Experts talk about frustration in cancer management in the country occasioned by the fact that most victims seek care quite late. A gynaecologist, Dr Uche Onwukwe was forced to opt out of further cancer care and concentrate on its prevention as a result of this. He has been working on that through his cancer foundation for about two years now. In this interview with WINIFRED OGBEBO, the cancer awareness campaigner talks about issues surrounding the disease and his involvement in its screening and treatment.

*How long have you been in this preventive cancer campaign?

We got registered in January this year but I have been doing it for the past two years unofficially- creating awareness about cancers and conducting free screening services. This year, we decided to make it official and register with the CAC and have a foundation with terms and conditions. The name of the foundation is Gynicare Research and Cancer Foundation.

*What has been your experience with cancer care?

We’ve been more in the urban centres as it is a bit more financially tasking going to the rural areas. In the urban centres, the awareness is still very poor. Worse than that, we also found out that just being aware does not translate to carrying out the screening. People need to be pushed to do the screening. We found out that many who go for screening go there because they had someone who had died of one disease or they are afraid they have the diseases for some reasons but we found out that we don’t have the culture of going for screening. Awareness is still power especially among women.

*With this knowledge, what have you done to change this recurrent trend?

Part of the vision as a foundation is to create awareness about the different gynaecological cancers- cervical, breast, ovarian and prostate cancer for men. We have been able to create awareness in terms of newspaper publications; we have radio and television programmes where we talk to people. We have carried outreaches to various churches, the doctors in NYSC camps where we talk about the human papilloma virus which causes cervical cancer. We have also been able to train about 30 healthcare workers in the last eight months and we hope these people can be fussed into the system so that they can go ahead and create awareness on their own too. We found out that the job is enormous. Statistics tell us that we have about 48 million ladies from the age of 15 in the country. This shows that we have a large population that we need to reach.

*For two years you’ve been carrying out testing and screening, what has been the estimated results in terms of those who test for cancer and those who do not?

So far we don’t actually test for HPV because the gadget used for HPV testing is quite elaborate. Most centres don’t have the facilities for its testing. What we test for is the long term effect of the HPV on the cervix. So far, we found out that about 2 to 3 percent of the population will have changes on the cervix that will require attention and these are the changes that could lead to cancer in the long run if it is not being treated. For many of them, we have done follow up and in a number of cases, there have been resolutions. In the last one year, we found about 12 clients with cancer already, and for them, we referred straight to the National Hospital. For those stages, we can’t do much about them, but for the other cases, we have been able to give counsel and we have the treatment ready and available for them.

*Let’s talk about the treatment you offer to those without full cancer?

When the HPV virus affects the cervix, it can take up to 15 or 20 years before it can progress to cancer. So if you pick it up at the pre-cancer stage, one of the treatments that can be offered is called cryo-therapy. It is a freezing technique where you can freeze the cervix with a gas; it is very short treatment that can be done within 10 minutes. However, it gives about 85 percent cure when it is done. For those women, there would be no further progression over the years for cancer. But they have to be on follow ups to ensure that they’re okay. Another treatment which we don’t have the capacity for that here now is called the leep, where you can cut off a part of the cervix with a machine called the diathermy machine and send them to histology. Those two particular treatments have been found to be very useful in preventing the progression of these pre-cancerous growths to cancer of the cervix.

*In simple terms, what can women do to prevent cancer development?

Cervical cancer is the one that is 100 percent preventable and it starts from the age of nine. Girls from this age can take the vaccine and the best time to take the vaccine is before the girl becomes sexually active. Girls from the age of 9 to 14 take two doses. From the age of 15, they take three doses. The vaccine alone can give up to 50 percent protection against the cause of cancer. Secondly, we encourage girls to live a healthy lifestyle. Sex should be discouraged early because early sex is one of the risk factors for cervical cancer and multiple sex partners are also discouraged. Early childbirth should be discouraged and having too many children can also be a risk factor.

From the age of 25, we encourage women to go for screening for cervical lesions every 3 to 5 years up onward to the age of 65. From then, most people say that there is actually no need to continue the screening. That way, we can ensure that we have a reduction in the number of cervical cancer patients in the country. Presently in the country, we have about 10,000 new cases every year dying from it. That means we lose about 26 women every day and it is worse because we don’t have the centres to manage these cases. So it is still better to prevent them. Preventive care is still the best in which a woman can live her normal life.

*How often should the screening be done?

The recommendations is every 3 to 5 years for women but for those who have an increased risk factors like women with HIV, women who are immuno-compromised or on steroidal drugs, they have a low immunity to fighting the HPV, so they are encouraged to do it every year because they are more at risk of developing these cancers. Unfortunately, HPV which leads to cervical cancer also causes cancer of the vagina, the vulva, the anus and the throat. So the vaccine has multiple protective effects against these cancers.

The main thrust now is vaccination of the girl child and women. There is a recent publication in Time Magazine and the summary of the publication is that women who have the HPV cannot also benefit from the vaccine. So the vaccine is more than just being prophylactic- preventive-but now we are saying those who have the virus can take the vaccine because it can cause resolution of the virus because it can help the person fight the virus. There is a lot of focus in the western world about vaccine now. However, we don’t hear a lot about them here because there is still a lot of fears and cultural beliefs that the vaccine is there to sterilize the girl-child. Over 120 million doses of the vaccine have been given worldwide and found to be effective without those effects.

*What about vaccination for boys considering the increase in throat cancer and other forms of cancer in men?

The vaccination for boys is standard. The HPV is sexually transmitted in boys and girls. However we are looking at the cost benefit ratio. For men, HPV causes 30,000 cases of penile cancer every year. For women, it causes 500,000 cases of cervical cancer every year. Looking at it from a public health point of view, the emphasis is on the women. However, in the industrialised nations, they are also vaccinating the boys. But in countries like ours where they have not accepted it for the girls, talking about the boys will be a distraction but if you vaccinate both sexes, it can reduce the prevalence of HPV in the society.

Why we are still focusing on the ladies is that if all the ladies get vaccinated, you reduce the pool of HPV because if one lady sleeps with a guy and is vaccinated, he cannot pass it to her and she cannot pass it to another guy and so she protects the next person. However, sexual practices are changing, homosexual guys have now become an issue. The recommendation is to vaccinate the boys. But for now, because of the resources available, the emphasis is on the ladies because of the huge burden of cervical cancer compared to penile cancer.

Source:
http://leadership.ng/news/471462/how-we-can-reduce-cervical-cancer-cases-in-nigeria