Expert links tobacco use to cancers of the mouth

Former Chief Medical Director (CMD), Lagos State University Teaching Hospital (LUTH), Professor Onatolu Odukoya, has urged Nigerians to be wary of tobacco use, irrespective of its form, due to its strong link with cancers of the mouth.

Professor Odukoya, who gave the charge at a valedictory lecture to mark the sent-forth of Professor Jonathan Lawoyin, at the College of Medicine, University College Hospital (UCH), Ibadan, declared that evidences indicate that tobacco, whether in the form of snuff, cigar or cigarette, contained a cancer-causing substance called nitrosamine.

Unfortunately, he stated that a lot of nitrosamine was present in palm wine, thus the need for Nigerian researchers to verify whether drinking palm wine could lead to individuals having cancers of the mouth.

Professor Odukoya, who described cancers of the mouth as the sixth commonest type of cancer worldwide, stated “tobacco alone might not be linked with oral cancer in Nigeria, we should endeavour to do more studies that will establish a strong association between oral cancer and other causative factors of cancer.”

While pointing out alcohol, infections, radiation, HIV and injury as some other causative factors for cancers of the mouth, Professor Odukoya emphasised the need for individuals to eat well because malnutrition rendered individuals more susceptible to different disease, including cancers.

He stated: “we have found out that vitamins E, A and C can help to prevent the development of cancer, so the whole idea is that if you eat a balanced diet, you will be at a better advantage in not having this cancer.”

The expert, who stated that the commonest part of the mouth affected by cancer was the gum, lip and tongue, urged people to be watchful for any abnormal white or red patches in the mouth, a change in voice or hoarseness, sore throat that does not subside or pain or swelling in the mouth or neck that does not subside as they could be suggestive of an early stage of oral cancer.

Professor Odukoya said it was important that government supported more research into treatment and prevention of cancers of the mouth, adding that this would enable scientists to go into communities to screen and ensure early detections of this cancer.

According to him, “once cancer starts, it can be stopped and so everybody must get screened to ensure early detection and appropriate treatment instituted.”

Earlier, the Provost of the College of Medicine, Professor Olusegun Akinyinka, represented by the deputy provost, Professor Oluremi Ogunseyinde, described Professor Lawoyin, the first dean of the Faculty of Dentistry of the college, as a true Nigerian who gave his best to both the development of his profession and his fatherland.


Sade Oguntola via tribune.com

Concerns over Jonathan’s failure to sign Tobacco Control Bill

•President Goodluck Jonathan and Vice-President Namadi Sambo, with winners of the Nigeria National Merit Award. With them are (from left): Prof. Andrew Jonathan, Afigo Okpewho, Chairman Governing Board Nigeria National Merit Award, Oluwafeyisola Adekoke

A 28-year old graduate of Economics from Delta State, Dickson Dudu, was rushed to the Lagos University Teaching Hospital (LUTH) by some kind-hearted Nigerians after he slumped at the Ojuelegba bus stop. Dudu, an applicant, was in Lagos to attend an interview with a bank. His childhood friend disclosed that Dudu started smoking cigarette at the age of 15 when “we were in JSS 3”. He was very addicted to tobacco such that he can’t do without it unless he is asleep or in the lecture room. He has been having respiratory problems in the past three years and has been receiving treatment in the hospital.

His relations withdrew him from LUTH and took him to a private specialist hospital in Ikeja. He was examined by the doctor whose report showed that Dudu has developed lung cancer.  He died after two weeks in the hospital bed. An autopsy carried out by the hospital revealed that he died of a heart-related disease caused by his addiction to tobacco smoking.

Mr John Inyang’s case is different. He never smoked all through his 32 years on earth. But Inyang is down with lung cancer, which he got from the environment where he lives. He lives with his two brothers who smoke at least a packet of cigarettes every day. He didn’t know that their smoking habit could be more harmful to him than the smokers. Such victims like Inyang are called passive smokers.

According to medical experts, passive smokers are people living among smokers and exposed to smoke concentration in their environment. Unless Inyang gets proper treatment, he may be counted among the estimated 46,000 non-smokers who die yearly from heart disease and lung cancer.

Tosin Adeyanju, an undergraduate student, has been on hospital bed for three months for tobacco-related disease. She said cigarette smoking made her lose weight considerably. Before she was admitted in the hospital, she ate less and smoked at least 10 sticks every day. According to Tosin, she preferred smoking to eating. Lanre Onigbongi, a medical doctor at the University College Hospital, Ibadan, said this is one of the myths associated with smoking.

