Time to nail breast cancer

By Olukorede Yishau

Betty Anyanwu-Akeredolu woke up one day and had no cause to feel anything was wrong with her. She felt great and naturally had no reason to believe anything was amiss with her health. Then, she decided to have her bath. And her world came crashing like a ceiling that caved into a severe storm. It was in 1997. As she was having her bath, her fingers touched something on her. A lump? She told herself it could not be. It was a denial she did not even believe herself. Her emotions ran riot and fear took over her entire being.
For one week, she kept it to herself. She could not share the fear that she had breast cancer with anyone. Not even her husband or family doctor. She was under terrific emotional trauma. Not even her husband’s belief that she was withdrawn could draw her out.
But an angel soon came. The angel came via the a cable show. According to her, "I tuned to cable TV and chose UK living and there was Rolanda’s show tilted "this programme can save your life." It surely did, for it was about breast cancer survivors. That programme gave me what I needed most at that point in time hope that I could be a survivor too. It was the greatest spiritual upliftment I have ever had in my entire life."
She said: "By the following week, I summoned courage and went to an Alumna (University of Nigeria), Dr. Ubah at University College Hospital, Ibadan for palpation. She at last confirmed the presence of a lump. Cold reality. Numb shock. What kind of lump? Benign or malignant? It was rather too early to conclude as biopsy was yet to be carried out. However, it is pertinent to mention that by the time of confirmation of the malignancy, I had gathered myself, shut out emotions and was ready for whatever it would take to make me free of the affliction. My emotional preparedness, I want to believe, helped a lot in dealing with the problem. Without delay, on April 29, 1997, I had surgery at the University College Hospital, Ibadan successfully performed by a most caring team of doctors led by Dr. O.O. Akute (FRCS- Fellow Royal College of Surgeons). The best part of the good news was that my cancer was at stage 1 with the axillary nodes free of cancer cells."
Thanks to Rolanda’s Show, Anyanwu-Akeredolu came out of her quietude. But there are thousands of women and men currently groaning in silence over breast cancer and other forms of cancer in different parts of Nigeria.
Many are confused and find themselves pacing up and down, with beads of perspiration forming beneath their collars. Anyanwu-Akeredolu, who after surviving her ordeal founded Breast Cancer Association of Nigeria (BRECAN), said it is not unusual for people to groan in silence.
"While in the hospital, I noted the generally high level of fear, apprehension and secrecy among breast cancer patients. Nobody wanted to talk about it. Majority of the patients, due to ignorance and poverty were at the late stages of the disease when little help could be given. The lucky ones who had successful treatment shied away from discussing their experience. They simply got treated and walked away with sealed lips. Some that I managed to engage in discussions disclosed that their husbands would never let them go public about their experience with breast cancer, apparently fearing stigmatisation," she said.
It is in order to stop the silence associated with breast cancer that the month of October has been set aside worldwide to create awareness about the disease. In Nigeria, where the pandemic is on the increase, non-governmental organisations working in the area of cancer have used the month to hold events aimed at improving the awareness about breast cancer, the need for government to provide test centers and treatment facilities. Some have also used it to promote the need for legislations, which promote healthy living.
Interestingly, the need to pass the National Tobacco Control Bill, which is before the Senate has also found a space this month. The Senate Committee on Health led by Iyabo Obasanjo-Bello has held a public hearing on it, after it passed the second reading. The passage of this bill automatically means a domestication of the World Health Organisation’s Framework Convention on Tobacco Control (FCTC), a global treaty which Nigeria has ratified and is obligated to domesticate. The FCTC prescribes measures that discourage smoking and promote healthy living.
Though the causes of breast cancer have not been conclusively found, tobacco use is associated with many forms of cancer and causes 90 percent of lung cancer. Tobacco smoke contains over fifty known carcinogens, including nitrosamines and polycyclic aromatic hydrocarbons. Tobacco is responsible for about one in three of all cancer deaths in the developed world, and about one in five worldwide.
This is why the Programme Manager of Environmental Rights Action (ERA), Akinbode Oluwafemi, said it was time the Senate passed the National Tobacco Control Bill.
Akinbode told a press conference that "nobody at the public hearing, including tobacco industry lobbyists contended the lethal consequences of smoking."
He said: "Tobacco currently kills over 5.4 million people annually, over 70 per cent of those deaths occur in developing countries. Also, nobody at the public hearing (again including the tobacco companies) objected to the passage of the bill. The tobacco companies only raised a few inconsequential and unsubstantiated objections to a few provisions. Those objections were roundly defended through our presentations.
