Breast Cancer: C.O.P.E Eyes Subsidised Services, Collaboration with Ministry of Health

Since its establishment in Nigeria, the Care Organisation Public Enlightenment, C.O.P.E, has been at the front burner of giving succour to cancer patients and survivors and awareness to the public. In this interview with its Founder, Ebunola Anozie, she expressed readiness to collaborate with the Ministry of Health in mitigating the breast cancer mortality rate in Nigeria and improving healthcare access and outcomes for all Nigerians. She also urges women to get free and subsidised breast cancer services at C.O.P.E this October. Rebecca Ejifoma brings excerpts

You have talked about a comprehensive cancer treatment centre for years. Do we have one now?

You are correct. Over two decades ago, we urged and implored the government to establish at least one comprehensive cancer treatment centre to cater for cancer patients in Nigeria. Currently, we can proudly claim the presence of at least seven comprehensive cancer treatment centres across the country, a stark contrast to the times when we had none. In addition, several private entities have also stepped in to help fulfill this critical need.

However, there is still much work ahead. The reality is that when we address the imbalance in medical tourism and treat our citizens properly within our borders, it will become evident that our healthcare system is gradually aligning with international standards. For example, despite the availability of these comprehensive cancer treatment centres, the “Japa” movement within the healthcare sector remains a formidable challenge with grave implications in the years to come. Our best healthcare professionals are understandably leaving the country in droves for better remuneration, career advancement, and quality standard of living. The government has a lot of work to do to address this growing trend.

Radiotherapy is one of the cancer treatments. How many do we have in Nigeria, and are they functioning? Again, the number we have, is it enough compared to the country’s population?

There’s a vast distinction between owning something and that thing being genuinely beneficial or operational. In Nigeria, we currently have at least six radiotherapy centres, some of which are privately owned.

However, the actual functionality of these centres presents a distinct challenge. It is evident that the number of operational machines is insufficient to adequately serve a country as large as ours, with a population of almost 200 million people and growing. This challenge is further compounded by our current infrastructure and the ongoing struggle to experience reliable power supply, one of the primary obstacles responsible for impeding and incapacitating effective business operations.

Diagnosis is the heart of medical treatment, and C.O.P.E has been screening for a long time. What has the experience been like?

Diagnosis is indeed the heart of medical treatment. However, we are not a diagnostic centre.

Instead, we offer women subsidised nd free breast ultrasound scan screening services to detect the presence of lumps or abnormalities. Should we detect any, we recommend patients visit their personal physicians or diagnostic centres for further evaluation or tests.

I must also mention that over 28 years, our journey has been a roller coaster ride. Throughout this time, we have taken on a pivotal role in the fight against breast cancer in Nigeria. Our commitment to reducing the mortality rate of breast cancer would not have been

It is attainable without the unwavering support of our incredible partners, including Variant Advisory, Polaris Bank, Union Bank, Hardrock Café, SKLD, GE Healthcare, ASHOKA, Pfizer and the generous individuals who have stood by us through thick and thin.

As we continue our mission, we welcome additional local and international partners, both corporate and individuals, to join and support us on this journey and fight against breast cancer.

Together, we can make a significant difference in women’s lives in Nigeria.

Misdiagnosis is also a factor in treatment. Have you had such cases in the course of your screening, and how have you been able to manage that?

Of course, misdiagnosis is a significant factor in treating breast cancer. However, it is important to again emphasise that we do not diagnose. We provide breast screening services with state-of-the-art equipment that detects lumps or abnormalities in women’s breasts. We are very particular in engaging the services of qualified and experienced sonographers/radiographers and have been fortunate to have skilled healthcare professionals work with and volunteer with us. We also provide regular training to address any issues related to the detection of lumps proactively and have generally received very few complaints related from our patients. 

However, we recently encountered two separate incidents where one of our experienced radiographers did not detect lumps in two different patients and both patients brought it to our attention after seeking second opinions. In an abundance of caution, we initiated a review of all screening results for women who had undergone screenings performed by this particular radiographer during her three-year tenure with us. Additionally, as part of our commitment to ensuring the highest standards of care, we suspended her from her duties. Our guiding principle is the early detection of breast cancer, and we are dedicated to upholding it.

