Dr. Onwufor Uche [MB.BS, F WACS] is a Consultant Obstetrician/Gynecologist and Executive Director, Gynae Care Research and Cancer Foundation [GRCF], a registered NGO based in Abuja, Nigeria. He had his postgraduate training at the University of Benin Teaching Hospital (U.B.T.H.) where he spent two years in the Oncology Department of the Hospital and was planning to travel overseas for Specialist Training in Gynecological Oncology.
However, while in training he noticed with dismay the alarming death rate in cancer patients and the fact that more than 80% of these patients present in advanced stages of the disease, when only palliative (end of life care) is possible. Majority of these patients never had any form of screening to pick up these cancers in the precancerous stages as most of them lacked awareness about cancer and its predisposing factors. He also noted that our cancer centers were not properly equipped with the facilities for managing the increasing number of cancer cases in Nigeria. In 2013, he travelled to Dubai for a course in Cancer prevention and this sparked off a desire in him to establish an organization to increase public knowledge about the several cancers and how they can be prevented. He does this through advocacy, conducting free medical outreaches to religious organizations, corporate organizations, schools and communities. Medical screenings for cancers are also carried out during these outreaches.
What are the causes of cervical cancer?
Cervical cancer is caused by the Human Paploma Virus. 100% of patients who have had cervical cancer had virus found in them. The Human Paploma Virus is not the same as HIV. It is the commonest virus around which is sexually transmitted; men transmit it to women, women can transmit it to men but for the women the HPV could lead over time from 10 – 20 years to cervical cancer. The bad part is that this HPV doesn’t just cause cervical cancer it can also cause cancer of the vagina, the vulvae, the anus and the throat. Another cause of cervical cancer which we call risk factor is early age of sex. So if a woman has started having sex like around age of 12 or 13, it is a risk factor. Multiple sexual partners are risks. Having too many kids is also a risk. Some people talk about the hormonal contraceptives which are also risk factors for cervical cancer but the main risk have been tied to the Human Paploma Virus
.
Do you carry out treatment free as well?
For now we have had people on follow up. Our vision is to administer the treatment free especially to those who can’t pay but the screening is free. Voluntary support is also welcome. For the treatment we are planning to introduce a little fee to help us recuperate and hoping that when we get enough funding we will make it free for as many who can’t pay for it and of course for those who can pay we will charge a nominal fee that they won’t get anywhere else.
What is the link between cervical cancer and HIV/AIDS?
HIV/AIDS reduces the immunity of an individual to fight infections. In clients who have HIV it is possible they have also been infected with the HPV and if they have been infected with the HPV the body’s immune system won’t be able to respond adequately to the HPV so in this person cervical cancer develops faster. Actually cervical cancer is one of the 8 defining criteria; you have a patient with HIV having cervical cancer then it is AIDS already so that is the link, the immune system going down may not be able to fight the Human Paploma Virus
. Like I said most of us will be able to clear out the virus if the immune system of the body is intact but in HIV patients the ability of the immune system been able to fight the virus is reduced so they are more at risk of cervical cancer and that is why HIV patients should actually have a specific program where they go for screening regularly more than the normal population because they have an increased risk of developing the cancer
What is the surviving rate of patients with cervical cancer?
The survival rate depends on the stage at presentation. At stage 4 up to 70 percent of them will be dead in the next 5 years. The more advanced the stage the less the chances of survival and that is why we keep saying that if you can pick it up on time something can be done about it. Most of our clients come in when the cancer is advanced and it is only palliative care you can carry out; end of life care to make life more tolerable; reduce pain, diagnosis and all that, just to help the person die with less pain. Can cervical cancer be treated with chemotherapy? Usually at the early stage you can remove the uterus and do what we call chemo radiation but at the advanced stages they are usually difficult. I think the opinion of people differ depending on their level of exposure and where they were trained and their experience also but basically one of the ways of treating cervical cancer is what we call chemo radiation drugs and radiotherapy to manage it. We have done that with some good effect but like we said most of the drugs we get are from India where you don’t have control over the actual dosage of the drugs because there are cheaper and affordable for the patient most times the patient goes for it.
On the recent awareness of cancer in the country, has there been any improvement on people turning out for tests? I will say yes and no. Urban population still has 80% of women who have never had any form of screening. It is worse in the rural areas. I know national hospital did that some time ago, Garki did that they had some funding for that but we still carried some outreach and people where still not aware and some who were aware felt maybe it was not convenient for them going there that they may have to pay. Some things are involved like the lack of trust for the health care system which I’m sure makes people shy away from going for such screening. For some persons they may have some cultural beliefs, religious beliefs and all that. So for us it is an uphill task, we still have many who need to do screening. I also think there will be need for women advocates to go into this, religious leaders should also talk about these things. Recently when we go on air to announce for people to come we have 80% of the callers who are men asking for information for their wives and most of these women finally turn up so if the men get involved especially the Muslim men their women will come for such and the turn out will be better.
