS – the greater your chance is of also having HPV.
* A weak immune system. Most women who are infected with HPV never develop cervical cancer. However, if you have an HPV infection and your immune system is weakened by another health condition, you may be more likely to develop cervical cancer.
* Cigarette smoking. The exact mechanism that links cigarette smoking to cervical cancer isn’t known, but tobacco use increases the risk of precancerous changes as well as cancer of the cervix. Smoking and HPV infection may work together to cause cervical cancer.

Complications
Treatments for invasive cervical cancer often make it impossible to become pregnant in the future. For many women especially younger women and those who have yet to begin a family infertility is a distressing side effect of treatment. For a specific subgroup of women with early cervical cancer, fertility-sparing surgery may be a treatment option.

Causes
In general, cancer begins when healthy cells acquire a genetic mutation that turns normal cells into abnormal cells. There are two main types of cervical cancer:
* Squamous cell carcinomas begin in the thin, flat cells that line the bottom of the cervix (squamous cells).

Screening
Most guidelines suggest beginning screening at age 21, and some recommend starting within three years of becoming sexually active, or no later than age 21.
*Pap test. During a Pap test, your doctor brushes cells from your cervix – the narrow neck of the uterus – and sends the sample to a lab to be examined for abnormalities.
* HPV DNA test. Your doctor also may use a lab test called the HPV DNA test to determine whether you are infected with any of the 13 types of HPV that are most likely to lead to cervical cancer.

Diagnosis

Your doctor may examine your cervix:: During an exam called colposcopy, your doctor uses a special microscope (colposcope) to examine your cervix for abnormal cells.
Staging exams:
* Imaging tests. Tests such as X-rays, computerised tomography (CT) scans and magnetic resonance imaging (MRI) help your doctor determine whether your cancer has spread beyond your cervix.
* Visual examination of your bladder and rectum. Your doctor may use special scopes to see inside your bladder (cystoscopy) and rectum (proctoscopy). Your doctor then assigns your cancer a stage.

Treatments and drugs
Treatment of cervical cancer that’s confined to the outside layer of the cervix typically requires treatment to remove the abnormal area of cells. For most women in this situation, no additional treatments are needed.

For Invasive cancers
Cervical cancer that invades deeper than the outside layer of cells on the cervix is referred to as invasive cancer and requires more extensive treatment.

Treatment options may include: Surgery to remove the uterus (hysterectomy) is typically used to treat the early stages of cervical cancer. Hysterectomy can cure early-stage cervical cancers and prevent cancer from coming back, but removing the uterus makes it impossible to become pregnant.
* Radiation therapy uses high-powered energy to kill cancer cells.
* Chemotherapy uses strong anti-cancer medications to kill cancer cells. Chemotherapy drugs, which can be used alone or in combination with each other are usually injected into a vein and they travel throughout your body killing quickly growing cells, including cancer cells.

Prevention
You can reduce your risk of cervical cancer by taking measures to prevent HPV infection. HPV spreads through skin-to-skin contact with any infected part of the body – not just during intercourse. Use a condom every time you have sex in order to reduce your risk of contracting HPV.

SOURCE

The war against cervical cancer

Editorial


As a result of the increasing cervical cancer deaths in the country, the Federal Ministry of Health has adopted a cost-effective test and a cervical cancer policy to checkmate the rampaging monster. To this end, the ministry also plans to incorporate the cervical cancer vaccine into the national immunization schedule as well as conduct six pilot studies in six states of the federation on two different cancer vaccines-Cervarix and Gardasil.
The ministry has entered into an agreement with the Global Alliance on Vaccine Initiative (GAVI) in order to reduce the cost of the vaccines. According to medical scientists, the new Visual Inspection with Acetic Acid (VIA) or ‘see and treat’ approach, which uses a test that costs $2 (N300), would help doctors prevent 100,000 cervical cancer deaths a year in women in poorer countries. They believe that the VIA could provide the answer to cervical cancer deaths.
Already, research findings in some rural communities have confirmed that VIA significantly reduced cancer death rates. The only snag is that more awareness needs to be created so that more and more women will come up for screening.
According to scientists, the Human Papillomavirus (HPV) belongs to the papillomavirus family of viruses that infect humans. About 30 to 40 types of HPV are transmitted through sexual contact. They usually infect the anogenital region.
While some sexually transmitted HPV types may cause genital warts, it has been established that persistent infection with ‘high risk’ HPV types different from the ones that cause warts, may progress to precancerous lesions and invasive cancer.
Till date, HPV infection is said to be responsible for almost all cases of cervical cancer. The World Health Organisation (WHO) has revealed that about 300,000 women throughout the world die annually from cervical cancer. Unfortunately, about 85 percent of the deaths occur in developing countries.
Available statistics from the Health Ministry’s Cancer Control Unit show that over 30 million Nigerians are already afflicted by one form of cancer or the other. There are strong indications, too, that about 100,000 new cases would be identified, annually. And, there are even fears that if nothing urgent is done to contain the scourge, over 500,000 people might be affected by the disease, this year alone.
Health experts in Nigeria have identified three leading cancer killers in the country as those of the breast, cervix and prostate. Of all, cervical cancer has been found out to be the leading cause of cancer death among women in developing countries. In these countries, there are poor health service infrastructure and high costs of screening and vaccines.
We welcome and applaud the new initiative aimed at curtailing cervical cancer our country. Let the government provide the simple VIA test methodology in all government health facilities in both urban and rural areas. We also enjoin all the health departments of the three tiers of government to work in concert to ensure the success of this exercise. They should ensure that there are enough enlightenment campaigns in English and vernacular languages to ensure that every part of Nigeria benefits from this cervical cancer policy.
As more Nigerian women have been identified to be dying of the monstrous disease, we must do everything humanly possible to contain the ailment.
While we welcome the plan by the government to include cervical cancer vaccination in the national immunization schedule, and the proposed six pilot studies on cervical cancer vaccines in six states in Nigeria, we caution that their safety be ascertained and guaranteed before use.
Let the nation’s health authorities pursue this laudable initiative to its logical conclusion.

