Dr. Uchechukwu Nneka Shagaya, an Oncologist with National Hospital,Abuja has stated that cancer is curable and advises that people go for screening in order to detect symptoms early. She spoke about cancer generally during a chat with newsmen in Abuja. Excerpts:
Q: May we know you officially?
A: My name is Dr. Uchechukwu Nneka Shagaya. I am a Consultant Oncologist.
Q: What is cancer?
A: Cancer is not just a disease. It is a group of more than two hundred diseases that have too many and common characteristics.
One is a purposeless persistent group of cells which makes the cells look immortal.
Second is the ability of these cells to move from one area to another. In totality the aim of these abnormal cells is to kill the host.
Q: Who can get cancer?
A: Everyone can get cancer. Even animals get cancer. A child can be born with cancer. A ninety five year old can have cancer. It is no respecter of age, race or sex.
Q: What causes cancer?
A: To be honest with you, we don’t really know what causes cancer. We have been able to study certain behaviors that cancer is common among those people.
Some of those behaviors are peculiar to certain cancers. So we have the common things; obesity, cigarette smoking. Certain occupations can expose one to cancer, example, there are certain chemicals that are used by farmers; rubber farms. People who dye clothes and skins (tanners) can be exposed to certain types of cancers.
People who work in ship yards or asbestos firms are exposed to certain types of cancers.
There are also some infections that can expose one to cancer. Top of the list is human papillomavirus (HPV). This can be contracted most times sexually. It exposes people to the cancer of the pelvic, cancer of cervix, cancer of the vulva and the cancer of the throat.
When one gets hepatitis c and hepatitis b both of them can expose one to liver cancer.
Q: When can cancer be detected?
A: If you can find cancer early, it is a good thing because you probably can cure the patient. If you can prevent it from happening at all, that is even better.
Q: How can cancer be prevented?
A: In trying to prevent cancer, you will have to talk about screening. Cancers are screenable. What do I mean by screening? Cancer can be detected before they become rupturable. Some of them have pre-malignant stages. You can screen and find them before they become cancer; for example, the column cancer in the intestine. You can do a colonoscopy. It is just a procedure where you put torch light on a camera through the anus, all the way to all the intestines. You can find the pre-malignant stage and take it to the laboratory. You can cut off part of the intestine at this stage.
Cancer of the cervix too can be screened. This type of screening can be done every two years, in a two consecutive period. This can be done once the lady is sexually active. It is a screenable cancer.
Breast cancer, once the lady reaches the age of forty, she is asked to do a mammogram. Even prior to that, once a lady starts having breasts, she should be taught how to do self breast examination. This should be done every month after her menses. This is done to look for any abnormality like a lump in the breast.
Another thing that can be checked is HPV. More than 95% of cancers of the cervix are associated with the invention of HPV (Human Papillomavirus). If you are able to vaccinate a young lady with HPV vaccine, thereby preventing her from ever having HPV it helps her from having cervical cancer.
Q: Which areas of the body can cancer attack?
A: Cancer can affect any part of the body; the teeth, the nose, the mouth, the tongue, the stomach, the intestine; the brain – every single cell in the body is susceptible to cancer. But remember, it is a combination of the genetic makeup and environmental exposure that makes it happen.
Q: What are the beliefs about cancer?
A: Beliefs are sometimes culturally bound. What you find in the south of this country is very different from what you find in the north. Some people believe it is spiritual, some believe it is an attack, some people also believe if you biopsy it you die. There are so many beliefs out there.
I am always in the clinic; it is you in the media that will take the message to the people out there. And make sure the people hear the truth. The honest truth is that chemotherapy given by the right people in the right manner, at the right dose, to the right patient, should be no problem.
But if a patient is taken to the wrong place, it will become a poisonous thing.
Another thing people don’t understand is that if a patient is diagnosed two or three years ago and has gotten a treatment plan, they ran away or refused to do it. By the time they come back, they are no longer early detection. It is now a late or metastatic disease. At that point they are disparate. They now take chemotherapy. Unfortunately, if they pass on people will say it is the chemotherapy, but it is the advanced disease.
So I urge everybody who can come across this message to know that prevention, and early detection is the way out. And even when you find it, seek help in the right places.
Q: What is the level of cancer awareness like now?
A: Breast cancer has been around for a long time. We are better at diagnosis now. The world is enlightened. More people are coming but we are still seeing patients coming late. Women are still keeping breast cancer until it becomes a huge wound that is smelling and big. This means that when it was just a small lump, she was hiding at home. The narrative in Nigeria is late presentation, and late presentation makes the treatment more expensive, more cumbersome and makes one’s chances of beating the cancer hard.
So, I really urge us every Nigerian out there to please hear this message. Those that are screenable, screen them. Know your family history.
Q: What are the challenges?
A: The challenges in cancer care are enormous. For the continent there is a problem. But Northern Africa and Southern Africa have gotten it right. But sub-Saharan Africa is still struggling.
In Nigeria today we have only six radio therapy machines. Two are owned by the private sector. One in Lagos is owned by the private sector, there is another one in LUTH which is PPP.
Remember when you are talking of the private sector, it is not cheap. It comes at a price. And we have one in Abuja, at the National Hospital. It is totally government driven. The charges are quite affordable.
Now, radiotherapy machines are capital intensive, and it is just one of those inputs. Cancer care is broad; it is not what one doctor can manage. Cancer care is multi-disciplinary field, you have the surgeon, you have the clinical oncologist or medical oncologist, you have the nurse, you have the pharmacist, you have the physiotherapist, you have the dietician, you have the pathologist, so many doctors are needed for optimal care of cancer patient.
Q: Who should one go to if someone has cancer?
A: It depends on where one is diagnosed. Most of them are either diagnosed by the surgeon or the general practitioner. They now move them to the surgeon who will do the biopsy and send it to the pathologist. At this point, I urge whoever is involved to go to a place that promotes multi-disciplinary care for cancer, two heads are always better than one.
In Abuja we are lucky we have a centre that has a radiotherapy machine, but we also have other hospitals in the metropolis that do cancer care. The National Hospital that I have mentioned before has a radiotherapy machine, there is Garki Hospital, there are other hospitals like Turkish Hospital, Ceda Crest, FMC Jabi, they all have clinical oncologists.
What these people have in common is that every other specialty has their own primary specialty. Cancer care is just an arm of whatever they are doing. But the clinical oncologist like me that has my own training, all I do is cancer care. I don’t have any other profession. Cancer care is primarily what I do. We have our association. In Nigeria we are not up to hundred in number. It is called Association of Radiation and Clinical Oncologists of Nigeria.
Unfortunately we tend to cluster around where there are radiotherapy machines. So you find out that cancer care in Nigeria is better in the urban areas around where machines are. The rural areas don’t have those specialties.
However I still urge that at primary care level, if the doctor has a high index of suspicion, direct them to the appropriate places.
Q: What is the way forward?
A: Cancer care is so costly; I have a patient that her bill is close to one point three million naira. It is scary. So the fear of that money can make a man say I don’t have money for this. Let me go to native doctor. This amount is truly enormous.
There is what is called Cancer Health Fund. This is an initiative of the Federal Ministry of Health and it is meant to support indigent patients. But presently it is meant for cervical cancer, breast cancer and prostate cancer. These three are the commonest. Patients can access it online, if they cannot fill the form online, they should go to where they are treating cancer and be reviewed and start getting the support.
The aim of this interview is to encourage people and not to scare them. It is to direct them on what to do when they have symptoms of cancer. Finally cancer is not a death sentence; it is just a chapter in one’s life.
Q: Thank you for your time.
A: You are welcome.