Home Women & Child Development Press Release By Her Excellency, Betty Anyanwu-Akeredolu in Commemoration of the 2020 World Cancer Day in Akure, Ondo State; 30th of January, 2020

Press Release By Her Excellency, Betty Anyanwu-Akeredolu in Commemoration of the 2020 World Cancer Day in Akure, Ondo State; 30th of January, 2020

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It is twenty years and we are proud. We are proud of never giving up; through the tears for the ones we lost, through the shared pain with the ones diagnosed, through all the burden and sweat, even then we push on. We are proud; the world is proud. World Cancer Day is 20 years this year and we make bold to say significant gains have been achieved on the world scale. 20 years ago on the 4th of February 2000, World Cancer Day was written into the Charter of Paris Against Cancer. This year is the future we saw 20 years ago, and it is time to take stock and reflect on the achievements we have made over the years.
At the world scale we have made significant progress to understanding some risk factors for breast cancer. In 2015, the International Agency for Research on Cancer (IARC) established convincing evidence of the link between the consumption of red meat and cancer. A year later, IARC linked being overweight and obesity to eight new cancer sites. We also got some wins against Tobacco, a major risk factor for several cancer types. In 2003, the World Health Assembly adopted the Framework Convention on Tobacco Control (FCTC), which was put into force in 2005. Focused on protecting public health and reducing demand for tobacco, it is among the most widely adopted treaties in the United Nation’s history and is a touchstone for public health promotion.
There were also some breakthroughs in cancer treatment.

In October 2018, cancer immunotherapy researchers James P. Allison and Dr. Tasuku Honjo were jointly awarded the Nobel Prize in Physiology or Medicine. Their ground-breaking research on “unleashing the immune system to attack cancer cells” has led to the development of a number of immunotherapy drugs.

The research promises “life-changing possibilities” for those diagnosed with certain types of cancers, and in particular for individuals diagnosed at an advanced stage where the chances of survival are typically lower. In 2006, the first vaccine against the human papillomaviruses (HPV) was approved by the Food and Drug Administration.

The breakthrough vaccine helps to protect against the types of viruses which are responsible for approximately 70% of cervical cancers and pre-cancerous lesions.
Although we have made good progress from the world lens, same accolades cannot be taken when considering sub-Saharan Africa , particularly Nigeria. Nigeria ranks amongst countries with poorest cancer care and control system. Studies have shown that basic breast cancer screenings like clinical breast examination are highly cost effective, yet it is still not generally available at the primary health care level in Nigeria.

On the contrast, Morocco and India which are countries referred to as low-middle income countries like Nigeria have CBE generally available at their primary health facilities. Nigeria has a population that is five times bigger than morocco and about 7 times smaller than India. It implies then that population size did not influence the better cancer control and care system India and Morocco possess in comparison to Nigeria.
Radiotherapy is an important treatment option for cancer patients yet it is not generally available in Nigeria. About 9 radiotherapy centers, most of which are usually not functional for most of the year are available in a country of over 190 million people, whereas Morocco with a population of just about treatment 6 million people has 17 functional radiotherapy centres as of 2014. Although Nigeria has a national cancer plan, it is yet to be implemented and domesticated at the state and local government level.
The federal government is yet to commence any routine based campaign to raise awareness on any form of cancer. Majority of the awareness creation on cancer are organized by non-governmental organisations working around cancer.

Population based cancer registries are equally almost non-existent, making it quite impossible to understand the cancer needs in the country.
It must first be recognized that most factors impeding positive cancer outcome are multi-faceted yet integrated. It is therefore important to apply a holistic approach to breast 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 awareness almost useless. The problems are indeed integrated and must be addressed using a holistic approach. To achieve any remarkable success in cancer care, all aspects from detection to treatment must be considered.

It is both intuitively and scientifically correct to assert that early diagnosis of cancer can significantly improve cancer outcomes and patients’ survival. It is therefore important to proffer context-appropriate strategies to improve early diagnosis in Nigeria. NGOs have been doing a lot of campaign to educate women and men alike on how to conduct breast self-examination and must not relent at this time.

An additional way to go is routine based population-level screening using Clinical Breast Examination (CBE). Whereas mammography-based screening program is the current trend, however, the applicability is limited in low- and middle income countries because of the challenges of poor infrastructure, poverty, and inadequate manpower. Waiting until such capabilities are developed, will lead to continued loss of life as a result of late presentation. We therefore strongly advocates that population-based screening of breast cancer using CBE be adopted as a policy and offered at the primary health care facilities, nationwide. Using Ondo state as an example, there is at least one primary health care facility in each ward. If CBE 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 we 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. This strategy will significantly increase early detection and presentation of breast cancer in Ondo state.

With respect to 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. 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. Breast Cancer Association of Nigeria (BRECAN), has a team of survivors called “Team Survivors Nigeria” in many parts of the country and they have been providing psychosocial support to breast cancer patients. 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.
With a clear understanding that not a single NGO, civil society or government agency can achieve all that I have noted, we took the initiative to come together and join force to improve cancer outcome in Ondo State. Today we have the Coalition Against Cancer in Ondo State. A coalition made up of eleven formidable and concerned organization about cancer. We are sure that together we can do the impossible and bring cancer down to its knees in Ondo state.

Yes, we have a lot to do to tame these diseases but we will not quit until cancer case fatality drops to zero. A call to action is now, given that cancer which hitherto was seen as a distant disease is now at our doorsteps causing unimaginable tears and sorrow in many families in Nigeria.
We must act without delay!

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