How cheap is treatment for cancer and breast cancer in particular? You can also look at the cost of undergoing radiotherapy treatment and how many sessions a patient requires to stay alive. How much are cancer drugs, and can a poor man afford them?

The effectiveness of cancer treatment is heavily influenced by detecting it early and initiating appropriate interventions. Allow me to illustrate this with an example. During our routine free monthly screening in July 2022, we had a significant turnout. Among them was a remarkable woman who, just two months later, visited our office to purchase breast prostheses. As part of our standard procedure, we asked about the timing of her diagnosis and if she would be interested in joining our support group. She said she was and graciously shared her story with us.

She had taken advantage of our free breast screening service in July, made possible by Variant Advisory and SKLD. At the time of her visit to us, she was completely unaware of the presence of a lump but had noticed a sharp pain which persisted for three days, and she wanted to find out what was wrong.

Our radiographer detected a lump and strongly advised her to consult her physician for a thorough evaluation and potential removal. She did as advised, and the diagnosis revealed stage one carcinoma. She was presented with two treatment options: preserving her breast through chemotherapy and radiotherapy or opting for a mastectomy (complete breast removal) without further treatment. She bravely chose the latter! Her actions are an incredible testament to not just the importance of early detection, but also to patients adhering to our advice to consult their primary healthcare providers for further evaluation. Breast cancer treatment, as with all forms of cancer treatment, is incredibly expensive and it is important to be proactive with their health and detect any issues early.

The cost of cancer treatment is significantly reduced when diagnosed in its early stages. For example, the least invasive cancer treatment would start at approximately two million, five hundred thousand Naira. Again, treatment of cancer, which includes drugs, is not cheap, even people with abundant financial resources complain. This is also why we encourage women to have comprehensive health insurance to help with the cost of breast cancer treatment and healthcare treatment in general.

Now that Nigeria is faced with a forex exchange crisis. What is the impact on access to drugs, particularly on members of your support group?

There is no doubt that this will have an adverse effect on members of our support group. It will be challenging, and is actually difficult, for some of them to afford drugs recommended and prescribed by their physicians. We remain ever so grateful to our partners who provide financial support to our survivors who are still receiving treatments so they can live a healthy and fulfilling new normal life.

Is breast cancer treatment covered in NHIA?

As earlier mentioned, treatment for any type of cancer is very expensive. During the last regime, the scheme did not cover key treatments for serious ailments such as breast cancer. In most cases we have family members selling their properties trying to raise funds for treatments of their loved ones. It is heart-wrenching to see and hear about the difficulties cancer survivors are going through in accessing treatment for serious ailments like breast cancer. Thankfully, the Nigerian Cancer Society took a bold step by requesting funds from the federal government and assisting citizens in need. Access to affordable healthcare is a critical issue that affects the well-being of all Nigerians and the earlier we take the bull by the horns, the better it will be.

I know improving access to healthcare and ensuring essential treatments, including those for cancer, are available to all is a complex challenge that many governments around the world face. That said, the Nigerian government needs to provide tangible and sustainable solutions that ensure that Nigerians have access to basic and quality essential healthcare services without suffering financial hardship. We are glad C.O.P.E is able to fill some of these gaps for women in need dealing with breast cancer through the generous donations and support of our partners, and we continue to encourage others to support us.

What can you say about Nigeria’s rate of cancer survivors, are we having more cancer mortality due to lack of access to treatment and the high cost of drugs? Why is Nigeria recording more cancer cases presently?

There is no doubt that the breast cancer mortality rate is high due to a lack of access to proper medical care, ignorance, religious beliefs, poverty, unhealthy lifestyles, lack of exercise, late presentation and taboos. The intersection of these factors contributes to the increase in cancer cases that we’re currently experiencing. The more people are informed, are proactive with their health, are conscious of what they consume, and have access to quality cancer treatments, the higher the rate of cancer survivors in the country. Addressing these issues requires the work of all relevant stakeholders, which is very important.

What is it like surviving cancer in Nigeria with over 76 per cent out-of-pocket payment for healthcare?

