By Abiose Adelaja Adams

Experts at the Lagos University Teaching Hospital, Idi Araba, have said that one of the major setbacks in breast cancer diagnosis and treatment is the lack of multidisciplinary cancer specialists in Nigeria.

Breast cancer is the commonest cancer afflicting women, with one-in-eight women at risk, and one-in-25 dying from it annually, according to World Health Organization, WHO.

Though without a known cure, early detection, accurate laboratory diagnosis and a coordinated intervention by specialists can improve standard of treatment and increase the number of survivors.

In the treatment of cancer, a team of four oncologists (cancer specialists) namely the surgical, radiation, pathological and medical oncologists, are needed, but a Radiation Oncologist at Lagos University Teaching Hospital, (LUTH), Lola Salako, says this is lacking in Nigeria.

“We have no medical oncologists in Nigeria. Yet they are very key because, when we (Radiation Oncologists) are done with radiation, we hand over to them to administer chemotherapy. But in the absence of this, the surgical oncologists assumes the role of a medical, but this is not the ideal situation and it can affect treatment outcomes,” he said.

Salako, who spoke at a media training in preparation for the breast cancer awareness month every October, observed that there were only 15 radiation oncologists in Nigeria, until recently when federal government sent more doctors for training.
This, he said, “explains why cancer patients prefer to seek medical care in countries like India.”

In the same vein, a consultant Cancer Pathologist, a Adetola Daramola, relating this to the international best practices said that no one person makes a single decision about cancer, because no one person has the full knowledge to manage a cancer.

“Having a multidisciplinary team is the way to go in the treatment of cancer patient. Until when we all talk, before we can have a formal decision about management,” she said.

“What is obtainable abroad is that every week, it is part of the management policy for the consultants to sit to have an official meeting before any verdict is given. In some Nigerian hospitals, it is done but not as a rule here, not official.”

She lamented that “it is in a developing country like ours that you see the surgical oncologist doing the biopsy, doing the radiation, and the chemo and taking all decisions, this affects the treatment outcomes, and that is why we are a developing country.”

She traced this shortfall to the underfunding of the health sector which makes government not put enough money for cancer research, treatment and capacity building of professionals.

“A lot of us are training ourselves,” she says.

The diagnosis of cancer in Nigeria is also fraught with infrastructural issues such as power supply and the experience and skill of the professionals taking the biopsy (cancer test).

Drawing from the example of Dora Akunyili, former minister of Information, who was initially diagnosed of cancer in Nigeria but told by foreign doctors it was not cancer, Daramola said that if multiple opinions had been sought, the cancer could have been nipped, but it killed her almost 2 decades later at full blown stage.

“It is possible that the sample tested in Nigeria contain the cancer cells, while the one tested abroad do not yet have the cancel cells. It therefore behooves the oncologists to be highly skilled,” she added.

Yet another setback is the issue of late detection and high cost of treatment. Clinical experience and evidence-based research across several tertiary hospitals have shown that Nigerian women report to the hospital when cancer has reached an advanced stage.

According to a study by A.T. Ajekigbe of the department of Radiation Biology, LUTH, 87 per cent of Nigerian breast cancer patients report to the hospital at the third and fourth stage of cancer advancement.

It is important to note that at these latter stages, it is almost too late to cut it out because in stage 3, the cancer is said have spread to the lymph nodes and the skin, while at stage 4, it spreads to the liver, kidney, lungs and heart and an eventual organ failure leading to death.

Reasons for late clinical presentations range from the woman’s lack of awareness, lack of knowledge on how to conduct the self-breast examination, living in denial, patronizing alternative medicine, financial difficulty, as well as poor cancer care delivery service in Nigerian hospitals.

Salako, who is also a member of the board of trustees of Sebeccly Cancer Care and Support Center believes that in spite of this, “ten per cent of breast cancer cases can be detected and treated. If this 10 per cent can be detected, then why do we let them die of it.”

Comparing notes with western medicare she reasoned: ‘If we have 40 breast cancer patients in Africa, and 200 breast cancer patients in America, 40 will die in America, while all 40 in Africa will die. So you see them having more incident, but less fatalities and more survivors, but in Africa, you have fewer cases and more deaths.”

“This is unacceptable. We should give every patient the chance of surviving through treatment.”

Talking about treatment, she said that a one stop treatment model is needed. By this she explained that it should be a policy never to let any patient who seeks medical help from cancer,(especially at the early stages), be sent away to carry out tests at another hospital because when such patients come back, the cancer would have been full blown or they are dead.

“There should be a dedicated breast cancer hospital where a woman can do the tests, be counseled, monitored, and it should be at subsidized price too,” she offered.

A 30-year old breast cancer survivor, Veronica Okafor, told www.icirnigeria.org how the high cost of cancer treatment impoverished her relatives at the time she was diagnosed three years ago, until help came from Sebeccly Cancer Care and Support Center.

“It affected my fiance’s business, we closed down two shops and rented it out, as I was spending hundreds of thousands on radiotherapy,” she lamented.

There are four cancer sub types, but compared to the sub types common in white women, the one amongst African women are clinically proven to be extremely aggressive with the worst pathologic features and outcomes. It attacks women in their late 20 and 30s, unlike in white women where it is seen in older women in their 50s, 60s.

Risk factors

Cancer is caused by damage to the cells which results in an inexplicable and uncontrolled proliferation of malignant cells. Having a family history of breast cancer is said to be accountable for 10 per cent of all cancer cases. Other factors are westernized diet, increased weight, exposure to ionizing radiation, insecticides, alcohol, food low in fibre content, having the first child after age 30, women with no children, usage of deodorant, especially those containing aluminum.

Although there is a need for research on cancer sub type in African women for newer and effective treatment, nevertheless, treating of cancer in Nigeria still remains the orthodox way of radiation, and chemotherapy, which are not without side effects.