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Surviving breast cancer

-By Allwell Okpi

Cancer was only a news item to Florence Balogun until 2006. She never imagined that the little lump in her breast was brewing cancer. Four years later, she survived the ordeal but is still battling its effects.

“I never noticed that I had breast cancer until I was diagnosed after my friend died of it. One morning, my friend’s sister told me that my friend died the day before of breast cancer. I was shocked because she told me that she had a lump in her breast and I also told her I had a lump in my breast too. So I went to the hospital; the doctor did some test and said the lump was malignant, that I have cancer of the breast,” Mrs. Balogun said.

The prevalence of cancer in Nigeria, especially breast and cervical cancer in women, Kaposi Sarcoma, liver and prostate cancer in men, is no longer a myth. According to Peter Eric, the World Health Organisation (WHO) representative in Nigeria, 667,000 new cases of cancer were recorded in 2008 affecting 314,000 males and 353,000 females and causing 518,000 deaths involving 252,000 males and 266,000 females. With this statistics, cancer is now about the deadliest killer-disease in the country.

Fund-guzzling ailment

For Mrs. Balogun and her family this statistics is real. After she was diagnosed of cancer, the race for fund began. The treatment of cancer, reputed in Nigeria as “the disease of the rich”, is quite expensive.

“It was terrible. Family, friends, and my church stood by me. It was very difficult raising money. You know, it is a very expensive thing to treat. So one went through hell, perhaps a thing that would have lasted about four, five, six months took more than one year because of inability to raise funds,” she said.

“I can’t even calculate how much was spent on my treatment. The different tests that I did alone, was over N50,000; I think everything was over half a million Naira. I did my chemotherapy in UCH (University College Hospital) Ibadan, so I was going from Lagos to Ibadan everyday for four months. And since then I have been taking drugs every day; you must not miss any one for five years.”

Fear for children

Mrs. Balogun, who used to be a secondary school teacher, said the battle with cancer has left her weak and she is finding it difficult to do her business. But that is not her greatest worry. The fact that cancer is hereditary is giving her a deep concern about the fate of her three children, particularly the eldest, a girl in her early 20s.

“Early this year in the church when we were writing prayer points for the year, I peeped at what my daughter wrote and one of them was “God, let me not have breast cancer like my mother.’ I was deeply touched by this. My children are already concerned. I pray that they don’t go through what I have gone through,” the 47-year-old mother said.

As the prevalence of cancer increases, more and more people are going through an ordeal similar or worse than Mrs. Balogun’s. It is even more so because of the low interest in its eradication, compared to the attention given to HIV/AIDS.

While speaking at a seminar organised by The Bloom Cancer Care and Support Centre to mark the World Cancer Day on February 4 at the Nigerian Institute of Medical Research, Yaba, Aderemi Ajekigbe, an associate professor of Radiology, said it is unfortunate that Nigerian government is not taking cancer seriously.

“How can a country of 150 million people have only five radiotherapy centres, one of which is in a private hospital? The National Cancer Centre in Abuja is political; nothing is happening there. Even Lagos State does not have radiotherapy centre. If a private hospital can have it, then Lagos State can have 100 of it. They don’t talk about cancer until a prominent person dies of it, but people are dying of cancer everyday,” Dr. Ajekigbe said.

With her right breast free of cancer, Mrs. Balogun now has to raise money regularly for tests to ensure that the left breast is not affected while she keeps buying her drugs.

“It’s not easy for cancer patients that are not rich. The Lagos State government and the Federal Government should supplement to make the treatment affordable. Nigerians who are very rich should also assist,” Mrs. Balogun implored.

 

SOURCE

Using homeopathy to treat prostate cancer

PROSTATE cancer is a disease that usually affects men generally, from the middle age of life. It is due to the major effects of increasing factors which have affected the prostate at one time or the other. This ranges from duration to hypertrophy and finally abnormal tissue growth.

Prostate is a gland situated at the base of the urethra within the urinary bladder area of a man. Gland is a juice-secreting organ in the body. They secret specific juices or fluids which are required in the body for specific purposes, or externally a waste matter. For instance, sweat glands secret sweat which is a clear watery fluid that cools the skin and reduces excessive body heat.

The lacrimal gland, secrets fluid which baths the eye, or tears during emotions. Prostate gland which secrets acid phosphatase and fructose forms part of the seminal fluid during ejaculation. This is the only major role which the prostate plays in the body. Having described the prostate and its functions, it will also be necessary at this point to explain the word "cancer" and its effects.

Cancer is a disease characterised by unrestrained and excessive replication of abnormal cells. It may occur in anybody’s tissue at any age. Cancer cells accumulate and form in durations, which later results to tumour and could be benign or malignant. They permeate, compress, and ultimately destroy the surrounding normal tissue. It is a disease which eats away parts of the affected body or organ. It can be described as an eroding ulcer which is harmful to that part of the body or organ. It can also attack other parts of the body from the original place of location, which could lead to death.