"In addition, the Public Hearing was the biggest opportunity to unpack some of the lies being peddled in the media about possible negative consequences of the bill. The bill as appropriately titled is to control tobacco consumption so as to reduce the deaths, ill-health, social, economic and environmental costs associated with tobacco use. The bill has no provision about outlawing or forcefully closing down tobacco factories as being circulated in a section of the media. At the public hearing, the tobacco industry and their agents finally put paid to their widely peddled fairy tale of massive job losses if the nation implement effectives tobacco control laws."
He further explained that "In fact, the British American Tobacco Company Nigeria, the company which controls over 82 per cent of the Nigerian cigarette market, in its presentation at the public hearing, allayed all fears of massive job losses when it disclosed in the presence of distinguished Senators that it has 850 staff. To further debunk the massive job loss propaganda, the Association of Tobacco Wholesalers and Association of Tobacco Retailers put their combined staff strength at about 4,000. Thanks to the public hearing and the Senate Committee on Health, Nigerians now know for a fact that the 300,000 or 500,000 job propaganda is huge lie."
He said the only way forward is that "Senator Obasanjo-Bello and members of the committee should fire at full speed to present the Bill before the Senate plenary. We urge the Senate to complement the success recorded by the Health Committee and the example shown by the Osun State House of Assembly by fast tracking the National Tobacco Control Bill. Nigerians are dying by the seconds due to tobacco addiction while tobacco manufacturers smile to the banks. Every delay is more deaths, more ill-health. Nigerians and indeed the entire world are watching. We are waiting."
While the waiting game continues, experts have pointed out that though women may be more affected, but breast cancer is not exclusive to women. In fact, experts say it kills men faster because they are flat-chested. Statistics from the Nigerian Institute of Medical Research (NIMR) shows that men account for 20 percent of cancer cases in the country. This means one in every hundred men, as against two in every hundred women, are affected by breast cancer.
The statistics are generally glooming. Of all cancer cases that have been recorded in Nigeria, breast cancer is the leading killer, with over 30,000 cases recorded annually. Globally, not less than 400,000 women are lost to breast cancer annually.
No wonder the Executive Director of International Union Against Cancer, Isabel Mortara, said "each year, the number of women diagnosed with breast cancer and dying from it rises and the gap in survival rates between developed and developing countries widens."
It is for this reason that Anyanwu-Akeredolu said: "Cancer in general is a word that strikes fear into the heart of everyone. It is a sure killer if allowed to take control."
Another breast cancer survivor and promoter of Bloom Cancer Care and Support Centre, Dr. Kofoworola Orija, said "our personal experience of breast cancer is indeed a social issue. Every woman battles through her disease so as to bounce back in life striving to be part once more of an inclusive society."
For breast cancer patient, there are stages of cancer, which basically indicate how far cancer cells have spread within the breast to nearby tissue and other organs. Carcinoma in situ refers to the condition when cancer is static in the ducts and has not spread to other organs of the body. It has two types known as Lobular Carcinoma in Situ and Ductal Carcinoma.
Stage 0 is that stage when the cancer cells are still within the duct. By the time it gets to stages 1 and 2, the cancer has invaded nearby tissue. At stage one, the cancer is two centimetres and once it has gone beyond two centimetres, it has entered the second stage and might have spread to the lymph nodes under the armpit. At these two stages, it is not yet critical.
The critical stages begin from stage three when the cancer has grown beyond five centimetres and have spread to the lymph nodes. It is also possible that it would have spread to the chest wall, inside the chest and the skin.
As for stage four, the cancer has invaded the lungs and the bones, aside spreading to the lymph nodes. Both stages three and four are critical.
As a way of catching the lump early and killing it, the American Cancer Society (ACS) recommends annual mammogram from age 40. Mammogram is a test carried out to detect lump. ACS also recommended clinical breast examination every three years for women in their 20s and 30s and older. Also, it advises women to know how their breasts normally feel and report any change to healthcare providers. "Women at risk should talk with their doctors regularly about the benefits and limitations of starting mammography earlier, having additional tests or having more frequent exams," the ACS recommends.
It also prescribes breast self-examination (BSE) for women starting from their 20s.
BSE, says Ebunola Anozie, who is the co-ordinator of Care Organisation Public Enlightenment, is the primary weapon through which cancer can be detected early.
What are you waiting for?

