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An Address Delivered by Her Excellency, Betty Anyanwu-Akeredolu at the Multidisciplinary Cancer Management Course Organized by Society of Oncology and Cancer Research of Nigeria (SOCRON) and American Society of Clinical Oncology (ASCO); 13th of July, 2019.

Ladies and gentlemen, I am most delighted to be in the midst of great minds who have dedicated a good part of their time to proffer innovative solutions to Cancer care the world over. Seeing women and men come together from different yet related fields of life in an attempt to improve cancer outcome in Nigeria is indeed commendable and I am saying a big thank you to SOCRON and ASCO for facilitating this meeting.

I have spent three days from my packed-tight schedule with you all in this room and I must confess to you all that I do not regret making the decision to honor this invitation. I have always believed and continue to believe that to end cancer, all hands must be on deck; meetings must be held, deliberations must be made, collaborations must be formed, but above all, we must walk the talk. It is not an easy task to host a prestigious meeting like this – bringing experts from different parts of the world. It is however quite easy to forget all the discussions and deliberations made in this meeting.

Hence, I am using this opportunity to urge everyone here today to see that this meeting translates to improved breast and cervical cancer outcomes in Nigeria.
A lot has been said over the past three days which I consider very illuminating and resourceful in the fight against cancer, I will however put a few things to the fore here as we continue to strategize on context-appropriate approaches to improving cancer care and control in Nigeria. I would not like to bore you with statistics in attempt to elicit the burden of breast and cervical cancer since virtually everyone in this room is some sort of an expert in cancer.

I will however crave your indulgence to remind you again that we have very little sleep time if we have any at all, considering the fact that every single day in Nigeria, 39 women are diagnosed of cervical cancer most of which occurs at the late stage while another 22 women die on that same day. The statistic is even worst for breast cancer which kills 36 women daily. These are our mothers, our sisters, daughters; it could even be me or one of your cherished friends. Knowing we share in this great tragedy, we are left with no choice than to never sheath our swords until breast and cervical cancer case fatality drops to almost zero.

Now the question is how do we fight? We must first recognize that most factors impeding positive breast and cervical outcome are multi-faceted yet integrated. It is therefore important to apply a holistic approach to breast and cervical cancer programming. Addressing an aspect of the continuum in isolation will in many cases yield very little positive result. Creating awareness without addressing the issue of patient navigation and quality cancer care services will render our awareness almost useless.

The problems are indeed integrated and must be addressed using a holistic approach. To achieve any remarkable success in cancer care we must consider all aspects from detection to treatment. Permit me to briefly share few of my thoughts on how I think we should approach cancer control and care in Nigeria with emphasis on breast cancer.
Starting with detection, you will agree with me that it is both intuitively and scientifically correct to assert that early diagnosis of cancer can significantly improve cancer outcomes and patients survival. To go by evidence, M. A. Richards, in his work which was titled “The size of the prize for earlier diagnosis of cancer in England”, noted that between 5000 and 10 000 deaths within 5 years of diagnosis could be avoided every year in England if efforts to promote earlier diagnosis and appropriate primary surgical treatment were successful. It is therefore important to proffer context-appropriate strategies to improve early diagnosis in Nigeria. We have been doing a lot of campaign to educate women and men alike on how to conduct breast self-examination and we must not relent at this time.

An additional way to go is routine based population-level screening. Screening of breast cancer must take place at the primary health care facilities. Using Ondo state as an example, there is at least one primary health care facility in each ward. With our current plans to ensure clinical breast examination services are offered at all the primary health centers, we can be sure we will be covering up to 80% of our target population since 85% of pregnant women in the state receive ANC at health facilities and up to 74% have institutional delivery, indicating high patronage of the health facilities by women of reproductive age. The primary health facilities are then required to refer patients with symptoms to the general hospital at the local government for what I will call “first-level diagnosis”. Patients with positive diagnosis are then referred to a well-equipped cancer diagnostic center in the senatorial district to complete diagnosis within a specified time frame. We believe this strategy will significantly increase early detection and presentation of breast cancer in Ondo state.

Talking about presentation, we must actively engage religious leaders who in most cases are either the first point of call or the only point of call for women noticing breast cancer symptoms. This we’ve started doing in Ondo state as we have just commenced a study to understand the knowledge, perception and pastoral practices relating to breast cancer among Christian religious leaders in Akure, Ondo state. We are also set to conduct a similar study among Muslim clerics and traditional healers “babalawo” in collaboration with some researchers from University of Washington by August this year. Aside from understanding the problems associated with delay in presentation from this angle, these studies are also setting the stage for an effective collaboration with these religious leaders to ensure they provide only psychosocial support and referral services rather than make attempts to treat.

In addition, it yields positive result when we get breast cancer survivors to share their stories and provide psychosocial support to women diagnosed with breast cancer. My NGO, Breast Cancer Association of Nigeria (BRECAN), has a team of survivors called “Team Survivor” in many parts of the country and they have been providing psychosocial support to breast cancer patient. The Government needs to invest in this area as well.

It is equally important that we work to improve patient navigation at the health systems level. A sizable proportion of patients are lost to follow-up in the cancer care continuum as a result of the complexity and poor functioning of our health system especially as it relates to cancer care. We must evaluate our health system critically and re-model it to ensure accessibility, affordability and quality in order to curb loss to follow-up. The State ministry of health must take up this responsibility.

To achieve all I have said here, both health providers and civil societies must consciously and conscientiously engage the government at all levels – not federal government alone – to act more responsibly in ensuring the formulation and implementation (I stress the word implementation) of cancer care and control at their respective levels.
Given the low position breast and cervical cancer occupy on the ladder of health priorities in Nigeria, we must not relent in advocating for government to make both forms of cancer a priority and create a budget with adequate funding for its control.

A call to action is now given that both breast and cervical cancer which hitherto were seen as distant diseases are now at our doorsteps causing unimaginable tears and sorrow in many families in Nigeria. Having survived breast cancer for twenty two years and still counting, there is no better poster child to show that breast cancer can be beaten if you take the right steps at the right time. One of such steps is being breast aware, which I strongly believe is the entry point to surviving breast cancer. Yes, we have a lot to do to tame these diseases but we will not quit until breast and cervical cancer case fatalities drop to zero. Given my experience, I can confidently say breast cancer is not a death sentence and it should kill no woman.
Thank you.