Cancer in Nigeria, Part 2: Registries and Cancer Centers, Prevention and Cost

Clement Adebayo Adebamowo, MD, ScD

@adebamowo

Even with the low level of development, we can use our resources better in Nigeria—with better and earlier identification of cancer, implementation of low-cost, early-detection strategies, improved patient navigation that decreases patient and medical delay before presentation and before treatment, improvement of the referral system, regionalization of services, and monitoring of the quality and efficiency of care delivery so that there is optimum use of scarce health care resources.

For a population of over 160 million people, Nigeria does not need more than 6 to 8 population-based cancer registries in different regions of the country to reflect the diversity of the population. These can be supplemented by hospital-based cancer registries. From a technical, implementation, and epidemiologic point of view, these would be sufficient to serve our needs. The federal government, in collaboration with development partners like the Institute of Human Virology Nigeria, understands this and is implementing it in collaboration with the World Health Organization, the International Agency for Research on Cancer, the International Prevention Research Institute, and other international agencies.

Good quality data is urgently needed to convince policymakers about the urgency of the cancer problem, its epidemiology, pattern, and distribution, and to guide them in policy implementation and resource allocation. About two-thirds of cancers in Nigerian women are either of the breast or the cervix. This is good and bad news. Good news in that we can, with appropriate intervention, engender a significant reduction in the cancer burden of Nigerian women through appropriately targeted intervention. Bad news because we are currently not doing so.

Given the size of Nigeria, the current status and spread of health care institutions, development of regional cancer treatment centers that integrate and scale up existing infrastructure at a resource-appropriate level is probably the most equitable and just way to provide cancer care to a large proportion of the nation at reasonable social and economic cost. The matter of an ultra-modern national cancer center requires considerable thought and planning. Such a center will cost hundreds of millions of dollars in capital costs and tens of millions of dollars in recurrent costs. How does one contextualize a single 5-star national cancer center that draws preferential funding from the government’s general revenues and is not accessible to the majority of patients with cancer in a country like Nigeria? What is the comparative effectiveness, cost/benefit, and appropriate locus of such a strategy within a comprehensive, systematic, and resource-level-appropriate response to cancer in Nigeria? How does such a center serve the cancer problems of the average Nigerian who lives on $2 a day?

Fair and equitable use of limited government resources to provide cancer prevention and care is also a human rights issue and an ethical issue. Access to highly subsidized care by a limited few either because of privileged access to services, resources, or support from general government funds is an injustice to the majority who do not have such access.

Putting in place preventive services requires planning, organization, implementation, monitoring, evaluation, and cost-effectiveness research, none of which are easy or free. There are models that can be used to provide these services efficiently even in a low-resource environment like Nigeria. The Centers for Disease Control and Prevention, Bill and Melinda Gates Foundation, National Institutes of Health, and other organizations are directly and indirectly funding several breast and cervical cancer screening programs in many parts of the country. We need leadership and coordination at the government level to manage different interventions and reduce overlapping coverage in urban centers with little or no coverage of rural areas. While many of these programs have ambitious targets of hundreds of thousands of women screened, compared to the population and the need to cover 70% to 80% of the population, a lot needs to be done in this regards.

Most cancer drugs are available in Nigeria, but the costs are prohibitive, distribution is inefficient, and efficacy is uncertain (in some cases because of unverifiable sourcing/importation while in other cases because of poor supply chain management). The pharmaceutical industry needs to work more closely with hospitals to build demand, ensure efficient and safe distribution of drugs, and support development of specialized oncology services. We need to put in a proper business model to manage cancer care—one that engages the public and private sector and brings some discipline and regulation to the sector.

We should re-visit the application of subsidies for certain sectors of cancer care, especially the aspects of cancer care that are not easy to abuse (e.g., radiotherapy or chemotherapy). Nobody will take an anticancer drug when he does not have cancer just because the drugs have been paid for by the government. However, drugs can be taken from the public to the private sector or sold across the border to other countries where the drugs may cost more. In contrast, the potential to abuse radiotherapy services is more limited.

Development of infrastructure for modern cancer care is probably beyond the ken of most low- or middle-income country governments. This requires strong public-private partnerships, a sustainable business model supported by fair regulatory framework, and judicial support for enforcement of contracts that will ensure that all stakeholders get fair and equitable treatment within the system. Patients would get high-quality, reasonably priced treatment, drug companies are ensured a predictable and stable market for their products, government sees that citizens have access to health care, and oncologists practice high-quality clinical practice and have job satisfaction.

Many patients have been treated and cured of cancer in Nigeria, which we are thankful for, and many more cancers are being prevented. Having said that, many cancers cannot be prevented and are not curable here or anywhere else. We all should continue to do the best we can and support those with cancer with compassion and love. We can also improve our efforts to support medical professionals with education and training, which I will discuss in my next post.

Type 1 diabetes raises risk for certain cancers, study finds

Type 1 diabetes may increase the risk for some forms of cancer but lower the risk for others. This is according to new research published in the journal Diabetologia.