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Letting Loose From The Law

By Banji Adisa

THE report was not supposed to amuse anybody, but that is what it instinctively did. Osun lawmakers had just passed a bill prohibiting smoking in public places - to protect non-smokers from the dangers of smoking. In fact the idea is not novel, neither is it exclusive to the state government because a similar legislation is gathering dust in the archives elsewhere. Looking at the workability of the Osun law, however, the story was unambiguous that the effectiveness of the law is in doubt as the government had not established a mechanism to ensure compliance. That is the crux of the matter, as well intentioned as the law may be.

Taking a cue from global experiences, local environmental rights activists have long engaged the tobacco companies operating in the country in a serious battle aimed at the firms' taking responsibility for health hazards they may bring to bear, directly or indirectly, on the citizens. That at least shows the great danger smokers expose themselves to, more importantly the risk passive or non-smokers face in an uncontrolled smoking environment. (Remember the case of the late legal icon, Chief Gani Fawehinmi, whose terminal illness was linked to inhaling excessive smoke during his confinement in prison in the heady days of his struggles for justice and social order? He never smoked, but the advocate of the masses had to contend with a fatal lung ailment).

Against this background, the action of the lawmakers was perfectly in order. But who will obey this law, or rather who will enforce it, considering the capacity of the average Nigerian to resist change - someone says it is natural - or to break such laws that seemingly curtail freedom, with impunity. So, who shall we send to bring the intended sanity to our society, not only on smoking but on other equally important social disorders this piece will soon touch.

Nigerians are an enterprising lot, they travel a lot; they can be found in almost every corner of the globe. It is curious that while they disregard such protective laws here, as soon as they step out of the country's shores, they obey without complaints similar legislations in foreign lands.

I recognize that any adult above 18 years is free in most countries to buy and smoke cigarettes, of course with health warnings clearly marked on the packs. There are also designated spots within cities, outside of one's home environment that is, where smokers are allowed to do their thing. That was my experience in Japan last year. The rule is simple: just move into the cubicle out there and satisfy yourself in the midst of fellow smokers). This is sensible enough, I think.

Here, the norm is that every inch of space in a public place is available to puff the choking smoke even if it is discomforting to other people. But because of non-compliance with set rules, the only option open to non-smokers is to walk away with style even though you have every right to be there like your tormentor. A smoker with a poor orientation hardly takes to correction no matter how polite. You would only be lucky if he doesn't pick a quarrel on account of his correction.

Smoking is not the only area an average Nigerian is guilty of anti-social behaviour. There is a ban on the use of siren in the traffic except by ambulances, security patrols in emergencies and certain categories of public officials. That is as far as it goes; nobody listens. Bullion vans, pilot vehicles of 'big men', private individuals and commercial motorcyclists (okada riders) are unrepentant culprits. Surprisingly, road safety escort vehicles are not exempted as witnessed on the Apapa-Oshodi expressway this Monday evening (the mad rush along that axis is always en route the airport to catch a flight). But then which ordinary law enforcement agent will stop the mad fleet of vehicles in the traffic with armed escorts in tow? This society is sick.

There was a sigh of relief the other day the FRSC banned riding on a motorcycle by the driver or the passenger without a safety helmet. Not only that, it became an offence to carry more than one passenger. My people, oh my people! They needed only a few weeks of compliance with the traffic law. Now, it's back to business with two passengers and without the protective helmets, done even with the encouragement or active connivance of passengers themselves. You then begin to wonder whether the people have any sense of value for their own safety.

Of course it is more money for the okada man and the ubiquitous uniformed men in black (did you get my drift) and certain touts from the local councils who present as law enforcement agents? The longer an okada man stays on the roads after the allowed limit of 10 p.m - for security reasons - the more cash for the uniformed men at the toll points. That is another example of a brazen breach of the law. The okada man is ready to take the risk to breach the law to charge a higher fee, assured that workers would always be stranded for lack of functional transport system. Among other dysfunctions, that is a legacy of men of the past, leaders without vision who cared less about the people they govern. Who shall we send then to effect the change we don't believe in?

