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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‘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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Vehicles of death: growing links between lung cancer and smoke

Tobacco Smoking a sure way to contract lung cancer

Revolutionary case against tobacco use in Nigeria

-Alexander Chiejina

…Tobacco control bill yet to be passed by National Assembly

Without a doubt, the health, economic, social, and environmental consequences of tobacco use in Nigeria and the continent are enormous. Little wonder the World Health Organisation (WHO) recently revealed that African countries are experiencing a 4.3 percent annual increase in the rate of tobacco consumption.

This has resulted in an upsurge of lung cancer and related cases which are now prevalent in the society. It was against this background that experts, at a recent training for health reporters on cancer reporting organised by Journalists Advocacy on Tobacco and Health held recently at Ogba, Lagos urged that the trend should be checked. Speaking at the event, Akinbode Oluwafemi, programme manager, Environmental Rights Action/Friends of the Earth (FoEN), noted that tobacco smoking is responsible for more than 85 percent of lung cancers. This, he explained, is because smoking-related cancer accounts for 30 percent of cancer-related deaths, adding that renowned journalists in the country like Steve Kadiri, Yinka Craig, Momoh Kubanji, Tina Onwudinwe and Beko Ransome Kuti lost their lives due to the health hazards associated with the consumption of cigarettes. “Research findings have it that there are about 599 approved additives in a stick of cigarette. However, cigarette smoke has been proven to contain over 4000 toxic and cancer causing chemicals; carbon monoxide, nitrogen oxides, hydrogen cyanide, ammonia, to name but a few,” Oluwafemi disclosed. According to him, cigarette advertising, promotion and sponsorship such as ‘Welcome to London, cool feeling’ have made cigarette smoking appealing to a lot of youths, without some of these tobacco companies apprising the public of dangers associated with smoking.

Lending his view, Tosin Orogun, programme manager, Communications and IT, Africa Tobacco Control Regional Initiative (ATCRI), declared that the rise in cigarette smoking in the society is traceable to tobacco companies which increasingly target the developing world as barriers rise and smoking rates fall in more mature markets. “What we (ATCRI) have been trying to do is to facilitate the adoption, implementation and enforcement of effective in-country tobacco control policies, legislation and programs in Nigeria and across the continent,” Orogun revealed. Already, a 2009 report on the implementation of smoke-free environments aimed at combating Global Tobacco Epidemic shows that five more countries (Djibouti, Egypt, Islamic Republic of Iran, Malaysia and Mauritius) meet the best practices for health warnings on cigarette packages. Three other countries (Israel, Romania and the United Arab Emirates), meanwhile, offer comprehensive help in the drive to eradicate tobacco consumption. In the same vein, only Panama has joined the small group of countries that ban all forms of tobacco advertising, promotion and sponsorship, even as more than 90 percent of people lack protection from tobacco industry marketing. Six more countries (Czech Republic, Estonia, Fiji, Finland, the Netherlands and Seychelles) have levied tobacco taxes higher than 75 percent of retail price.

Lastly, of the world’s 100 most populous cities, 22 are smoke-free. Sadly, though, reports from the recently concluded media summit hosted by the American Cancer Society ahead of the AORTIC cancer in Africa, stated that 55 percent of school students are not aware that secondhand smoke is harmful to health, and only 1 percent of Nigeria’s population are protected by strong smoke-free laws. This lays bare the fact that if nothing is done to hastily check public smoking in the country, the rising figures of cancer and other non-communicable diseases may remain.

The bill to ban cigarette smoking in public places which had its public hearing before the National Assembly 19 July this year should quickly be passed into law. A part of the bill which seeks to protect people from secondhand smoke, raise taxes on tobacco, enforce a level of ban on tobacco advertising, promotion and sponsorship would in the long run, save Nigerians from self- inducing cancer types.

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Myths and facts of a disease

• By Olukorede Yishau

Rahama Sani is a social worker. In her career, she has seen many women with cancer. But that never prepared her for the fate that befell her in August 2005. As a habit, Sani, every month, carries out breast self-examination or BSE immediately after her monthly menstrual period. Unlike her previous experience, she discovered there was a lump. Is it invasive or benign? She wondered. Fear enveloped her. Yet, she decided she would go for proper examination.

In her words: "I wanted a female doctor to examine me. So, I waited till September when the female doctor arrived. She confirmed there was a lump and ordered some investigations. All investigations confirmed it was just a benign lump. So, there was no problem. Then I was planning to go for umrah. I planned that if I travelled to Saudi, I will have it removed and looked at properly. Unfortunately, I could not make it because I could not get the visa."