At this point, the condition can be said to be virulent, meaning that it could posses the properties that can change the character of the cells at any of the affected parts (anaplasia). It can also affect other surrounding organs or tissues (invasion) and can also be transmitted from one part of the body to another through the blood stream or the lymph channels across the body cavities. The main feature is a harmful abnormal growth of surface tissues of the affected part or the lining tissues (carcinoma). It could also form sarcoma of the connective tissues. Sometimes cancer does not spread. They only attack the organ from where they develop (benign). Cancer is a terrible disease to the sufferer. Pains are usually unbearable coupled with discomfort. The pain usually moves around the body giving the patient a biting or pinching sensation. Therefore prostate cancer can be described as abnormal changes or growths in the tissue or epithelial cells of the prostate. It could be terminal through invasion, the cancerous cells can enter into other organs as well as glands to attack them and hamper their functions. From enlargement, it can obstruct the flow of stool or urine which could result to obsolete constipation or urine/fluid retention in the body.

Causes

Prostate cancer can be caused by a trauma of the pelvic region. But the main cause is usually suppressed or palliated infection of the genital tract with the complications, which result in inflamation of the gland (prostatitis) or hypertrophy. The common pathological organisms that usually cause the problem are chlamydia, gonococcus, staphylococcus and trichomonas.

Signs/symptoms

The first and foremost sign of prostate cancer sets in after a suppressed or protracted genitol-urinary tract infection. They include difficulty (strain) in passing urine which is usually accompanied by dull pain and mild spasmodic cramps within the perineum. It is usually progressive and could lead to suppressed flow. The urine could be accompanied with a drop of blood at the end. Constipation is another sign. In this case, the patient will have the urge, but must have to strain before passing the stool no matter the quantity or texture. The reason is due to narrowing of the anal canal as a result of the enlarging prostate. Stools may also be retained after each round of defecating. Whenever a hard stool is passed, there will be a discharge of a milky substance from the urinary meatus via the urethra. Sometimes it is mixed with blood. As this continues, pain will increase, gradually extending to the lower part of the thigh and leg and radiation to the back up to the sacroiliac region. Shortly after, the patient may begin to notice constant discharge of blood whenever he urinates or even stools. The blood may be bright red. He may notice a protracted irritation within the urethra after micturition (urinating). Polyurea (increased frequency of passing urine) may also be noticed. This is usually a resultant effect of pressure from the enlarged prostate on the bladder (hypertrophy). Burning sensation within the urethra is also a common sensation.

Diagnosis There is no specific kind of test that is to be conducted to exclusively diagnose prostate cancer. But the diagnostic process includes a combination of medical investigatory tests such as scans and other medical examinations with clinical signs to complete the diagnosis.

Management

The term "cancer" usually sends cold waves down the spine of many people because it is always connected to an incurable or terminal disorder. With constant research in all sphere of medical care, the scourge of cancer is being eradicated. There are many methods of management using various systems of medicine. Let me state categorically here that despite any system of medicine that is being used for the management, interest must be laid on complete control /eradication.

Treatment

Once a diagnosis is made and the case is established. Treatment then commences using the best application system of medicine suitable for the patient. In the popular therapy, three major kinds of treatment exist. There are surgery, radiation therapy and chemotherapy. In complementary system of medicine, such as naturopathy, acupuncture and homoeopathic. Alternative methods of treatment exist. In all, a homoeopathic remedy stands out and yields excellent results in the treatment of prostate cancer. A remedy known as prostain fort which contains a few homoeopathic remedies in a special blend is usually engaged in the treatment of prostatic cancer and hypertrophy. It is a non-chemical remedy with vast activities of action on the cancerous prostate. The remedy comes in tasteless powder form, and is electronically potentisised for proper efficacy. Therefore, in any case of prostate cancer in which the patients fail to respond well to popular therapies or does not go through surgery, then "prostatin fort" is a remedy of choice for these patients.

SOURCES:  Story  Pix

Cancer drugs rot at National Medical Store

Emmanuel Ulayi


FAILURE of Nigerians to access drugs for the treatment of various forms of cancer at the National Medical Store in Oshodi, Lagos, is responsible for the high rate of the disease in the country.
The President of African Organisation for Research and Training in Cancer (AORTIC), Prof. Isaac Adewole, who disclosed this, said that some of the drugs had expired.
He also regretted that doctors and pharmacists had failed to make the drugs available to the patients.
To this end, he identified doctors and pharmacists in government hospitals as a clog in the treatment of cancer in the country.
Adewole spoke a media awareness campaign against cancer on the African continent where he decried the attitude of the professional health workers.
He said they should be held liable for not doing enough towards arresting the situation.
Adewole said: “All that is needed is the doctors and the pharmacists to do their jobs by prescribing and dispensing the drugs. They are available at the National Store. Many of these drugs have expired and there is no way the stock can be replenished because since they are still available and unused, there is no way more can make case for more.”
He, however, suggested that the concerned health authorities should prescribe and dispense the drugs for those in need.
Noting that the number of cancer treating institutions in the country is grossly inadequate, the University of Ibadan lecturer said, “though we have just five radiotherapy machines in the country right now for a population of over 150 million, respite will soon come the way of cancer patients.
“Though that is not the only equipment we find in a cancer treatment centre, we gathered that the Federal Ministry of Health is about to acquire and install 10 new such machines in our cancer treatment centres to boost other equipment we have on ground now.”
Adewole said the essence of the organisation was to find a platform for the government and the private sector to buy into the awareness campaign on the disease on the continent.
He added that, “Awareness is the key to this disease and that is one thing that is lacking which the organisation is keen to bridge.”
Former Peoples Democratic Party (PDP) women leader, Mrs Josephine Anenih, the President of National Council for Women Societies (NCWS), Hajia Ramatu Usaman and the President of Medical Women Association of Nigeria, Dr Nma Wokocha and others assured that efforts would be made to enlighten the continent about the disease.