It is easier for residents of a city to dump refuse right under a signpost indicating 'don't dump refuse here' and even attack sanitation officials in spite of possible sanctions. Vehicles can be parked illegally against designated points. In Abuja, the Directorate of Road Traffic services arrests an average of 140 vehicles weekly for illegal parking, in spite of road signs indicating otherwise.

For as long as anybody could remember, police Inspectors-General have been mouthing 'no more checkpoints' seen by the public as toll collection centres by officers and men. The IG emphasises motorized patrols. That is not a law in the real sense but the rule has variously been abused over time. Only a fool would think that senior officers at the desks are unaware of the deployment of their men on any particular day?

Our children are supposed to be protected to a great extent under the Child Rights Abuse laws. But this has been so ineffectual in as many states that have passed them, including at the federal level. Whether it's ignorance by parents or guardians, have the laws stopped an army of children hawking on the streets, being offered for prostitution or being subjected to physical abuse by wicked guardians? Has the abuse stopped marrying out children in some parts of the country through some funny cultures?

Prostitution is supposed to be an outlawed trade among women. Are the makers of our laws immune to patronage of the ladies of the night? The women feel so secure paying dues to some law enforcement agents in return for protection. Some officers might even be patrons of the women of easy virtues. Regrettably, the country's prostrate economy has not made matters any better for women, including female students who have been accused by the professionals of taking a good chunk of their means of livelihood.

In public hospitals in Lagos where the government has done a lot to assist patients believed to be resident tax payers, it is against the law to charge illegal fees. But a friend whose wife was in labour at a General Hospital in Isolo area narrated an ugly experience of having to pay for mundane items like detergents, gloves and what have you to get attention from the medical personnel. What a load of rubbish is this? Well, he had no choice in a matter of life and death, where some people think they hold the ace.

A lecturer in the university who charges illegally for handouts or forces students to pay for a book he managed to piece together as a survival instinct is not doing the society and the struggling parents (or students) any good. So it is for a traffic officer who extorts money from offending commercial drivers to escape the law. The list is endless.

Corruption is the bane of this society. It is hard to divorce the habit of breaking laws from corruptive tendencies of law enforcement agencies. The day that is taken care of, there is a likelihood the society would get better. It would require a lot of re-orientation though, preceded by a reordering of societal values. The awareness has to be there. But who shall we send, as we are all guilty one way or the other as law breakers?

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Tobacco Control: ERA/FOEN laud Osun Govt

Group Calls for Quick Passage of Tobacco Bill

Group urges Senate to expedite action on Tobacco bill

By Ben Ezeamalu

Sequel to the July 20 and 21 senate public hearing on the National Tobacco Control Bill 2009 (NTCB 2009) organised by the Senate Committee on Health, a non-governmental organisation, Environmental Rights Action/Friend of the Earth Nigeria (ERA/FoEN), has urged the National Assembly to fast track the presentation of the bill before the Senate plenary.

Akinbode Oluwafemi, the programme manager of ERA/FoEN, made this call, yesterday, at a press briefing to update the media on the status of the NTCB 2009, in Lagos."The bill has passed the first and second reading, and there was a public hearing in July. Now we are expecting that the Senate Committee on Health will present the 'new bill' with the inputs of the public hearing to the plenary for discussion," said Mr. Oluwafemi.The National Tobacco Control Bill 2009The bill, sponsored by Adeleke Olorunnimbe Mamora, the senator representing Lagos East Constituency, sought to regulate and control the manufacture, sales, distribution, and marketing of tobacco products in the country.

While the bill had no provision for forcefully closing down tobacco factories, it attempted to control tobacco consumption so as to reduce the deaths, ill-health, social, economic, and environmental costs associated with tobacco use.It also sought to domesticate the World Health Organisation - initiated Framework Convention on Tobacco Control (FCTC) which has already been ratified by 167 countries.

The FCTC is an internationally co-ordinated response to combat the tobacco epidemic. It tackles tobacco industry marketing campaigns executed in different countries and cigarette smuggling, often co-ordinated in many countries by the tobacco industries.Mr. Oluwafemi said tobacco companies and their agents finally debunked their initial tales of massive job losses, up to 500, 000, if the country implements effective tobacco control laws during the public hearing.