She was thus left with the Hobson’s choice of doing the pathological examination of the lump in Nigeria. That was in October 2005. The result came in November 5, 2005. Since the past results had shown that the lump was not invasive, she was not prepared for what she got. The result said the lump was invasive, which means it was capable of developing into other areas. She was shocked, confused and almost fainting.

The truth was too much for her to believe. She said: "When I got the result, I was like, this was not my own because there was a typographical error in my name. But when I went to see the pathologist, he confirmed it was mine. I said we should have a second opinion. This was done by this renowned pathologist in ABU Teaching Hospital, Dr. Rafindadi. I went to see him in Zaria and they did the test again and he confirmed the same result. I was so confused. But he counselled me."

Before then, the only sign she could remember having in 2004 was shoulder pain radiating to the breast. After the discovery, she confided in her family. "But I took the decision to have mastectomy alone because no one would support to have one of your breasts removed, especially when it happened when you were thinking of having a child.

"I did not have a child in my first marriage and was just planning to remarry and have a child when this happened. They just thought have you ever seen somebody who is living with one breast, or have you ever seen somebody who has a baby with one breast. I took the decision alone because I am well-informed that if I don’t take a decision early, it may be more traumatising. The person I wanted to marry was in the UK and he was very supportive all through," she recalled.

Like Sani, Gladys Boateng, a Ghanaian also participated in the 7th conference of the Africa Organisation for Research and Training in Cancer (AORTIC), in Dar es Salaam, Tanzania, which was attended by over 700 people from different parts of African and the Diaspora. Both of them are cancer survivors. But unlike Sani, Boateng knew next to nothing about cancer when she was diagnosed in 1999. The mother of three had to contend with all kinds of myths.

According to her, "in October 1999, I had gone to the hospital for something else and the doctor conducted some tests and after thorough examination of my breast he found something hard. I didn’t notice it until the doctor told me. It was like mosquitoe’s bite and they discovered the place was a bit hard. He asked me to see a surgeon and after seeing the surgeon, he confirmed that it was cancer."

Boateng said: "I have heard about people who had cancer but I know that they don’t normally go to the hospital. They only stay at home. They don’t even like to talk about it and later on, you hear that they are dead. I thought the same thing was going to happen to me. So, I was scared because I felt it was a death sentence that has been passed on me. "

After the test, she chose to consult a priest who advised her not to go to the clinic. Boateng told Newsextra that if she went to the clinic she would emaciate, lose her hair and later die. She was made to believe that all she needed were prayers.

"He prayed for me and told me about so many people that had died. He also told me that his wife had a worse case than mine and he was able to pray for her and she became healed. He said mine too cannot be a difficult one that if I go to the hospital, I will lose all my hairs, grow lean and die at the end.

But it took a vist to a relation in South Africa for her to realise that the priest had fed her with myths. She also met other survivors and gave her hope to fight and defeat cancer.

Boateng: "Later on, I went to the hospital and also went to South Africa to live with a relation because at that time my family was not around. So, I had a surgery done in South Africa and after the surgery, the doctor told me that the cancer had gone to one. I thought it was a good news. But a patient close to me in the same hospital told me that it means it had gone into my system to appear anywhere in my body. So, I became scared at that point. But another survivor from South Africa came to visit me and I attended their meeting. At the meeting, I met other survivors who encouraged me.

"In Ghana, there was no survivor because people were afraid to come out and talk about it. At the meeting, I saw about 300 people who had cancer and I was encouraged. After the meeting, they broke into smaller groups and were sharing their experiences. After hearing their stories, my eyes became open to the real fact about cancer that it does not kill, that if you go for early treatment, you can still live. After the meeting, I had a change of heart and I became encouraged and felt I could do the same in Ghana."

That was how she started Reach for Recovery Ghana, which gives support to breast cancer survivors, especially the young ones who have refused to talk.

But is cancer as dangerous as many like Boateng were made to believe? As far as Dr. Sani Malami, cancer specialist and publicity secretary of the Nigerian Cancer Society (NCS) is concerned, it is dangerous when it is not discovered early and treated appropriately. "Most cancers lead to death. We know for a fact that globally cancer was responsible for more deaths than malaria and HIV/AIDS and tuberculosis combined and you know these are the major public health problem that we face at the moment, but because of modalities that have been put in place in our country and other countries, they do not constitute much fatal consequences as cancer does," he said.

