“Let’s talk Nigeria and the mass hysteria” – Alicia Keys

2024 marks the final year of the World Cancer Day campaign ‘Close the Care Gap’. This annual global call to action unites humanity to prioritize life-saving cancer care and to eliminate health inequities. The focus of the 2024 campaign is “Together, we challenge those in power” to shake the very foundations of injustice—to become lifelong advocates fully equipped to push for lasting change.

Cancer is a major public health priority and leading cause of death globally. It is a major cause of geographic, racial, social and gender inequality. causing 1 in every 6 deaths and affecting almost every household (1 in 5 persons diagnosed globally). WHO estimates that worldwide there were 20 million new cases and 9.7 million deaths from cancer in 2022. The global cancer burden is projected to increase by about 77% by 2050. Sadly, cancer places its heaviest burden on developing countries like Nigeria, where more than 60% of the world’s total new annual cases and over 70% of cancer deaths occur, yet only 5% of global spending in cancer care takes place in these countries.

The cancer situation in Africa is disheartening. In 2022, 1,173,771 new cancer cases occurred on the continent, with 756 531 deaths. Cancer deaths in Africa is projected to reach about one million per year by 2030. This is so because cancer survival rates in Africa is currently only 12%, compared to over 80% in High-Income Nations. Nigeria is the number one contributor to these dismal statistics.

The major risk factors for cancer include tobacco use, obesity/overweight, physical inactivity, unhealthy diets, and air pollution. Some infections can also predispose to cancer, including hepatitis B and C (which affect the liver) and human papillomavirus - HPV (which affects several parts of the body including the cervix, throat, mouth, anus, scrotum among others). Although hepatitis B and HPV can be easily prevented via vaccination, these infections are still prevalent in Nigeria, which explains why cervical and liver cancers are among the top five (5) causes of cancer deaths in Nigeria.

Lung cancer was the most common cancer worldwide in 2022, with 2.5 million new cases (12.4% of new cases). Breast cancer ranked second (2.3 million cases, 11.6%), followed by colorectal (1.9 million cases, 9.6%), prostate (1.5 million cases, 7.3%), and stomach cancers (970 000 cases, 4.9%).

There were about 127,763 new Nigerian cancer cases in 2022 (48,096 cases in men and 79,667 in women). The five most common cancers were breast (25%), prostate (14%), cervical (10%), colorectal (6.4%) and Non-Hodgkin lymphoma (4.1 %) cancers. These five account for over 60% of Nigeria’ new cancer cases. In 2022, there were 79,542 cancer deaths in Nigeria, with more women (46,637 deaths) dying than men (32,905 deaths). The "Big Five" cancers which cause the most death in Nigeria are Breast cancer which is the leading cause of cancer death in Nigeria (16 332 deaths, 20.5% of the total cancer deaths) followed by prostate cancer (11,443 deaths, 14.4%), cervical cancer (7,093 deaths, 8.9%), colorectal cancer (5,912 deaths,7.1%) and liver cancer (4,252 deaths, 5.3%).

Cancer patients in developing countries have a much higher risk of dying due to late diagnosis and poor access to quality treatment. “WHO’s new global survey sheds light on major inequalities and lack of financial protection for cancer around the world, with populations, especially in lower income countries, unable to access the basics of cancer care,” said Dr Bente Mikkelsen, WHO Director for Noncommunicable Diseases. “Despite the progress that has been made in the early detection of cancers and the treatment and care of cancer patients–significant disparities in cancer treatment outcomes exist not only between high and low-income regions of the world, but also within countries. Where someone lives should not determine whether they live. Tools exist to enable governments to prioritize cancer care, and to ensure that everyone has access to affordable, quality services.

Nevertheless, each of us can make changes to reduce our risk of developing cancer, since 50% of cancers can be prevented by lifestyle modifications such as: avoiding smoking, reducing the intake of processed foods and increasing intake of fruits and vegetables, exercising regularly, and keeping up with recommended screenings and vaccinations.