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Fed Govt orders for eight mammography machines

By Dele Anofi
The Federal Government has placed orders for mammography machines and screening equipment to check cancer, Minister of Health Prof. Babatunde Osotimehin has said.
Eight Federal Medical Centres are to benefit from the gesture.
Osotimehin spoke at the weekend during the cancer awareness and free screening campaign to mark this year’s world cancer day at the Wuse market, Abuja.
He said regular medical screening would prevent the disease.
The minister advised the traders "to examine yourselves regularly and report to the nearest health centre immediately abnormality is noted."
Osotimehin said cancers, including cervical cancer, are preventable and treatable as long as they are detected early and managed effectively.
He said: "Orders have been placed for mammography machines and screening equipment for eight of the Federal Medical Centres in the country to check cancers."

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WHO tasks countries on cancer, others

By Chukwuma Muanya
THE World Health Organisation (WHO) has tasked countries on the implementation of the global strategy for the prevention and control of non-communicable diseases.
Cancer is one of several non-communicable diseases, which affect millions of people and cause life-long illnesses. WHO and its partners have developed an action plan to prevent these diseases from occurring and to help those already affected to cope.
WHO's Assistant Director-General for non-communicable diseases and mental health department, Dr. Ala Alwan, in a post-World Cancer Day podcast said: "The global strategy for the prevention and control of non-communicable diseases has three key priorities. First is to map and monitor non-communicable diseases, which are, in addition to cancer: heart disease, stroke, diabetes and chronic lung disease. Second reduce the exposure to the risk factors and these are tobacco, unhealthy diet, physical inactivity and the harmful use of alcohol. Third, is to strengthen health care services for people with cancer and other non-communicable diseases.
"The action plan is being implemented by all countries and so achievements in the prevention and control of cancer and non-communicable diseases will have a major positive impact."
The focus of the World Cancer Day, which was celebrated on February 4, this year, was cancer prevention.
Also, the National Cancer Prevention Programme (NCPP) has said that cancer prevention in Nigeria is the responsibility of all, as everybody is a potential sufferer of the deadly disease.
National Coordinator, Dr. Kin Egwuonwu, at the commemoration of the International Cancer Day in Lagos, said: "This is a time for us all to join hands together to fight the cancer scourge. Other countries of the world have taken pro-active steps to fight the scourge and they have had positive results."
The commemoration, with the theme, Saving Lives Via Screening and Vaccination, also coincided with the inauguration of marketing communications veteran and Chairman of Troyka Holdings, the marketing communications conglomerate, Biodun Shobanjo, as the maiden Ambassador General of the programme for the next one year and the commencement of the Attack Cancer Today (ACT) Initiative.
According to the WHO, each year, over 12 million people are diagnosed with cancer. It says cancer kills more people than Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS), malaria and tuberculosis (TB) combined but the good news is that approximately two out of five cancers are potentially preventable.
"The death toll is set to rise dramatically in the coming decades. Two-thirds of cancer-related deaths occur in countries where resources available for cancer control and services are limited or non-existent. But the good news is that approximately two out of five cancers are potentially preventable. The World Cancer Declaration has set out targets to stop and reverse current trends."
Chief Executive Officer of the International Union against Cancer, Mr. Cary Adams, said: "One of those targets - target three - is about prevention, the things that we can all do, which will limit the chances of us getting cancer in due course. For example, stop tobacco use, limit alcohol consumption, avoid excessive sun exposure, maintain a healthy weight and of course, protect against cancer causing infections."
Director of the International Agency for Research on Cancer, Dr Chris Wild, said prevention was critical, especially in regions of the world which have the least capacity to treat this disease as they have the least developed clinical services.
Wild said: "In the example of Africa where we currently have 500,000 new cases of cancer each year, we have fairly precise estimates that in the next 30 to 40 years, there will be three to four times as many cancers in that part of the world. It is very difficult to envisage treatment being able to respond to that challenge, whereas prevention would be a much better approach to reduce the burden of disease."
It has been shown that one-fifth of all cancers worldwide are caused by a chronic infection. Some examples are human papilloma virus - also known as HPV- which causes cancer of the cervix; hepatitis B virus (HBV) which causes liver cancer; and Helicobacter pylori causing stomach cancers.
Prof. Harald zur Hausen, a German virologist researching cancer of the cervix, discovered the role of papilloma viruses, for which he received the Nobel Prize in 2008.
Hausen said: "HPV is clearly a causative agent of cancer of the cervix and in addition, there is good reason to suspect that it also causes parts of all pharyngeal cancer of the throat and in particular of the tonsils and it is also involved in other cancers in particular in anal cancer."