Onigbogi said the others include perception that smokers appear calmer, sophisticated and successful. “The success factor is a myth because very poor people constitute a high percentage of chronic smokers. The habit makes them poorer because of the money they spend on treating tobacco-related diseases”. According to him, tobacco smokers are not calm but are actually very uneasy until they take a few puffs at a cigarette. This is caused by the presence of nicotine in cigarettes.

Mrs Grace Chukwuka, 45, has been married for 15 years without a child. She had experienced miscarriages on many occasions. Her husband had taken her to many hospitals in search of solution to her problem. Reports  showed that Grace used to smoke cigarettes during pregnancy. This, according to the report, put her and the unborn baby at risk. The dangers of smoking during pregnancy, medical experts say, include premature birth, birth defects and infant deaths. Experts explained that smoking can cause problems with the placenta-the source of the baby’s food and oxygen during pregnancy. For example, the placenta can separate from the womb too early, causing bleeding, which is dangerous to the mother and baby.

Another deleterious effect of the tobacco industry in Nigeria is the issue of youth markets. Today, Nigeria is one of the largest markets for tobacco products in Africa. Statistics show that youths form over 40 per cent of the Nigerian population and 20 per cent of the youths smoke.
According to a tobacco control activist, Dr Olusegun Owotomo, statistics show that about 93 million sticks of cigarettes produced yearly in Nigeria are consumed by smokers. He said between 150,000 and 300,000 children under 18 months get respiratory infections, such as pneumonia and bronchitis from second-hand smoke.

The harmful effects of tobacco led Senator Olorunimbe Mamora and ERA/FOEN to collaborate on a law to control the tobacco industry. The law was passed six months ago by the National Assembly, but has remained unsigned since then. Analysts are of the view that Nigerians are the worse for it. Mamora and Akinbode said the president must sign  the bill or give reasons why he has not assented it.
Addressing a news conference in Lagos yesterday, Akinbode said Nigeria has failed to set a leadership role for the rest of Africa.
Will Jonathan heed the call or allow the industry operate almost unregulated? Time will tell.

SOURCE: THE NATION

Smoking Now Kills More Nigerian Women

by Annette Oghenerhaboke

Death from smoking-related ailments is on the increase among Nigerian women

Smoking among women is on the increase globally and this is doing a lot of harm to their cardio vascular system, lung function, reproductive system and bone density. Latest reports indicate that out of the more than one billion smokers worldwide, 250 million are women. About 5.5 percent of them die annually from smoking-related ailments. “The number of women that smoke would triple over the next generation and more than 200 million will die prematurely if nothing is done about it.” Kemi Odukoya, a doctor with the Lagos University Teaching Hospital, LUTH, said during a recent seminar held in Lagos.
Odukoya, who observed that women are so important that when they die, their death affects the family, society and the nation, said the increase in the number of women smoking in the less developed countries like Nigeria is worrisome. “The current trend shows that men smoke more than women and if we don’t do anything about it, that gap will narrow and that means the female will start smoking just as much as men and in some countries, females are even already smoking more than men,” she said.
According to a recent study by the World Health Organisation, WHO, tobacco accounts for nearly one in three cancer deaths worldwide. The study also revealed that in Nigeria, there are more than 13 million active smokers out of which more than five million die annually. Of this number, approximately 1.5 million are women and unless urgent action is taken, tobacco could kill more than eight million people by 2030, out of which 2.5 million would be women.
Medical experts say smoking affect a woman’s mental, social and economic health. Other major health effects peculiar to women are menstrual problems, pelvic inflammatory disease, infertility and premature menopause. Odukoya said tobacco is a major risk factor for about 44 different kinds of diseases and that more than 4,000 toxic chemicals have been found in tobacco smoke. And because women bear the greatest burden of environmental tobacco smoke, they are at risk of particular health hazards. “Women that smoke during pregnancy are more likely to have ectopic pregnancy. Ectopic pregnancy is when a pregnancy does not form inside the womb and this can kill because the baby has been poisoned by cigarette smoke.”
Apart from the risk of fertility problems, they more are likely to have spontaneous abortion, a condition known as miscarriage. They are also at risk of delivering babies with low birth weight while their baby runs the risk of sudden infant death. Smoking also increases the risks of painful and irregular menstruation.
Unfortunately, most women are not aware of the dangers of smoking. Lanre Oginni, executive director, All Nigeria Consumers Movement Union, ANCOMMU, said while many tobacco users generally know that tobacco use is harmful, studies have revealed that most of them are unaware of the true risks.
It was in a bid to address this problem that the Environment Rights Action / Friends of the Earth Nigeria, ERA/FoEN recently held a seminar to commemorate the 2010 World No Tobacco Day, WNTD. The WNTD tagged: “Tobacco and Women, with emphasis on marketing to women,” condemned the marketing strategies employed by the tobacco industries and their tactics of luring women into smoking. Betty Abah, gender focal person, ERA/FoEN, said the theme was timely because it seeks to highlight the dangers that the world face when women, whom she described as “mothers, home makers, great dreamers and achievers,” fall deeper into the snare that turns them into puffers. “But very prominently, this year’s theme seeks to expose the ongoing subtle, sly, but aggressive marketing strategies that the tobacco industry employs to make tobacco use attractive to women, to hook them as lifelong smokers and therefore, continue in this evil, dehumanising circle,” she said.
In order to curb this problem, Akinbode Oluwafemi, programme manager, ERA/FoEN, urged Nigerians to pressurise the government to implement the WHO’s Framework Convention on Tobacco Control, FCTC, that regulates tobacco marketing to minors, ban smoking in public places, and ultimately reduce the harms caused to women and girls and everyone from the use of this dangerous product.