"In fact, the British American Tobacco Company of Nigeria, which controls over 82 percent of the Nigerian cigarette market, disclosed that it has only 850 staff. The Association of Tobacco Wholesalers and Association of Tobacco Retailers put their combined strength at about 4, 000," Mr. Oluwafemi said.Great expectationsAccording to Mr. Oluwafemi, the NTCB 2009 will not suffer implementation problems that previous public health bills have suffered."We'd learnt our lessons from those bills that there were no clear provisions about who is going to enforce what? And in cases where they overlap, who does what?

When you look at this bill clearly, it has everything well defined," he said.On October 20, the Osun State House of Assembly passed the Osun State Prohibition of Smoking in Public Places Bill, 2009, making her the first and only state to pass the bill yet.Mr. Oluwafemi said though Osun State had made more progress than the national bill, the enthusiasm shown during the public hearing by members of the public and the parliamentarians would enhance the speedy passage of the bill."We don't have any doubt that the people in the senate, from their submissions during the preliminary and second hearing of this bill, will give Nigerians a strong public health bill," the environmentalist said.

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African Lawyers Meet in Nairobi to Build Alliance for Tobacco Control Legislations

Today, a Legal Workshop for Tobacco Control Lawyers in Africa opens in Nairobi, Kenya with over 50 lawyers from over 32 countries present. The workshop, which is jointly organized by the International Legal Consortium at the Campaign for Tobacco-Free Kids (CTFK) and the Africa Tobacco Control Alliance (ATCA) is providing the platform for discussing common concerns and issues related to tobacco control in Africa, sharing information on effective tobacco control legislation in Africa and shaping the goals, objectives and activities of the Lawyers network.

Deliberations at the meeting will be around the WHO Framework Convention on Tobacco Control (FCTC), which is the first global public health treaty negotiated under the auspecies of the World Health Organization for the regulation of tobacco product manufacturing, sales and promotion. The FCTC currently has 167 countries of which Africa has 40, who are parties and are obliged to fulfill the provisions of the convention.

Providing a comprehensive overview of tobacco control legislation and the FCTC, Patricia Lambert a South African, who works with the Campaign for Tobacco-Free Kids (CTFK) in Washington, DC noted that “Africans played a major role in the negotiations for the FCTC. It is an African document. Now is the time to translate the powerful words of the FCTC into concrete actions in every African country” “

African lawyers must be prepared for litigation with full consciousness that the tobacco companies are not lying-down. There is no need to be afraid as the FCTC has provided the guides for ensuring successful implementation of a smoke-free Africa” says Rachel Kitonyo, Chairperson of the Africa Tobacco Control Alliance (ATCA).

According to Mr. Adeola Akinremi, FCA Africa Coordinator, “This workshop is coming at the very right time for Africa bringing together lawyers at this critical time that many countries on the continent are reviewing their tobacco control legislation”

According to the WHO, “African countries are experiencing the highest increase in the rate of tobacco use amongst developing countries. In the African region tobacco consumption is increasing by 4.3 percent per year.” This development is driven in part by the tobacco industry, which increasingly targets the developing world as barriers rise and smoking rates fall in more “mature” markets around the world.

Globally, tobacco use causes one in ten deaths among adults worldwide – more than five million people a year. Unless urgent action is taken, tobacco will kill 8 million people a year by 2030, 80 percent of them in developing countries.

Countries represented at the meeting include Mauritius, Nigeria, Zambia, Burkina-faso, Lesotho, Swaziland, Kenya, Ghana, DR Congo, Gabon, Senegal, South Africa, Cameroon and Togo. Others include Malawi, Uganda, Tanzania, Mali, Madagascar, Niger, Sierra Leone, Eritrea, Cote d’ Ivoire, Chad, Congo Brazzaville, Benin, The Gambia, United States and Canada.

The Africa Tobacco Control Regional Initiative (ATCRI) promotes the adoption, implementation and enforcement of effective in-country tobacco control policies, legislation and programmes across the African continent by providing the platform for information sharing, institutional support and capacity building among all tobacco-control stakeholders.