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‘Reducing cancer begins with supporting Tobacco Control Bill’

Appolonia Adeyemi
When news that former First Lady, Mrs. Maryam Babangida had died from ovarian cancer in far away United States (US) filtered through the airwaves on December 27, 2009, many Nigerians realised that if the latest cancer victim was wife the former military President, Ibrahim Babangida, it is indeed time to check the killer disease. One way to fight cancer, a non communicable disease involving abnormal growth of cells, is keeping away from tobacco smoking.
According to data issued by the World Health Organisation (WHO), cancer affects people of all ages with the risk for most types increasing with age. With the increase of cancers recorded globally since 2008, the link between cigarette smoking and cancer has been brought to the fore.
Researchers have clarified that tobacco use is associated with many forms of cancer and that cancer caused about 13 per cent of all human deaths in 2007. Also, research has shown that cancer causes 90 per cent of lung cancer. These are some of the issues raised at a training on Cancer Reporting for Health Reporters organised by Journalists Advocacy on Tobacco & Health (JATH) in Lagos recently. Among resource persons at the workshop were Mrs. Ebun Anozie, Chief Executive Officer, Care Organisation Public Enlightenment, also known as C.O.P.E., Akinbode Oluwafemi, Programme Officer, Environmental Rights Action/Friends of the Earth Nigeria (ERA/FoEN), Tosin Orogun of JATH, among others.
Tobacco’s role in increasing the chance of lung cancer is one of the most widely known of tobacco’s harmful effects on human health. Decades of research has demonstrated the link between tobacco use and cancer in many sites in the body in addition to the lungs. Other parts of the body that cancer can affect are the head and neck, (coveringof the esophagus, larynx, tongue, salivary glands, lip, mouth, and pharynx), urinary bladder and kidneys, uterine cervix, breast, pancreas, and colon.
According to the Programme Officer, Environmental Rights Action/Friends of the Earth Nigeria (ERA/FoEN), Akinbode Oluwafemi, there are about 599 approved additives in a stick of cigarette. He said, “Cigarette smoke is proven to contain over 4,000 toxic and cancer causing chemicals. The list is long: carbon monoxide, nitrogen oxides, hydrogen cyanide and ammonia to name a few.”
He noted that smoking is a major risk factor for different cancers and apart from the high cost of cancer treatment and the infrastructural challenges, smoking related cancers account for 30 per cent of cancer related deaths.
Therefore, taking prompt action to check cancer related deaths becomes more compelling now considering the large number of smokers in the nation. Data issued by the WHO states that 17 per cent of Nigerian adults smoke, resulting in 17 million Nigerians. “And because research has shown that half of smokers are going to die of tobacco-related illnesses, that means 6.5 million Nigerians are going to die as a result of that smoking habit,” he said.
Consequently, Akinbode said that is why it is very urgent for government to begin to take actions in order to reduce tobacco use in Nigeria.
While he noted that tobacco related deaths are preventable, Programme Officer of ERA/FoEN urged the government to put in place policies that will discourage people from putting up the habit of tobacco smoking and for people who are already smoking to quit.
A speedy passage of the National Tobacco Control Bill 2009, sponsored by Senator, Olorunnimbe Mamora will help, Akinbode said.
The bill, which has passed through the First Reading at the National Assembly seeks to domesticate the Framework Convention on Tobacco Control that was negotiated under the WHO. Nigeria became a party to that convention in 2005.
Since Nigeria is now a part of that Convention, he said, “We should domesticate all the provisions of that international treaty.”
The provisions talks about Tobacco Demand Reduction, the mechanisms of which include ban on advert, sponsorship and promotion of tobacco products, raising taxes on them, creating smoke-free environment for the citizens and making the public places smoke-free.
Similarly, it includes awareness creation and obligations on cessation of tobacco smoking.
The other side of it that has to do with manufacturing talks about packaging and labeling of tobacco products.
How do manufacturers package tobacco products? Programme Officer of ERA/FoEN said they have to put in place appropriate warnings on cigarette parks.
“For instance, Akinbode said the Framework Convention on Tobacco Control recommends 50 per cent pictorial warnings, meaning that manufacturers have to put on the cigarette park pictorials on what is cancer, that cigarettes cause impotence, that cigarettes smoke is dangerous for unborn babies and pregnant women, among others.”
According to him, these pictorial warnings are already being put on cigarette packages in some African countries. He said, “For instance, Mauritius has even moved a step further to say that those warnings will occupy 75 per cent of the display area on the cigarette park Besides, it is the same companies that are here that are manufacturing cigarettes in Mauritius. So, they don’t have any excuse for not complying with those laws in Nigeria.”

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HIV/AIDS and other cancer risk factors

Appolonia Adeyemi

TODAY, February 4, the entire world will once again shift attention to cancer, which is the leading cause of death globally and Nigeria is not left out.

Since the death of former First Lady, Mrs Maryam Babangida, from ovarian cancer on December 27, 2009, many Nigerians have been puzzled about cancer, which has no respect for individuals. Even the high and mighty have succumbed to cancer.