SOURCE

Cancer: Cost and causes of a killer ailment

By NIYI ODEBODE

Until 2007 when she was admitted to the Lagos University Teaching Hospital, Idi-Araba, Comfort Adio was hale and hearty. Before December that year, the 46-year-old woman had never been hospitalised. But what she thought was an ordinary sore on her right breast later became fatal. She was forced to consult a doctor, when the sore did not heal after two months of self-medication.
Her husband, Martin, said, ”We did not suspect that it was a serious illness. We thought that it was a sore that we could treat with an antibiotic.”
The woman was diagnosed with breast cancer at LUTH. According to her husband, the cancerous cells had spread to other organs. In September 2007, she decided to go to India for treatment. The 46-year-old teacher required N4m for surgery and other treatments in India. She died early 2008, while her husband and other relations were making efforts to raise the fund.
While Comfort lost the battle of her life to breast cancer, another patient, Adeola, has been bed-ridden by the ailment. She was diagnosed with it in 2008. Adeola initially took a lump in her left breast for granted because it was painless. When the lump persisted, she strolled to a hospital, where she was diagnosed with the cancer. She has been living in pain since 2009, when she began cancer treatment.
The women‘s cases typify the problems associated with cancer in Nigeria. Besides the two, the ailment, which was hitherto thought to be foreign, had claimed lives of prominent Nigerians. Such people included a Lagos-based lawyer, Chief Gani Fawehinmi; a broadcaster, Mr. Yinka Craig; a popular musician, Mr. Sunny Okosuns and recently, the wife of a former military president, Mrs. Mariam Babangida, who died of ovarian cancer in a United States hospital.
These eminent Nigerians died abroad after unsuccessful treatments. Some of them, particularly, Fawehinmi, were forced to seek foreign treatments, when their conditions were misdiagnosed in the country.
Cancer patients are a pitiful sight to watch when they are in agony. A consultant oncologist at LUTH, Dr. Remi Ajekigbe, said, ”There is no pain as worse as cancer pain. It is the worst pain anybody can have.”
The World Health Organisation estimated that 7.6 million people died of cancer in 2005 globally. It stated that there were 100,000 new cases annually. The world body predicted that the figure would increase to 500,000 as from 2015.
Currently, Nigeria does not have a national cancer registry. There are no reliable data on the prevalent rate of the ailment. What the country relies on are hospital-based statistics. There are, however, indications that hospitals are seeing more cases of different types of cancer.
Ajekigbe, who confirmed this, said, ”There are increasing cases of cancer all over the world. As Nigeria is also part of the world, there is increase in the country. Here in LUTH, if we compare what we are seeing now to what we used to see in 1980s, there has been a 25 per cent increase.”
Also, studies in Ibadan showed that there had been an annual incidence of 10,000 cervical cancer cases in the South-Western part of the country.
What are the reasons for the increasing cases of cancer? One of the reasons is the increase in the level of awareness. More Nigerians, particularly, the educated, now go to hospitals for treatment rather than dying at home.
Medical experts, including Ajekigbe, said that there had been an increase in the level of awareness. Ajekigbe also said, ”We are getting more westernised. We are doing everything the Western way. We are changing our diet and importing virtually everything, including foreign diseases.”
In spite of the increase, cases in hospital may be a tip of the iceberg as cancer screening centres are not in many parts of the country.
While the Federal Government in 2009 directed its tertiary hospitals to set up screening services for breast, cervix and prostate cancers, these are not available in many secondary and primary health facilities. Where facilities are available, only a few Nigeria go for check-ups.
The Coordinator of the National Cervical Control Prevention Programme, Dr. Kin Egwunomwu, at the inauguration of the organisation in Lagos, said that some groups that were offered opportunities of screening rejected them.
Narrating his experience, he said that a church did not allow its members to undergo free cervical cancer screening, when his organisation went there. ”What we often hear from such organisations is ‘God forbid. It is not our portion,” said Egwunonwu, who is also a reverend.
Corroborating the cleric, Ajekigbe said that most cases of cancer in Nigeria were presented late. He said, ”Cancer of the inner parts of the body may not be detected early because it affects parts that are not seen. But the cancer of the outer part can be detected early. Our people report late. They say they are bewitched. They go to native doctors and pastors. They come to hospitals as a last resort.”
