Nigeria’s national cancer control plan keeps failing as cancer of the prostate mauls Nigerian men, thousands at a time, reports Gbenga Ogundare
Twenty five years ago, the national prostate cancer risk was only two percent in Nigeria. About 20,000 men died annually of the non-communicable disease then, 64 percent of that being within two years of metastasising, according to a report in the Journal of Urology.
The 1997 report showed that Nigerian men presented late because they had no idea what was eating them, thus increasing their risk of dying.
Today, most Nigerian men haven’t changed; the figures have, though. And it’s for the worse. The cumulative risk for cancer of the prostate (CaP) is now 4.27 percent; incidence rate, 12 percent; and estimated mortality, 10 percent,according to Globocan, a project of the International Agency for Research on Cancer.
CaP, it says, constituted 30 percent of all new male cancers recorded in 2020. It has now ranked the most common and deadliest cancer ravaging menfolk, 104.5 million strong, in Nigeria.
The situation has triggered more studies, advocacy, enlightenment, and screening campaigns. And problems—causes, prevention, management, and others—also keep popping up in the findings. One of them, however, remains prevalent: victims presenting late. And most of those efforts, especially enlightenment and screening, have been, broadly, about cancers—the most emphasis being on breast and cervical cancers. The up-trend in the rate at which CaP afflicts and kills men rarely comes to focus, and the critical mass of potential victims in the grip of it just don’t bother with what little they know.
Government failure is obvious here. Even with its one-cap-fits-it-all plan for all cancers in Nigeria. The earlier draft of the NCCP (2013-2018) listed, among its goals, the plan to bring cancer enlightenment and screening programmes to the primary health care level. Goal 1B of the 2018-2022 plan also states: Make screening services and early detection of cancer available for all Nigerians
There are over 30,000 primary health centres in 9,565 wards in 774 local government areas across the nation. Making screening available this way could have made a difference. Cancer enlightenment programs, too, would sure have covered prostate cancer, and the awareness could have encouraged men to take further action—like screening, diagnosis, and others.
But a review of the 2013-2018 NCCP revealed how the plan, though broad, was a non-starter on the access and screening levels. This further limits the opportunity for CaP to get more attention.
The imbalance has dulled the interest in knowing more about the life-threatening growth that attacked the semen sack of over 15,000 men in 2020, according to Globocan.
Owolabi Ganiyu is not yet a victim. With a Higher National Diploma in Mass Communication, he is educated enough to know a thing or two about CaP, orthodox and otherwise. “Yes, I read about it,” he said, in a manner that dismissed any kind of alarm. “If a man doesn’t have sex for a long time, he’s got a tendency to have it,” he added, admitting there was no ‘empirical evidence’ to it. He then offered a spiritual dimension: demonic attack. And he wasn’t under such attack. For that reason, the morbidity of the disease couldn’t even whip up any curiosity in him. In his late 40s, Owolabi wouldn’t go for screening, despite knowing where he could get it: the Obafemi Awolowo University Teaching Hospital in Ile Ife where he lives.
“Why should I,” he said, “when I remain intact and there’s no bulging sign down below?”
Sitting ducks like Owolabi abound in Nigeria. They have an idea of what CaP is, but need a symptom to kick them into action. Research also indicates that whenever it dawns on many individuals what is at stake when it comes to CaP, the desire to go for screening spikes. Many are even willing to take the Digital Rectal Examination (DRE), the alternative to the Prostate Specific Antigens (PSA) method (embarrassing as most men consider it), if it’s the only one on offer.
But they can only wish. Over 80 percent of men from 40 upward in Nigeria have not been screened for CaP, according to Project Pink Blue’s Executive Director Runcie Chidebe. There’s just not enough provision to reach them where they are—at the grassroots.
Despite the inclusion of the earlier unattained goal of starting from the PHC ground level up (40 percent screening at all levels) in the current plan, little has happened.
There’s no single PHC in Nigeria that screens for cancers generally, much more for the insidious prostate cancer. Most of the centres lack the facilities and expertise. On occasions when a PHC does, it is usually a collaboration between the centre and some advocacy groups or CSOs. And it’s a one-off.
The Lagos State government has organized seven rounds of such for cancers, including CaP, across all its 57 LGAs since it started in 2008.
The National Association of Seadogs, Egbeda branch, for instance, organized one of such for CaP at the Bola Ahmed Tinubu Primary Health Centre, Egbeda, Alimosho, Lagos in April 2021. The President of the chapter, Hassan Aidorolo said organisations that collaborated with the Seadogs included the Lagos State Primary Healthcare Board and Olukemi Specialist Clinic and Urologist Centre, Akure, Ondo.
It’s not impossible a good portion of the18 percent of Nigerian men screened for CaP did so through these collaborations.
Other Nigerians who could afford it on their own had their screening at private centres—because they had little trust in government services. Like Jide Esan, an owner of a façade and branding outfit at Ikeja, Lagos. He had his prostate screen at a private centre. “I use and depend on private centres for such because it’s closer, and I have the means.” He said he really didn’t mind getting screened again, though on the cheap.
In many other instances involving NGOs, prostate cancer, of all cancers for screening, doesn’t always make the cut. Many of the cancer advocacy groups have thematic areas other than CaP.
An analysis of 16 of the advocacy groups focusing on cancers in Nigeria reveals that four concentrate on CaP, seven on breast and cervical cancers, four on children cancers, and one, Project Pink Blue, covers every area.
Its executive director revealed the imbalance CaP suffers in Nigeria, and how men are silently bearing the brunt. “Every October, virtually all cancer NGOs roll out their drums of awareness focused on breast cancer; prostate cancer is always missing, while hundreds of men die in silence and pain because their prostate cancer was discovered at late stages,” he said in a report he published in the American Society of Clinical Oncology in 2018
The NGOs shouldn’t take the blame alone. Most of the government screening centers are embedded in tertiary health centres, including federal medical centres. There are 18 of them providing cancer treatments to over 124,000 patients Nigeria records annually. These screening centres lie beyond the means and reach of ordinary Nigerians, including those likely to come down with CaP.
The health ministry recognizes how much it needs the NGOs in the current NCCP which expires this year. And it states the manner of collaborations in the plan is to make screening accessible. Just like it failed in establishing cancer screening centres at PHCs in the first and second plan, the health authorities might have made no success in its effort at synergy either.
In human terms, that failure translates to over 75,000 men flattened by prostate cancer between 2018 and 2022. More than 50,000 of them die, by Globocan’s five-year mortality estimates of 21.27 per 100,000 men.
And the risk keeps rising.