Cancer treatment is expensive and many poor people explore herbal treatment, is there any herbal cure we speak? Cancer is something that happens to anybody; rich and poor but when you talk about the treatment yes it is quite expensive. In some places three weeks treatment of cancer can cause almost half a million naira and we are talking of a country where most times our machines are breaking down so we find most of our clients travelling out and when they come back they tell you the amount is in six digits, running into millions.
The herbal medications are upcoming and I think where they have a problem is they have not passed all the stringent rules that the orthodox drugs have passed through because in formulating a drug it goes through physics of development; they test it, they know the side effects, they know the active components and know how much a patient can take but with the herbal drugs there are usually no dosages, they haven’t passed the stringent processes like the orthodox drugs and I won’t say I would recommend it because we are not sure they are treating what you say they are treating. And now we are also talking about not only treatment but also preventive options. Do you see that option as remedy? Yes. Preventive care is still the best because like cervical cancer up to 95% cases of it can be prevented. There are vaccines now and if you vaccinate all the young girls before they start engaging in sex you reduce the rate by 50% already. But the issue is this, the vaccines are a little bit expensive and they are not free. Secondly if every woman does her screening we can reduce the rate because we pick up those who have the virus and they can be treated and the treatment is much cheaper than going for treatment of cancer. So with the pre cancer it can be treated with less than 30,000 naira and it won’t need to progress to cancer. How many Oncologists do we have in Nigeria? Presently I won’t have the full statistics but put it to about 250 and that is a country where we have 48 million women who are above the age of 15 so it is quite frightening and the number of cancer cases … like cervical cancer alone we have 14,000 cases every year and 10,000 women dying from it every year and part of the reason is because we don’t have centres. We just have six centres and about three years ago the government came up with the news of creating about 10 more centres but we are still waiting and we are still hopeful that those centres will function.
Do you see the rate of cancer increasing or decreasing?
The international cancer centres has predicted an increase in cancer rate. Like cervical cancer there is an increase in HPV sexually transmission, girls are becoming sexually active quite early so we expect an increase in rate and then there is an increase in population and we don’t have facilities on ground to cater for them health wise, there is no culture of screening. In some hospitals they don’t carry out screening for cervical cancer. You have to go to another hospital to get that and then environmental factors are coming too. We have a lot of radiation around now, sedentary life style is also a threat and of course we talked about environmental degradation, environmental pollution from cars, we are buying a lot of second hand cars, the fumes and damage to the system is much.
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However, while in training he noticed with dismay the alarming death rate in cancer patients and the fact that more than 80% of these patients present in advanced stages of the disease, when only palliative (end of life care) is possible. Majority of these patients never had any form of screening to pick up these cancers in the precancerous stages as most of them lacked awareness about cancer and its predisposing factors. He also noted that our cancer centers were not properly equipped with the facilities for managing the increasing number of cancer cases in Nigeria. In 2013, he travelled to Dubai for a course in Cancer prevention and this sparked off a desire in him to establish an organization to increase public knowledge about the several cancers and how they can be prevented. He does this through advocacy, conducting free medical outreaches to religious organizations, corporate organizations, schools and communities. Medical screenings for cancers are also carried out during these outreaches.
What are the causes of cervical cancer?
Cervical cancer is caused by the Human Paploma Virus. 100% of patients who have had cervical cancer had virus found in them. The Human Paploma Virus is not the same as HIV. It is the commonest virus around which is sexually transmitted; men transmit it to women, women can transmit it to men but for the women the HPV could lead over time from 10 – 20 years to cervical cancer. The bad part is that this HPV doesn’t just cause cervical cancer it can also cause cancer of the vagina, the vulvae, the anus and the throat. Another cause of cervical cancer which we call risk factor is early age of sex. So if a woman has started having sex like around age of 12 or 13, it is a risk factor. Multiple sexual partners are risks. Having too many kids is also a risk. Some people talk about the hormonal contraceptives which are also risk factors for cervical cancer but the main risk have been tied to the Human Paploma Virus
.
Do you carry out treatment free as well?
For now we have had people on follow up. Our vision is to administer the treatment free especially to those who can’t pay but the screening is free. Voluntary support is also welcome. For the treatment we are planning to introduce a little fee to help us recuperate and hoping that when we get enough funding we will make it free for as many who can’t pay for it and of course for those who can pay we will charge a nominal fee that they won’t get anywhere else.
What is the link between cervical cancer and HIV/AIDS?