Type 1 diabetes has been linked to increased risk of stomach, pancreatic, liver, kidney and endometrial cancers in the new study.

Type 1 diabetes accounts for around 5% of all diabetes cases, occurring when the pancreas is unable to produce the hormone insulin, resulting in high blood glucose levels, or hyperglycemia.

Study coauthor Dr. Stephanie Read, of the Usher Institute of Population Health Sciences & Informatics at the University of Edinburgh in the UK, and colleagues note that previous studies have suggested that people with diabetes have a 20-25% greater risk of cancer than those without diabetes.

However, they point out that the populations of such studies have primarily consisted of people with type 2 diabetes, given that it is the most common form of diabetes, accounting for 90-95% of all cases. This means the association between type 1 diabetes and cancer is less clear.

"It is possible that the relationship between type 1 diabetes and cancer is different from that observed between type 2 diabetes and cancer as a result of differences in the underlying disease characteristics, drug therapies and patterns of risk factors, such as obesity," the authors note.

As such, Dr. Read and colleagues compared cancer incidence among individuals with type 1 diabetes across five countries, with the aim of gaining a better understanding of the link between the two conditions.

Increased risk of site-specific cancers

The researchers identified people with type 1 diabetes - under the age of 40 - using nationwide diabetes registers from five countries: Australia, Denmark, Finland, Scotland and Sweden. They monitored these individuals for cancer incidence, identifying 9,149 cancers across 3.9 million person-years.

The team linked the data with information from national cancer registries in each country, allowing them to compare the cancer incidence of people with type 1 diabetes with that of the general public.

Looking at overall cancer risk, the researchers found that men with type 1 diabetes were at no higher risk than men without the condition. Women with type 1 diabetes, however, were found to have a 7% greater overall cancer risk than women without type 1 diabetes.

When it came to specific cancers, the researchers found that men with type 1 diabetes were 23% more likely to develop stomach cancer, while women with type 1 diabetes were at 78% greater risk for the disease, compared with the general public.

Both men and women with type 1 diabetes were also at greater risk for cancers of the liver (two-fold for men, 55% for women), pancreas (53% for men, 25% for women) and kidney (30% for men, 47% for women), while women also had a 42% increased risk for endometrial cancer.

Lower risk of prostate, breast cancers

However, the researchers also found that women with type 1 diabetes had a 10% reduced risk of breast cancer, while men with type 1 diabetes had a 44% reduced risk of prostate cancer, which the team says may explain why no increased overall cancer risk was identified among men with type 1 diabetes.

Fast facts about type 1 diabetes

• Around 1.25 million children and adults in the US have type 1 diabetes
• Type 1 diabetes is most commonly diagnosed in children and young adults
• The condition is primarily managed through multiple daily injections with insulin pens or syringes or an insulin pump.

While the authors cannot explain exactly why type 1 diabetes was associated with a lower risk of breast and prostate cancers, they have some theories.

Reduced risk of breast cancer among women with type 1 diabetes in the study may be down to the younger cohort, which consisted of fewer postmenopausal women among whom breast cancer is most common.

The lower risk of prostate cancer identified, the researchers speculate, could be down to lower testosterone levels often found among men with type 1 diabetes.

"Higher testosterone levels were previously shown to lead to an increased risk of prostate cancer, while hyperglycemia has also been shown to inhibit testosterone production," the authors explain.

The researchers also found that the risk of cancer was highest in the first year after a diabetes diagnosis; cancer incidence was 2.3 times higher for both men and women in the 12 months after being diagnosed with type 1 diabetes.

The team suggests that this finding is likely down to identification of pre-existing cancers soon after a diabetes diagnosis rather than a result of diabetes itself, noting that cancers are more likely to be detected when a patient is receiving more medical attention.

For most specific cancers, the risk reduced with increasing duration of type 1 diabetes, though the researchers note that the risk of endometrial cancer for women remained elevated for around 18 years after type 1 diabetes diagnosis.

For men, cancer incidence overall fell to a level comparable to that of the general public after around 20 years of having type 1 diabetes. For women, cancer incidence fell to the level of the general population after 5 years of having type 1 diabetes.

Increased cancer risk 'unlikely a result of insulin therapy'

Previous studies have suggested that insulin therapy may be to blame for increased cancer risk for diabetes patients, but Dr. Read and colleagues say their findings indicate this is not the case.

They explain that if insulin treatment was a key risk factor for cancer, their results would have shown a higher cancer incidence for people with type 1 diabetes than those with type 2, given that a significantly smaller number of people with type 2 diabetes are treated with insulin.

"Furthermore, the absence of an association between overall or site-specific cancer risk and increasing duration of diabetes in our study does not support a dose-response relationship between exogenous insulin use and cancer incidence," they add.

Instead, the researchers suggest the observed increased risk of certain cancers among people with type 1 diabetes may be down to shared metabolic deficiencies in people with type 1 and type 2 diabetes, such as high blood glucose levels.