Those who have died from cancer in the country included the 51-year-old former Yobe State Governor, Mamman Ali, the human rights activist, Ganiyu Oyesola Fawehinmi, 71 and the ace journalist, Yinka Craig. Although, many commoners have also died from cancer, the death of personalities has helped to bring the issue of cancer to the consciousness of many Nigerians.
For instance, in the aftermath of Mrs Babangida's death, the Surulere Lagos office of the National Cervical Cancer Prevention Programme (NCCPP), a Non-Government Organisation (NGO) and an initiative of the Mass Medical Mission, which works on cancer, witnessed a massive turnout of Nigerians who went there to screen for both cervical and breast cancer.
The National Coordinator of NCCPP, Dr Kim J-Egwuonwu, who confirmed the development, said the people did not only screen, they sought information on things to do to prevent different types of cancers.
Cancer is a class of diseases in which a group of cells display uncontrolled growth and sometimes spread to other locations in the body via lymph or blood.
Unfortunately, before now, many Nigerians were not taking cancer as seriously as they should. With literacy that is below world average, Nigerians rank lowest on global cancer awareness.
Some simply lack the knowledge of the existence of the disease and for those who are literate, cancer hardly lies within the spectrum of their consciousness.
Another factor contributing to low cancer awareness in the country is poverty. With 71 per cent of Nigerians living on less than $1 per day, many are preoccupied with the hustle and bustle of daily living.
Similarly, the fear of finding out is another factor. Some ask, “What will I do if I know?” Hence, the general attitude is that most people will not go for screening different types of cancers including lung cancer, colon cancer, prostate cancer, etc and they run the risk of going down with these diseases.
Furthermore, experts say poor medical access also account for why Nigerians are not taking cancer seriously. Consequently, a lot of people are dying from the disease.
Every year, 12 million people are diagnosed with cancer and 7.6 million people die of cancer worldwide.
According to the World Health Organisation (WHO), if no action is taken, the global impact of cancer is projected to reach 26 million new diagnosis by 2030 and the disease will cause about 17 million deaths.
In the last five years, there has been increased prevalence in all forms of cancer, especially with the pandemic of HIV infection in Nigeria.
“This has resulted in increased incidence of cancers generally and Kaposi Sarcoma particularly,” said Dr Patience Osinubi, the coordinator, Cancer Control Programme, Federal Ministry of Health (FMOH).
Explaining the dramatic rise in the number of new cancers developing throughout the world, the Chairperson, World Cancer Day Planning Committee, Institute of Human Virology in Nigeria (IHVN), Dr Elima Jedy-Agba, disclosed that although a few type of cancer occur among the young, it is a disease of old people.
People are adopting lifestyle changes that are increasing their risk of cancer. These include the amount of physical activity they do, putting on weight, smoking tobacco and drinking alcohol.
According to Dr Jedy-Agba, in the past few decades, a new threat has emerged in the form of HIV/AIDS as a risk factor for cancers. She noted that HIV/AIDS is very common in Nigeria and the rest of Africa and because the infection weakens the immune system, it increases cancer risk.
This association between HIV and cancer was recognised very early leading the United States Center of Disease Control and Prevention (CDC) to classify some cancers as AIDS Defining Malignancies (ADM). That is, these cancers are so commonly associated with HIV/AIDS that anybody who has them should be suspected of having AIDS and should be tested. Dr Jedy-Agba listed these cancers as those of the uterine cervix, lymph nodes – Non-Hodgkin’s Lymphoma – and Kaposi Sarcoma.
The key message for today's World Cancer Day is, ‘HIV/AIDS increases Cancer Risk…stay safe, stay healthy”.
“We encourage individuals who are HIV negative to stay safe by avoiding infection and we encourage individuals who are HIV positive to stay healthy by being compliant with their medications and seeing their doctor if they have any suspicious symptoms and insist that they are examined thoroughly,” Dr Jedy-Agba added.
Furthermore, she said recently, particularly in countries where HIV treatment had been available for a long time, “We are now seeing People Living with HIV/AIDS (PLWA) developing other types of cancers more commonly than is expected. These are called Non-AIDS Defining Malignancies (NADM) and together, these two conditions are increasing the cancer burden among PLWA.”
It has been estimated that 10 per cent of all HIV/AIDS patients will go on to develop cancer.
In Nigeria with over three million people affected by HIV/AIDS, this means that HIV/AIDS is responsible for an additional 300,000 cases of cancers that would not be there if there was no HIV.
In a statement to mark the World Cancer Day 2010, the chairperson of the World Cancer Day Planning Committee at the Institute of Human Virology in Nigeria, pointed out that as a result of the looming threat that cancer poses, particularly to HIV/AIDS patients, the institute has begun to carry out cancer prevention, treatment and research activities in Nigeria in collaboration with the Federal Ministry of Health.
These include resuscitation of a national system of cancer registration through training, infrastructural support, and mentoring of cancer registrars in Nigeria.
The IHVN is also developing a network of cancer clinical trials centres in collaboration with Society of Oncology and Cancer Research of Nigeria (SOCRON) and 13 teaching hospitals and research institutes.
IHVN, which was established in 2004 to address the HIV/AIDS crises in Nigeria, has also been designated an international site for clinical trials with the United States’ National Institutes of Health funded AIDS Malignancy Consortium, an international cancer research group that is focused on developing new treatment for cancers occurring among PLWA.
Similarly, experts are advocating increased awareness among Nigerians as a strategy to reduce cancer deaths.
Accordng to Dr Osinubi, if cancer awareness messages go out from NGOs, electronic and print media, religious leaders, professional bodies and associations, school principals, among others, the populace will be well enlightened.
On his part, Dr J-Egwuonwu said massive awareness of cancer among Nigerians could be converted into testing and screening.
More than 30 per cent of cancer could be prevented by modifying or avoiding key risk factors, according to a 2005 study by international cancer collaborators.
Risk factors include: tobacco use, being overweight or obese, low fruit and vegetable intake, physical inactivity, alcohol use, sexually transmitted HPV-infection, urban air pollution and indoor smoke from household use of solid fuels.
Prevention strategies increase avoidance of the risk factors listed above including vaccination against human papilloma virus (HPV) and hepatitis B virus (HBV), the control of occupational hazards, reduction in the exposure to sunlight and early detection. About 30 per cent of cancer is treatable if discovered early.
Recognising early signs of cancer and seeking prompt medical attention will similarly help. Symptoms to look out for include: lumps, sores, persistent indigestion, persistent coughing, and bleeding from the body's orifices, among others.
Screening programmes to identify early cancer or pre-cancer before signs are recognisable include mammography for breast cancer, and cytology (a “pap smear”) for cervical cancer.
Highlighting the efforts of the Cancer Control Programme of the FMOH to combat the disease, Dr Osinubi said the primary focus was cancer prevention because it was far more economical to prevent the disease.
“A major effort of the Federal Government of Nigeria is the signing of the Framework Convention on Tobacco,” she said, adding that the FMOH advocated tobacco control and effective policies at federal, state and local government levels. The convention, will however, be domesticated to have the desired significant impact.
Another area being aggressively pursued is cervical cancer prevention, Dr Osinubi said.
It is documented that Human Papilloma Virus (HPV) infection, particularly high risk types 16 and types 18, is likely to lead to cervical cancer.
It is preventable by the administration of HPV vaccine to young girls' pre-sexual exposure. The National Cervical Cancer Control Policy states that girls from ages nine years should be eligible for the vaccine.
Also, the FMOH advocates breast cancer prevention by encouraging self and clinical breast examinations and mammography.
Dr Osinubi said, “This should be done at least every two years from age 35 years for early detection of breast cancer.”
She added that abnormal breast lumps could be evaluated this way for very early treatment intervention. A mammogramme goes for N3,000 to N5,000 in public hospitals.
On skin cancer, the FMOH advocates the use of sunscreens and protective covering like hats, long sleeve clothing to reduce excessive exposure to sunlight.
Men are also advised to check the serum level of Prostate Specific Antigens to detect any unusual rise in the levels as high levels may indicate early onset of prostate cancer. The FMOH said in the future, vaccines would be available to treat this cancer.
Undoubtedly, it is laudable that some Nigerians want to know about cancer. But do they have to wait for personalities to die from cancer before individuals take measures to check cancer?