Surviving cancer in Nigeria is not easy and the issue is further compounded because more often, many people present when the cancer is at an advanced stage. As I earlier mentioned, the least a

Nigerians will pay for cancer treatment is 2.5 million depending on the stage and the more advanced the cancer, the more expensive it is to manage because of the various forms of treatment that will be required. When you think of the statistics that reveal 80 per cent of Nigerians do not have access to health insurance and a lot of the health insurance packages do not include treatment for cancer, this gives us a better understanding of why surviving cancer in Nigeria is challenging.

A major risk in the prevalence of cancers is the aging factor; we find that younger persons are coming down with cancers against the norm. Why is this happening?

Some individuals may carry genetic predispositions to specific cancer types. Inherited mutations in certain genes, like BRCA1 and BRCA2 for breast and ovarian cancer, can elevate this risk.

However, it’s worth noting that inherited genetic mutations are relatively uncommon, and most cancer cases are not directly linked to genetics.

Also, people who live a sedentary lifestyle (Insufficient physical activity) and have unhealthy eating habits can also put themselves at risk. A diet emphasizing fruits, vegetables, whole grains, and lean proteins is generally recommended for cancer prevention.

There’s also the issue of our exposure to environmental hazards with factors such as air pollution, chemicals, and carcinogens also playing a role.

It’s crucial to remember that although these factors can heighten the risk of cancer, they do not guarantee that a person will have cancer. Many people with risk factors do not develop cancer, and many cancer cases occur in individuals with no apparent risk factors.

We always advise people, both young and old, to reduce their cancer risk, by maintaining a healthy lifestyle, adhering to a balanced diet, refraining from tobacco use and excessive alcohol consumption, and protecting themselves from excessive sun exposure (using sunscreen as well), and adhere to recommended cancer screenings and regular check-ups. Early detection and prevention are key elements in managing cancer risk at any stage of life.

Many are dying from cancers. What’s the current prevalence in the country?

From our findings and discussions, cancer claims the lives of 72,000 individuals in Nigeria each year, while a staggering 102,000 new cases of cancer are diagnosed annually in the country. With a population exceeding 200 million people, Nigeria faces the emergence of complex diseases, particularly cancers, as a pressing healthcare priority for the future.

What is the way forward, especially now that we have a new minister of health?

It appears that your inquiry pertains specifically to a matter within the purview of the Minister of Health. We remain committed to fulfilling our duties in the battle against breast cancer for as long as we are able.

Dr. Muhammad Ali Pate is a respected physician and educator. We congratulate him on his new and very important role in moving the country’s healthcare sector forward. C.O.P.E is firmly committed to our mission, and we look forward to the opportunity to collaborate with him and the Ministry of Health in mitigating the breast cancer mortality rate in Nigeria and improving healthcare access and outcomes for all Nigerians.

C.O.P.E has been in existence for over two decades. What can you say about breast cancer and what are your findings in terms of treatment, care and support?

Yes, we have been in existence for over 28 years. We are dedicated to raising awareness of breast cancer among women and young girls in Nigeria. We believe in being proactive rather than reactive. Our mission is embodied by the SCREEN framework, which encompasses our core values and goals, (Screening, Counseling, Referrals, Education, Enlightenment, and Nurturing).

Breast cancer mortality rate is high in Nigeria due to a variety of factors including lack of access to proper medical care, ignorance, religious beliefs, poverty, unhealthy lifestyles, lack of exercise, late presentation, and taboos. Through our monthly screening initiatives, our goal is to detect breast cancer at its earliest stages, resulting in more cost-effective treatment options and significantly improved survival rates for women in Nigeria.

In terms of care and support, we provide emotional support and solicit financial assistance for women and have a vibrant support group system designed to nurture and uplift survivors, enhancing their overall quality of life. We believe in fostering “HOPE with COPE,” ensuring that survivors find hope in their journey and have the necessary coping mechanisms to navigate the challenges they face.

With October being breast cancer awareness month across the world, we strongly urge women to take advantage of our free and/or subsidised breast screening services. Empowering women to be proactive about their health is paramount because early detection plays a pivotal role in the battle against breast cancer.