Dr. Uchenna Onwufor is a consultant gynaecologist and the executive director of GYNAE Care Research and Cancer Foundation. An organization which carries out free cervical and breast cancer screening. Onwufor who is passionate about preventive oncology in this interview speaks on the preventive measures for cancers, the controversy around cervical cancer vaccine, government’s approach in tackling cancer ,and alternative remedies for cancer.
What is increasing the rate of cancer amongst Nigerians?
Life style changes. We are living like the whites now. The food we are eating is a bit different we are no longer eating fresh foods that much and we have a lot of environmental pollutions. Of course for the human papiloma virus (HPV) which causes cancer of the cervix is sexually transmitted so we are having more people developing it possibly because of sexual practices, and the reducing age which young girls initiate sex.
Why are you interested in preventive oncology?
In our country about 80 to 90 percent of women come to the hospital finally only when it is too late for them. So at that stage we do palliative care , more like end of life care, to make life a little more bearable before they die. I decided to go into preventive oncology because we don’t have a preventive culture here in Nigeria.
Most people wait until they have developed the disease before they start looking for a way to manage it. That is what I do and that is what my organization does.
What are the major cancers affecting Nigerians?
They are cancer of the colon that is the intestines, cancer of the lungs and particularly for women there is cancer of the breast , cancer of the cervix, the cervix is the part of the body that opens up when a woman wants to deliver. However , you find out that the organs that bring life could be a major contributor of death to women, and because it is hidden most people don’t think that it is such a problem to them. Cancer of the ovary is there but it is not as common as cancer of the breast and cervix.
What major preventive measures should women take to prevent these cancers you mentioned?
Of recent we noticed an increase in these cancers and this possibly because of an increase in diagnosis because a lot of people are getting enlightened about it. Basic preventive measure are life style modifications, living a healthy life that is number one.
If we come down on cancer of the cervix vaccinating the girl child against the cause of this virus is very important. Cancer of the cervix particularly is caused by a virus and it is the only vaccine preventable cancer. No other cancer has a vaccine that prevents it unlike cancer of the cervix. If a girl gets vaccinated from the age of nine and above, and right now it is being said that women up to 45 years can still take the vaccine , it reduces their risk of developing cancer of the cervix and some other cancers because the virus that causes cancer of the cervix that is human papiloma virus also causes about four to five other cancers.
Getting vaccinated is very crucial in reducing the risks and then subsequently getting screened at regular intervals can help pick up these cancers in the pre-cancer stage. That is before it develops to cancer we can do something about it.
There seems a controversy surrounding the cervical cancer vaccine with some reports suggesting it has long term negative effects on the girl child. What is your take on this?
The cervical cancer vaccine has been on for about nine years now. Till date they have given about a hundred million doses and most of these shots were given in the western countries.
The major side effects are things like pains . No major side effect has been found pertaining this vaccine but there are people who are worried that can get the girls to be promiscuous and reduce their fertility but I don’t think there is any truth in all this.
Because this is the first time we are having a vaccine that can attack a virus and prevent it from success. While the foreign world is planning and working to eradicate cervical cancer we are embroiled in controversy. We still have quite a number of people who don’t want to hear about it possibly because of their believes and out of ignorance. As for me my wife has taken the vaccine and I hope that when my daughter is that age she will also take the vaccine.
For the first time we have a vaccine preventable cancer and unfortunately people are talking about it in negative terms.
Only a handful of hospitals in Nigeria offer holistic cancer screening and treatment services. Infact only few have radiotherapy machines which are always breaking down leaving cancer patients stranded and some suffer metasis (Spread of cancer cells) rapid death. How can this problem be tackled?
HIV was a very heavy burden worldwide and the international community came together and agreed that we need funds to tackle it. Before long the treatment was made free and people could access care, take the drugs and live longer.
And all that is because of the priority placed on the treatment of HIV and detecting it on time. If the government decides to place priority on cancer I think we can do the same thing. We have only about five cancer centers in this country and like you said most times the machines are breaking down. Where I trained sometimes you send patients for radiotherapy and they will come back six weeks after to say doctor I am yet to get a slot and they are paying their bills there, and that is because the government has no policy on cancer, with cancer everyone is on his own.
The government has not deemed it necessary that cancer is something of interest that is why we still have very few centres in the country and even most of the centres are understaffed, their machineries are archaic, that is why they keep breaking down and of course maintenance culture is not there.
If the government can decide to take the bulls by the horns I think we can do better.
And give better care to patients who have developed cancers and help them live longer.
These days more cancer sufferers are resorting to alternative and herbal therapies?
I don’t have the facts and figures about that but they are resorting to them because the medical ones have failed them as we don’t have centres around and sometimes the drugs are very expensive.
Alternative care bring in cheaper drugs which are sometimes supplements which will boost your immunity and help you feel better .
Many people are going into that because the government has failed . In foreign countries they do that as they have organized cancer centres . Of course you can bring in alternative therapies but those alternative treatments have to be verified. There are stages they have to go through to be sure that they have been able to benefit the patients . If they do that and come out that will be very beautiful for example the drug quinine was extracted from the bark of a tree in China.
So it is possible some of these native stuff are helping but they need to be refined, brought out , studied and long term effects looked at. It is something that the government could partner with them and see how it will come out . But resorting in alternative therapy is because most people don’t have the finance.
So what do you advise patients who go for teas and herbs as treatment?
It will be very unethical as a medical doctor to advice people to use them because most times the drugs are not specific in managing the particular condition. We are talking about shooting the bulll’s eye, things we know will work. Those things have not been tested , refined or gone through the process of being called a drug. If they have gone through those processes , passed the stage and trial phases, have undergone production and have been certified 99 percent to have done the job then it will pass. But if it hasn’t gone through those stages it will be difficult endorsing it.
What is the best way to tackle cancer then?
The key in cancer care is prevention. Prevention is always better than cure. It is cheaper and less demanding when a patient has cancer it ruins the family. A lot of resources is involved.
A lot of time is involved and for a patient who has it , the man power is lost. Because the person has to go for treatment somewhere and somebody usually has to go with the person. There is a lot of worries and disappointment so prevention is really the best. We need to develop a policy and centres where people can be screened even free, and government should also push out awarenessness programmes to educate people about it .
Right now the awareness is still quite poor even in the cities. In the village it is worst. Screening there is almost non- existent. We don’t have well organized screening programmes as obtainable in western world.
There if you are supposed to screen every three years you get a fax message or email reminding you that you need to go and get screened. We need to go back to prevention instead of waiting to develop cancer and then treating them.