SOURCE

Government is expanding cancer treatment access – Osotimehin

With the celebration of the 2010 World Cancer Day yesterday, Appolonia Adeyemi reviews the federal government’s cancer control programme February, 2004. At 7.15 am, Ama Jonathan was the first patient to arrive the Oncology Unit, University College Hospital (UCH), Ibadan, Oyo State. Having been diagnosed of breast cancer, a private health facility in Port Harcourt, Rivers State, had referred AMA to UCH, which has medical facility and personnel to treat the condition. Arriving the unit that deals with cancers, she took her turn to see the doctors and did further tests to aid treatment but as dusk began to set, she became apprehensive on where to spend the night. Ama had no relation nor friend in Ibadan but had to follow up on the mastectomy, which the doctors recommended as the only way to nip her breast cancer in the bud. A mastectomy is surgery to remove a breast and it is performed either to treat or prevent breast cancer.
With nowhere to go to, Ama finally joined other patients who had accommodation problems in an uncompleted structure being developed in UCH. She spent the night there. The following day, she followed up on the treatment. After spending two weeks in UCH and getting a four week appointment for the surgery, Ama left for Port Harcourt.
Undoubtedly, moving back and forth from Port Harcourt where she lived to Ibadan, the location of the facility providing cancer treatment was an added burden to the health condition Ama faced but she was not alone. The problem of limited cancer treatment access was major a problem facing cancer patients in Nigeria.
Before the era of former President, Retired General, Olusegun Obasanjo, only six hospitals were designated as cancer treating centres. These were the UCH in Ibadan, National Hospital, Abuja, University of Nigeria Teaching Hospital, Enugu, Lagos University Teaching Hospital, Lagos, University of Maiduguri Teaching Hospital, Maiduguri and Ahmadu Bello University Teaching Hospital, Zaria. What this meant was that a patient residing in a rural area in Calabar could be referred to seek treatment in Abuja, Maiduguri or Zaria, depending on the health facility that had the requisite equipment and personnel for the case at hand. Of course, many poor people who had cancer must have missed out on treatment, resulting in the high incidence of cancer deaths in the country.
Cancer is a leading cause of death worldwide. World Health Organisation (WHO) estimates that 7.6 million people died of cancer in 2005 and 100,000 new cases are currently seen annually. This is estimated to rise to 500,000 new cases annually by 2015 if prevention and screening services strategies are not implemented urgently.
According to the Federal Ministry of Health, recent studies in Ibadan reported an annual incidence of 10,000 cervical cancer cases in the south west of Nigeria.
In Nigeria, the main types of cancer leading to overall cancer mortality among men each year are cancers of the prostate, liver, connective tissue, skin, larynx, Hodgkin disease, colon and rectum, Nasopharynx, bladder and nose. Among women, the commonest cancers are cancers of the breast, cervix, uterus, ovary, liver, non Hodgkin, lymphoma, colon, thyroid, soft tissue and bone.
With the increased incidence of cancer, the Federal Ministry of Health (FMOH) has upgraded more hospitals and increased their capacity to optimally treat cancer while others are still in the process of being upgraded. The process which was initiated by Retired. General Obasanjo with the rehabilitation of some tertiary hospitals is continuing to date, said the Minister of Health, Prof. Babatunde Osotimehin.
According to him, hospitals that are presently being upgraded to treat cancer are the University of Benin Teaching Hospital, Benin City, Edo State, Federal Medical Centre, Gombe, Usman Danfodio University Teaching Hospital, Sokoto, University of Ilorin Teaching Hospital, Ilorin, Kwara State and University of Port Harcourt Teaching Hospital, Port Harcourt. “Recently, Federal Medical Centre, Gombe received cancer treating equipment,” said Dr. Patience Osinubi who is the coordinator of Cancer Control Programme at the Federal Ministry of Health.
It is import to expand treatment centres because 30 per cent of cancers are preventable while about 40 per cent are easily detectable in the pre-malignant stages, thereby providing the opportunities to stem the course of the disease and increase the chance of cure.
However, another major problem facing the treatment and management of cancer in Nigeria is that many cancer cases present to the hospitals at advanced stages when effective intervention is not possible. “This has been one of the major reasons for the high mortality rates,” said Dr. Osinubi.
According to her, the FMOH has tremendously stepped up cancer prevention and early diagnosis through regular cancer screening. This will prevent late presentation of cases, she said.
