Twenty-eight-year-old Rose laid at the rear end of the surgical female ward A4 of the Lagos University Teaching Hospital (LUTH), quietly moaning, tossing and turning with pain on her bed.
She has stage IV breast cancer which has spread to her lungs, liver and legs causing her severe pains. She could barely speak audibly as she relates her story to National Mirror.
She said about one year ago, she noticed a lump on her right breast that was unusually bulky. Without the slightest idea that she could have cancer, she went to a chemist shop and bought antibiotics...
“When the lump refused to go away, I decided to try herbal drug. I took herbal drugs for a while but instead of going away, the lump got bigger and painful. That was when I went to LUTH where I was diagnosed with a grade 2 invasive ductal carcinoma. My left breast was cut off, following doctor’s diagnosis and advice.
After about 3 month’s chemotherapy session, Rose was referred for a radiotherapy session but the machine at the teaching hospital had broken down. She was told to go to National hospital Abuja for radiation treatment.
“Although I had exhausted all my savings, I still manage to borrow money and travel to Abuja. The day I went to Abuja, the queue was too long and they could not attend to me that day. The following day I started my treatment but few days later, it was stopped and postponed because the machine became faulty. In frustration, I returned to Lagos”, she said.
Six months later, Rose said she started losing weight, with severe headache and vomiting. She was readmitted at LUTH and according to the explanation by a Consultant Oncologist at LUTH, Dr. Muhammed Habeebe, her breast cancer had metastasized (spread) to the lungs, liver and spine. He also said the spread could have resulted from the delay in radiation therapy.
A statement given by the Head of Department, Department of Radiation Biology, Radiotherapy Radiodiagnosis and Radiography, LUTH, Prof. Remi Ajekigbe in a telephone interview confirmed that the linear accelerator at LUTH had broken down and needs to be repaired.
He also admitted that the current situation has delayed and denied many patients treatment.
“When you delay treatment cancer spreads. A Stage 2 patient may become Stage 3 then Stage 4 and by the time the machine is working again, the patient is dead. There is no reason why these machines should break down because there will be no alternative for those patients”, he said.
For Rose, her stage 4 cancer means she could no longer be cured of her cancer. Dr. Habeebe told National Mirror that cancers can only be cured at the early stage such as stage 1 or 2 but when advanced to stage 4, the sufferer has only a limited time to live depending on management.
With Rose currently on systemic chemotherapy treatment and palliative drugs, the doctors are hoping to control further spread of the disease so that Rose could be able to live for more years.
Her case is similar to that of another 46 year old woman at Radiotherapy ward of University College Hospital (UCH), Ibadan, who was undergoing treatment for stage IV HERS-2 Positive breast cancer, which has spread to the bones, lungs and hip. She looked frail, withered and kept writhing in pain ceaselessly. With her head bald, a common effect of chemotherapy, she was on intravenous drip and also placed on oxygen. Around May this year, the Cobalt-60 radiotherapy machine at UCH had broken down so patients were referred to Abuja or Usman Danfodio University Teaching Hospital Sokoto, for radiation treatments.
Like her counterpart in LUTH, lack of radiotherapy has affected the patient’s treatment. She was currently placed on morphine, other anti-inflammatory drug and chemotherapy all aimed at controlling further spread and treating symptom. This is the situation of most cancer patients in Nigeria with many succumbing to death from the disease.
This October’s breast cancer month celebration comes with the glaring report that the disease is now the commonest female cancer in the country, with high death rate of 17,000 and 27,000 new cases reported annually. Over 70 percent of these patients are diagnosed at late stages III and IV.
A Consultant Radiation Oncologist, Dr Omolola Salako, who gave this report, during her presentation on breast cancer at the Health Journalist Academy (HJA) training in Lagos, said late presentation, is one of the reasons for low survival in the country.
Most patients come to the hospital when the disease has already spread to lymph nodes or distant organs, an Associate Professor and consultant pathologist at LUTH, Dr Adetola Daramola further enlightened. “Metastasis (cancer spread) is the leading cause of mortality in patient diagnosed with breast cancer in Nigeria. Unlike in the developed countries where survival rate is 80 per cent, in Nigeria more and more women continue to lose their lives to breast cancer”, she explained, during her own presentation.
One of the reasons she gave, that makes women present late at hospital, is due to fear of mastectomy (surgical removal of breast). “But women need to know that these days, not all women diagnosed with breast cancer need to cut their breast. With the latest advancement in treatment, molecular testing can now be done to know the type of breast cancer a person has. If it is a hormone receptor positive cancer, hormone therapy can be administered. If it is HERS-2 positive, an aggressive type of breasts cancer that multiplies fast, HERS-2 positive therapy can be used with chemotherapy, so the patient can have better outcome unlike before when these drugs were not available”, she said.
The oncologist explained that most breast cancer deaths are due to advanced cancers, diagnosed when the disease have already spread to lymph nodes or distant organs.
On why patients seek treatment when the disease has advanced, a professor of radiology and consultant at the UNN Teaching Hospital, Enugu, Prof Ifeoma Okoye, blamed it on ignorance about the disease.
She said at the UNTH, Enugu, for instance, about two new breast cancer cases are seen each week while about 15-20 cases are also seen in the oncology clinic each clinic day, yet ignorance about the disease remain high.
Aside late presentation, lack of cancer facilities and breakdown of machines are worsening treatment.
According to Prof. Okoye, the World Health Organisation (WHO) recommends that countries should have at least One Radiotherapy Unit per One Million populations. Unfortunately, Nigeria currently has about 10 radiotherapy machines in tertiary hospitals across the country.
“These machines suffer from epileptic function; today they are functioning, tomorrow they have broken down. This has causes a lot of anguish and inconvenience to the patients and the incessant breakdowns also affect management and response adversely.
“Going by IAEA and WHO recommendation and assuming a conservative population of 160 million, Nigeria ought to have 160 Radiotherapy Units functioning efficiently in-country. If we look at other facilities for Cancer management, like CT Scan, we are also very deficient serving the entire population of 160 million people”, she said.
Another Professor of Radiology, Prof. Durotinmi-etti, also worried that the country’s limited facilities are resulting in delayed treatment and this is one of the reason for low survival in the country.
“We have only 10 cancer treatment centers in the country, and out of those ten, only two are working leading to overcrowding. A cancer patient needs to have an uninterrupted radiotherapy sessions but due to machine breakdowns or lack of access to machine, treatments are extended or discontinued. This can cause the disease to develop resistant or to progress”, he said.
Other major issues hindering quality cancer treatments in Nigeria, according to the Don, are lack of radiation oncologists and high cost of anti-cancer drugs.
by FRANKA OSAKWE
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