HIV/AIDS reduces the immunity of an individual to fight infections. In clients who have HIV it is possible they have also been infected with the HPV and if they have been infected with the HPV the body’s immune system won’t be able to respond adequately to the HPV so in this person cervical cancer develops faster. Actually cervical cancer is one of the 8 defining criteria; you have a patient with HIV having cervical cancer then it is AIDS already so that is the link, the immune system going down may not be able to fight the Human Paploma Virus
. Like I said most of us will be able to clear out the virus if the immune system of the body is intact but in HIV patients the ability of the immune system been able to fight the virus is reduced so they are more at risk of cervical cancer and that is why HIV patients should actually have a specific program where they go for screening regularly more than the normal population because they have an increased risk of developing the cancer
What is the surviving rate of patients with cervical cancer?
The survival rate depends on the stage at presentation. At stage 4 up to 70 percent of them will be dead in the next 5 years. The more advanced the stage the less the chances of survival and that is why we keep saying that if you can pick it up on time something can be done about it. Most of our clients come in when the cancer is advanced and it is only palliative care you can carry out; end of life care to make life more tolerable; reduce pain, diagnosis and all that, just to help the person die with less pain. Can cervical cancer be treated with chemotherapy? Usually at the early stage you can remove the uterus and do what we call chemo radiation but at the advanced stages they are usually difficult. I think the opinion of people differ depending on their level of exposure and where they were trained and their experience also but basically one of the ways of treating cervical cancer is what we call chemo radiation drugs and radiotherapy to manage it. We have done that with some good effect but like we said most of the drugs we get are from India where you don’t have control over the actual dosage of the drugs because there are cheaper and affordable for the patient most times the patient goes for it.
On the recent awareness of cancer in the country, has there been any improvement on people turning out for tests? I will say yes and no. Urban population still has 80% of women who have never had any form of screening. It is worse in the rural areas. I know national hospital did that some time ago, Garki did that they had some funding for that but we still carried some outreach and people where still not aware and some who were aware felt maybe it was not convenient for them going there that they may have to pay. Some things are involved like the lack of trust for the health care system which I’m sure makes people shy away from going for such screening. For some persons they may have some cultural beliefs, religious beliefs and all that. So for us it is an uphill task, we still have many who need to do screening. I also think there will be need for women advocates to go into this, religious leaders should also talk about these things. Recently when we go on air to announce for people to come we have 80% of the callers who are men asking for information for their wives and most of these women finally turn up so if the men get involved especially the Muslim men their women will come for such and the turn out will be better.
Cancer treatment is expensive and many poor people explore herbal treatment, is there any herbal cure we speak? Cancer is something that happens to anybody; rich and poor but when you talk about the treatment yes it is quite expensive. In some places three weeks treatment of cancer can cause almost half a million naira and we are talking of a country where most times our machines are breaking down so we find most of our clients travelling out and when they come back they tell you the amount is in six digits, running into millions.
The herbal medications are upcoming and I think where they have a problem is they have not passed all the stringent rules that the orthodox drugs have passed through because in formulating a drug it goes through physics of development; they test it, they know the side effects, they know the active components and know how much a patient can take but with the herbal drugs there are usually no dosages, they haven’t passed the stringent processes like the orthodox drugs and I won’t say I would recommend it because we are not sure they are treating what you say they are treating. And now we are also talking about not only treatment but also preventive options. Do you see that option as remedy? Yes. Preventive care is still the best because like cervical cancer up to 95% cases of it can be prevented. There are vaccines now and if you vaccinate all the young girls before they start engaging in sex you reduce the rate by 50% already. But the issue is this, the vaccines are a little bit expensive and they are not free. Secondly if every woman does her screening we can reduce the rate because we pick up those who have the virus and they can be treated and the treatment is much cheaper than going for treatment of cancer. So with the pre cancer it can be treated with less than 30,000 naira and it won’t need to progress to cancer. How many Oncologists do we have in Nigeria? Presently I won’t have the full statistics but put it to about 250 and that is a country where we have 48 million women who are above the age of 15 so it is quite frightening and the number of cancer cases … like cervical cancer alone we have 14,000 cases every year and 10,000 women dying from it every year and part of the reason is because we don’t have centres. We just have six centres and about three years ago the government came up with the news of creating about 10 more centres but we are still waiting and we are still hopeful that those centres will function.
Do you see the rate of cancer increasing or decreasing?
The international cancer centres has predicted an increase in cancer rate. Like cervical cancer there is an increase in HPV sexually transmission, girls are becoming sexually active quite early so we expect an increase in rate and then there is an increase in population and we don’t have facilities on ground to cater for them health wise, there is no culture of screening. In some hospitals they don’t carry out screening for cervical cancer. You have to go to another hospital to get that and then environmental factors are coming too. We have a lot of radiation around now, sedentary life style is also a threat and of course we talked about environmental degradation, environmental pollution from cars, we are buying a lot of second hand cars, the fumes and damage to the system is much.