For instance, in Nigeria, cervical cancer kills more women than any other form of cancer. The National Cervical Cancer Prevention Programme (NCCPP), a non government organisation and an initiative of the Mass Medical Mission (MMM), which is working on cancer, states that “Every two minute, a woman dies from cervical cancer.” Yet cervical cancer’s cancerous lesions can be detected through routine examination, making it easy to cure.
To stem the tide, in 2009, Prof. Osotimehin directed all Federal Tertiary Hospitals to set up cancer screening services to increase accessibility to cancer screening for the three major cancers in Nigeria – breast, cervix and prostate cancers.
Similarly, the NCCPP with support from governments, corporate organisations, among others is currently expanding access to awareness and screening for cervical, breast and prostate cancers. With screening and counseling centre already established in its Surulere Headquarters in Lagos, it plans to establish screening centres for the three major cancers in all 774 local government councils in the country.
Other activities at the FMOH to control cancer include awareness and advocacy through the media and partnerships with NGOs. “Many state governor’s wives are partnering with the Federal Ministry of Health to carry the cancer awareness and advocacy to the local government and communities,” Dr. Osinubi said.
In addition, the FMOH is partnering with the International Atomic Energy Agency (IAEA) on a programme called Programme of Action on Cancer Therapy (PACT). Going by government plan, within the next eight years, nuclear medicine equipment, which can diagnose cancer efficiently and more radiotherapy equipment (linear accelerators) will be available in more federal tertiary hospitals.” The federal government has committed to counterpart funding of $37.5 million dollars for the successful implementation of this programme, said the coordinator of the Cancer Control Programme at the FMOH, adding, “Nigeria has already paid the first $2 million to the IAEA to initiate the programme.”
Although, Dr. Osibubi admitted that currently, the cancer diagnostic and therapeutic facilities and trained manpower, especially in the area of radiotherapy and nuclear medicine physicists are still inadequate to meet the needs of the 140 million population, “we will have enough facilities to treat cancer patients by the end of the IAEA partnership.”
In Nigeria, an average of one linear accelerator per 20 million is available when compared to 3.4 and 8.2 radiotherapy machines per million population in the United Kingdom (UK) and the United States (US).
Cancer treatment is expensive globally and the major challenge facing patients in Nigeria is the inability of the National Health Insurance Scheme (NHIS) to fund cancer treatments. Although, the current co-pay of about N550 is inadequate to support the funding of cancer treatment, the scheme funds cancer screening and simple mastectomies and prostatectomy for breast and prostate cancers.
Following the huge cost of cancer treatment, the primary focus of the government is cancer prevention because it is far more economical to prevent the disease than allow for the onset of the condition.
Although, the federal government signing of the Framework Convention on Tobacco Control is laudable, domesticating the protocol will reduce tobacco consumption and ultimately prevent cancer.
On cervical cancer, the National Cervical Control Policy states that girls from nine years should be eligible for the vaccine, Gardasil, which prevents the onset of human papilloma virus that causes cervical cancer. The FMOH is trying to get Global Alliance for Vaccines and Immunisation (GAVI) country assistance to procure these vaccine at an affordable cost to sustain its inclusion in the National Programme on Immunisation (NPI).
In addition, the FMOH advocates for breast cancer prevention by encouraging self and clinical breast examinations and mammography. This should be done at least every two yeas from age 35 years and above for early detection of breast cancer. Abnormal breast lumps can be evaluated this way for very early treatment intervention, Osinubi said. A mammogram an x-ray of the breast to detect cancer, goes for, which is between N3,000 and N5,000 in public hospitals.
Furthermore, while current government policy urges men to check the serum levels of their Prostate Specific Antigens to detect any unusual rise in its level. High levels may indicate early onset of prostate cancer. Also, skin cancer protection programme is being pursued for albinos. Through Albino Foundations, the FMOH is advocating for the use of sunscreens and protective covering like hats, long sleeve clothing to reduce excessive exposure to sunlight, among others.
If Nigerians responds to the various awareness and preventive programmes in place, medical experts believe that it will translate into routine cancer screening exercises and result in preventing cancers. On the other hand, for those who get cancers like Ama, the increasing cancer treatment centres in the nation will bridge the gap created by limited cancer treating facilities.