Furthermore, cancer is often totally curable when detected and treated early. Although most cancers have no symptoms in the early stages, some screening tests such as mammography (for breast cancer) and PSA test (for prostate cancer), can detect cancer even when it is not obvious. This both reduces the burden of dealing with late-stage cancers and increases the chances of successful treatment. Indeed, cancer screening programmes have great potential to improve cancer outcomes. When organized effectively and quality-assured, they can reduce mortality and even prevent certain cancers like cervical and colorectal cancer – two major causes of needless cancer deaths in Nigeria.

To this end, the current focal cause of ↓↑GivingTide is the BIG WAR Against Cancer, which is operated by the National Cancer Prevention Programme (NCPP), a nongovernmental initiative of mass medical mission. Since 2007, NCPP has spearheaded community-based cancer prevention across Nigeria. In 2017, a fleet of Mobile Cancer Centres (MCC) was acquired and deployed, to scale up the reach and impact of the programme. The ultimate goal of the project is to establish a Comprehensive Cancer Centre (CCC) in Nigeria. To achieve this goal, major investments of resources are urgently needed.

A CCC is the only institution that can optimally tackle all the spectrums of cancer care. The CCC is NOT a hospital with a radiotherapy machine. Rather, it is a world-class, stand-alone tertiary health institution, with all its units focused on cancer care. The CCC houses first-class cancer research, preventive, curative and palliative care in one place resulting in better outcomes across a range of measures – including, most importantly, cancer survival. They serve as guiding institutions for all aspects of cancer control and are instrumental in operationalizing the cancer goals of countries.

In this regard, most nations are ahead of Nigeria. For instance, India has over 200 CCC - most of which are philanthropy-funded non-profits. African nations that have CCC include Egypt, Uganda, Tanzania, South Africa, Kenya and Sudan. Nigeria has no CCC, therefore while other nations work towards “closing the care gap”, our herculean task in Nigeria amounts to bridging an ever-widening chasm.

Cancer is the most expensive disease to treat. Therefore, the fact that Nigeria has no Comprehensive Cancer Centre is a major reason why Nigerians spend over one billion dollars on foreign treatment annually. This amount is sufficient to establish twenty (20) CCC every year! Unfortunately, most Nigerians who go abroad for treatment end up dying, often because of delays in diagnosis and even worse delays in treatment. Moreover, unforeseen situations (such as happened during the COVID-19 lockdown) may make it impossible to go on medical tourism, even if one could afford it.

Alicia Keys is the queen of songs with a message. Starting her music career in her teens, her songs always seemed wiser than her age. Alicia is the rarest kind of musical genius - a classically trained pianist who has won 15 Grammys and been named Billboard’s number one R&B artist of the 2000s decade. In 2014, Alicia released a rallying song titled ‘We are here’ in which she gave a striking (if unflattering) diagnosis of Nigeria’s systemic failure. Her diagnosis (mass hysteria) is in sync with the “Zombi” or ‘Suffering & Smiling’ ethos which Fela sang about thirty years earlier.

↓↑GivingTide believes that a few inspired, passionate, and dedicated heroes can help Nigerians to shake off the endemic ‘mass hysteria’ which has put the most populous black nation at the bottom of nearly all developmental sectors, including health and cancer care. Nigeria desperately needs heroes like Sir Dorab Tata and Mrs. Mazumdar Shaw (founders of India’s first and the largest Cancer Centres respectively); heroes like the founders of Sloan Kettering Cancer Center in New York (the first Cancer Institute in USA). The best way to nudge Nigerians away from the indolence of “mass hysteria” is to show them the still more excellent way. In line with the focus of WCD 2024, we can “challenge those in power” only if we lead by example. There is no alternative.

WCD 2024 is an opportunity for us to make a commitment to support the innovative strategies of ↓↑GivingTide designed to confront the entrenched and recalcitrant inequities of Nigeria, including inequity in cancer care. Addressing the root causes of these inequities will ensure that everyone can have access to quality health services when, where and how they need them. Together, we can!

•Dr. Abia Nzelu (Executive Secretary, ↓↑GivingTide Int’l); can be reached via info@givingtide.org

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