Also, the Coordinator of Cancer Control Programme of the Federal Ministry, Dr. Patience Osinubi, stated, ”30 per cent of cancer cases are preventable and 40 per cent are easily detectable in the pre -malignant stages.”
She, however, noted, ”Many cases of cancer are presented to hospitals at advanced stages when effective intervention is not possible. This has been one of the major reasons for the high mortality rate.”
Even when cases are diagnosed, does Nigeria have enough facilities to treat the ailment. Investigations show that currently, Nigeria has five radiography machines to serve a population of 140 million people. A radiotherapy machine is a major instrument for the treatment of cancer. A linear accelerator, an advanced form of radiography, costs N1bn, including the funds for the building and accessories.
The hospitals that have functioning radiotherapy machines include, LUTH; the University College Hospital, Ibadan; Eko Hospital, Lagos; Ahmadu Bello University Teaching Hospital, Zaria and the National Hospital, Abuja.
The five radiotherapy machines are not evenly spread in all the six s zones of the country. Three are in the South West, while one each is in the Federal Capital Territory and North Central.
Osinubi, ”In Nigeria, an average of one linear accelerator per 20 million is available when compared to 3.4 and 8.2 radiotherapy machines per million population in the United Kingdom and the United States of America respectively.
Besides radiotherapy, other treatment options available for cancer patients in Nigeria include, surgery, chemotherapy, and hormone therapy.
Management of cancer is multi-disciplinary. This, a consultant radiation oncologist at the UCH, Dr. Atara Ntekim, in an interview in Lagos, said was one of the reasons why the treatment was expensive.
Explaining treatment options in Nigeria, Ajekigbe said, ”Before anybody can be said to have cancer, the growth in any part of the body is taken by a surgeon and passed to a pathologist, who examines it under a microscope and give a written conclusion on the type of cancer the person has.” He added that the surgeon could remove the growth after diagnosis.
Other method of treatment is chemotherapy, which involves the use of chemicals that kills cells. ”They kill both cancer and non-cancer cells,” stated Ajekigbe.
The use of hormone therapy is common in cancer that is hormone -dependent. According to Ajekigbe, ”When we are treating any cancer that is hormone -dependent, we attack the hormone which the cancer feeds on. In breast cancer treatment, we give anti-estrogen hormone.”
With only five radiotherapy centres available in the county, it is obvious that the treatment of cancer is not accessible to Nigerians. Ajekigbe said that a cancer patients needed about N10m a year complete his or her treatment in Nigeria.
With 70 per cent of Nigerians living below $1 (N146) a day, most people cannot pay for the treatment from their incomes. This is compounded by the fact that the National Health Insurance Scheme, which currently covers about three million Nigeria, does not fund cancer treatment. It only covers cancer screening as well as mastectomies and prostatectomy for breast and prostate cancers.
The coordinator of the cancer control programme acknowledged this in an email sent to our correspondent. Osinubi said, ”Cancer treatment is expensive to treat any where in the world. In Nigeria, the challenge facing patients is the inability of the National Health Insurance Scheme to fund cancer treatment.”
A mammogram (an X-ray of breast cancer) goes for N3,000 - N5,000 in public hospitals in Nigeria, where the minimum wage still remains N9,500 a month.
Cancer patients normally undergo CT scan or a magnetic resonance imaging to detect organs that have been affected by the ailment. A CT scan costs between N30,000 and N40,000. An MRI, an advanced form of a CT scan, costs about N80,000 for just a part (chest for example). A patients may be required to do an MRI of three parts (the head, chest and abdomen).
Ajekigbe disclosed that a patient would require between N500,000 and N12m for chemotherapy ;and N2.5m for hormone therapy in a period of five years.
Cancer drugs are expensive considering the income an average Nigerian. For example Adriamycin, a breast cancer drug is N2,000 per bottle. Another breast cancer drug, Eprirubicin, meant for breast cancer patients with heart problem, costs N10,000 per bottle.
Investigations show that a mastectomy, which is the removal of a cancerous breast through surgery, costs about N50,000 in the country. A breast cancer patient that requires radiotherapy through a linear accelerator should be prepared to pay N100,000. A cervical cancer patient would pay N50,00 more. Chemotherapy costs an average of N100,000 per course of treatment.