Malami said: "The truth is that there are as many myths as the number of communities we have. But that is because of the fear of the unknown. It has been known in our communities that we have all kinds of cancer. Unfortunately because this has not been addressed appropriately and because there are no facilities to debunk some of these myths, it has been especially difficult to get people to understand. This is also because many of these cancers are detected late and they lead to death and especially death among people in their productive age. So, there is no relationship between cancer and evil spirit, casting of spell or as some people suggest that it is adulterous women who contract cancer. There is no truth in it. Cancer is caused by a single cell, which has undergone a change in its biological composition, and it multiplies very rapidly and invades other areas and inevitably consumes the individual."

It is the need to deal with all types of cancer that Sani told Newsextra that government needed to put in place facilities that could aid early detection. She said a situation whereby many patients are assigned to one doctor and they have to queue at major hospitals such as the University Teaching Hospital, Ibadan would not do the nation any good.

Sani: "I hope our government will put in place proper diagnostic facilities so that people won’t be wrongly diagnosed and they can take informed action. We need to improve the diagnostic system. I am sure a lot of people have been wrongly diagnosed."

However, for Dr. Paul Jubrin, consultant pathologist and Head, Department of Histopathology, National Hospital, Abuja, it is not much the problem of facilities. He told Newsextra in Dar es Salaam that "the facilities for the treatment of cancer in Nigeria are actually up-to-date."

So, what is the problem? Jubrin answers: "The problem is that it is not well-distributed. Cancer radiotherapy, one of the latest treatments of cancer, is only in Lagos, Abuja, Ibadan and Zaria. At least, you expect up to two of them in each geo-political zones of the country. If you come to the National Hospital, Abuja, we have state-of-the-art equipment. We recently introduced nuclear medicine, which you can use to detect cancer in your body and apart from that we have oncology unit. It is just distribution that is the problem. National Hospital has started training for oncologists. The screening method for cervical cancer called pap smear is between N2,000 and N3,000. It is not available everywhere. Now, we have what we call vispal inspection with iodine. You don’t even need a specialist for this."

Another important angle comes from Olufunmilayo Olopade, a professor of medicine at the University of Chicago. Olopade said at a session of this year’s AORTIC conference in Dar es Salaam that cancer researchers still have a lot of work to do. "I hope that this work will be done by members of AORTIC in partnership with all of us who are working in the Diaspora because until we get to the point where we can say we have eradicated cancer from the planet, our job is not done," she said.

This was also why the African Union chairman and Tanzanian president Jakaya Kikwete challenged African leaders to look for ways to battle cancer to a standstill. He said the continent lacked the wherewithal to do it alone. So, he called on international donors to assist. Kikwete, in response to a request from AORTIC founding father, Jim Holland, promised to get leaders on the continent to take the fight against cancer serious.

Along this line, the Chief Medical Officer of the American Cancer Society (ACS), Otis Brawley, urged those involved in the battle against cancer to use a report released at the AORTIC conference on winning smoke-free air as a tool. Brawley said with this report entitled Global Voices: Rebutting the Tobacco Industry, Winning Smokefree Air, smoke-free public places are examples of low cost and effective intervention against cancer.

Until that is achieved, people living with cancer can hang on to the words of Boateng that having cancer is not a death sentence. The secret, she said, is detecting and treating it early, without being bogged down by the many myths woven around it. "Having cancer is not the end of the world. There is life after cancer. You can still live," she counselled.

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Introduction - The JATH Initiative

JOURNALIST ADVOCACY ON TOBACCO & HEALTH INITIATIVE OF NIGERIA (JATH)  is a media-based health communication, not for profit, non-governmental organization dedicated to the understanding of public health issues and movement for change in public health awareness in Nigeria. It is a network of journalists and Academics drawn from various media organization in Nigeria who work to secure a safe, clean environment and healthy living by preventing tobacco use and advocating changes in public health and environmental policy.

AIMS AND OBJECTIVES:
To facilitate health communication and civic education.
To advocate policy change in public health.
To build strong media partnership for tobacco control and build capacity of Nigeria youths to respond to myriad problems of tobacco use.
To sponsor and/or support programs and/or activities aimed at promoting and propagating humanities ad human discourse in Nigeria.
To help people defend and protect their rights to clean air, for seeking legal redress on abuse of the environment.
To conduct research on public health advocacy.