"Hyperglycemia may be a plausible explanation given the identification of a dose-response relationship between glycated hemoglobin levels and the risk of certain cancers," they explain.

While these findings shed light on the association between type 1 diabetes and cancer risk, the authors say the results "do not support changing the policy for screening in persons with type 1 diabetes." They add:

"Similar recommendations for lifestyle approaches to reduce cancer risk such as weight management, increasing physical activity and avoiding smoking apply to persons with type 1 diabetes as for the general population.

Future work should be directed at ascertaining whether the increased incidence of some cancers among persons with type 1 diabetes leads to a raised risk of cancer mortality among persons with type 1 diabetes."

Source: Medical News Today

Can one still enjoy fertility after undergoing cervical cancer treatments?

By Eranga Isaac

Eranga Isaac is author of the book -
Understanding Basic Facts About Breast And Cervical Cancers

Treatment for cervical cancer often involves removing the uterus and
may also involve removing the ovaries, ruling out a future pregnancy.

However, if the cancer is caught very early, you still may be able to have children after surgical treatment.

A procedure called a radical trachelectomy can remove the cervix and part of the vagina while leaving the majority of the uterus intact.

Contact the author via isaac_editorial@yahoo.com
+2348059233001

What is Cervical Cancer? By Eranga Isaac - Breast and Cervical Cancers Author

According to the International Agency for Research on Cancer (IARC),
each year there are estimated 493,000 new cases of cervical cancer and
274,000 deaths globally. Cervical cancer occurrence in more developed
regions is 17 percent while in less developed regions, it is 83
percent. Cervical cancer is one of the diseases that affect the poor
excessively.

According to Global Health E-Learning Center, Cervical cancer occurs
when abnormal cells develop and spread in the cervix, the lower part
of the uterus. A unique fact about cervical cancer is that most cases
are triggered by a type of virus known as Human Papillomavirus (HPV).
When found early, cervical cancer is highly curable. The disease
progresses gradually from the time of infection with the virus, and
may take 15 to 20 years for cancer to develop.

The cervix is subject to a lot of stress during labour and delivering,
which appear to account for increased cervical cancer risk. The cervix
is also subject to micro trauma during sexual intercourse.

Foods that promote and prevent cancer By Isaac Eranga - a health journalist

According to the Dietitian of the Dietitics and Nutrition Unit,
General Hospital Onitsha- Mrs. Ngozi Okolo, the following food below
promotes or causes cancer:

1- Red meat such as fried red meat, grilled or barbecued meat (Suya),
ham, bacon, sausages, hot dogs, over cooked meat, etc.

2- Excess consumption of fat particularly from animal sources such as
meats, eggs, milk, etc.

3- Smoked, pickled, salted or highly spiced foods or meat.

4- Alcoholic beverages such as beer, stout, wine, liquors, coffee,
tobacco (cigarette, snuff).

5- Excess consumption of refined food products such as commercial
baked foods, refined sugars, sugary carbonated soft drinks, chocolate,
etc.

6- Saturated animal fat (butter), high calorie foods, acid (margarine).

7- Consumption of fried foods.


Foods that prevent cancer

1- Fruits particularly the citrus such as oranges, pineapples, apples,
grapes, pawpaw, mangoes, etc.

2- Vegetables - green leafy vegetables, carrots, cabbages, tomatoes,
onions, garlick, etc.

3- Legumes such as soy, tofu, soy milk, beans.

4- Vegetable oils such olive oil.

5- Whole grain cereals-bread and pasta (not refined), rice, rye, oats,
barley, etc.

6- Fermented dairy products such as the yoghurt.

7- All fibre containing foods.

Breast and Cervical Cancers Memo

The disease burden of breast and cervical cancers has brought
excruciating pains to the live and homes of many; it has caused
perpetual trauma and endless untimely deaths among people both at the
higher and lower classes of the society. Research shows that large
number of persons are still very much ignorant about the causes and
prevention of breast and cervical cancers.

It was this massive ignorance that prompted a Public Health
Communication Expert - Eranga Isaac to write a book on breast and
cervical cancers.

Breast and cervical cancers are preventable and curable when detected
in an early stage. Most of the cases of these diseases are discovered
late when treatment is less effective.

To get copy of the book "UNDERSTANDING BASIC FACTS ABOUT BREAST AND
CERVICAL CANCERS", call Isaac on +2348059233001 or email at
isaac_editorial@yahoo.com

Eranga Isaac is a member of the Global Health Network and is a
professional Health Journalist based in Edo State Nigeria.

Understanding Skin Cancer

SKIN CANCER GALLERY

        Skin cancer is by far the most type of cancer. All skin cancers can be treated effectively if they are found early, so knowing what to look for is important.
       There are many types of skin cancer, each of which can look different on the skin.
       This picture gallery contains some examples of the common types of skin cancer, as well as some other non cancerous types of skin growths. but skin cancers can look different from these examples.
       This is why it's important to see a our doctor in any other reason and treatment.