The high cost of treatment is compounded by dearth of manpower. Treatment of cancer requires a multidisciplinary approach. Experts needed for treatment include surgeons, pathologists, physiotherapists, oncologists.
In the country, total number of oncologists is less than 100. A consultant oncologists, Ajekgbe, who conformed this, said, ”There are 20 consultant oncologists and 40 others that are at different levels of training.”
Also, the coordinator of government cancer control programme, stated, ”For a country of 140 million population, there is a shortage of trained personnel like radiation oncologists, therapy radiographers, medical physicists and oncology and palliative care nurses. As at the last count, three years ago, there were about 27 qualified radiation oncologists, eight medical physicists and 14 oncology nurses.”
With the high cost of treatment, does cancer afflicts the rich alone? Experts, including Ajekigbe and Ntekim, said that it was common in both the rich and the poor.
According to Ajekigbe, ”There are some cancers associated with being poor. An example is cancer of the cervix. If a girl is pretty, but comes from a poor home, she may use her beauty to get what she wants. This may lead to her being loose or promiscuous, thus exposing herself to cancer of the cervix.
”Also, a rich person, who can afford certain things like food that is rich in high cholesterol may expose himself to cancer. He may shun local foods which can protect him against cancer of the colon..”
Besides these, some habits such as smoking and drinking alcohol may also predispose people to cancer.
Explaining further, Ajekigbe said, ”You cannot place your finger on a cause when you are talking about cancer, but there are factors that predispose one to it. For example, if your parent has certain cancer, you have a higher chance of having it than a person, whose parent does not have it.”
Experts said that Nigeria had facilities for the treatment of cancer. The major hindrance, however, is that they are few. Also, there are late presentation of cases, uneven spread and the high cost of treatment.
Ajekigbe explained why some Nigerians travelled abroad to treat cancer. He said, ”We normally do not refer patients abroad. But if a patient says we should refer him abroad, we do that. But we do not on our own refer patients abroad.”
On referrals, Osinubi said, ”The advantage of going abroad is the availability of several choices of cancer treatment centers. But Nigerian patients still have to pay a lot of funds except they have dual citizenship making them eligible for national health schemes.
”Only the rich, as has been observed in Nigeria, can go abroad for treatment. The outcome of their treatment will be the same unless the cancer is detected early.”
Explaining reasons for misdiagnosis of cancer, she said that it was not peculiar to the ailment. She said, ”Several diseases have similar presenting symptoms. A patient‘s diagnosis also depends on the level of competence of the medical facility he visits.”
With more Nigerians coming down with cancer, the Federal Government has intensified efforts to combat it. The government is partnering with organisations such International Atomic Energy Agency, Vienna to fight cancer.
Osinubi said, ”The partnership with the IAEA is called Programme of Action on Cancer Therapy. Within the next eight years, nuclear medicine equipment, which can diagnose cancer efficiently ,and linear accelerators, will be available in federal tertiary hospitals in all the six geopolitical zones.” The government has already paid the first $2m to the IAEA as part of the counterpart fund for the programme.
Government‘s efforts as laudable as they may be, experts and non-governmental groups said preventive measures should be intensified. The Executive Director of the African Tobacco Control Regional Initiative, Mr. Olufemi Akinbode, disclosed that only Osun State and the Federal Capital Territory had passed bill on smoking.
According to him, the bill is still in the second reading in the National Assembly. Akinbode said that tobacco-related cancer accounted for 30 per cent of cancer deaths globally.
Chronic Human Papilloma Virus can cause cervical cancer. It can be prevented through the administration of HPV vaccines. The National Cervical Cancer Control Policy states that girls from the age nine-years should be eligible for the vaccine. Adults can also get it.
The implementation of the programme is yet to start fully. But, Osinubi said, ”The Federal Ministry of Health is trying to get Global Alliance for Vaccines and Immunisation‘s assistance to procure the vaccines at an affordable cost to sustain its inclusion in the National Programme on Immunisation.”
While Nigerians await the full implementation and success of government‘s anti-cancer measures, who will tame the rampaging monster?

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