‘Why lung cancer is silently killing Nigerians’

The dearth of medical expertise, treatment facilities and requisite diagnostic equipment to accurately diagnose lung cancer at the early stages, and effectively manage is fueling death among people suffering from the disease, Daily Trust investigations have shown. Daily Trust reports that the disease is silently killing many Nigerians because it is often misdiagnosed or diagnosed […]

The dearth of medical expertise, treatment facilities and requisite diagnostic equipment to accurately diagnose lung cancer at the early stages, and effectively manage is fueling death among people suffering from the disease, Daily Trust investigations have shown.

Daily Trust reports that the disease is silently killing many Nigerians because it is often misdiagnosed or diagnosed at the late stages. Some of the sufferers sometimes only discover they have it when they travel abroad for care after a long time of searching for diagnosis and care in Nigeria.

According to the World Health Organisation (WHO), lung cancer is a type of cancer that starts when abnormal cells grow in an uncontrolled way in the lungs. It is a serious health issue that can cause severe harm and death.

The symptoms of lung cancer include a cough that does not go away, chest pain and shortness of breath.

• ‘Take-it-back’ movement insists on protest
• Plateau killings: Survivors recount ordeal, ACF urges end to attacks

Prof. Kelechi Okonta, a consultant cardiothoracic surgeon at the  University of Port Harcourt Teaching Hospital, and lecturer at the University of Port Harcourt, said lung cancer is  one of the five top cancers killing people in the country; and also among the top ten most common cancers in Nigeria.

However, he added that data collation and record keeping for lung cancer is still a challenge in Nigeria.

Prof. Okonta and some other researchers in a study published by the Journal of the Pan African Thoracic Society said though there is an irrefutable causal relationship between smoking and lung cancer occurrence, more recent evidence seems to report rising lung cancer incidence among non- or never-smoker populations, especially among people of African ancestry, and recent local data in Nigeria seem to corroborate this evolving pattern.

They said the role of clinical diagnosis remains a key component of the triumvirate as lung cancer shares similar features with many of the prevalent acute and chronic pulmonary infections in Nigeria, making accurate identification significantly dependent on the level of experience,  clinical acumen, and expertise of the first-line attending physician.

In the research titled ‘Management of lung cancer in Africa: Underdiagnosis and poor access to treatment – A close look at Nigeria,’ the researchers said     for many people, the first point is usually their local health centre where expertise to achieve early diagnosis and effect appropriate treatment usually is not available.

Experts say whereas there are fully-certified chest surgeons and pulmonologists—trained within and outside the country—practising in several centres across the country, “super-specialised” pathologists, molecular scientists, radiologists, medical oncologists, and radiotherapists who are focused primarily on lung cancer work are lacking.

 

Experiences of some Nigerians

Mrs Onama Ladi, 51, a lung cancer sufferer lost her life to the disease.

She was diagnosed with tuberculosis after over a year of several tests and scans at private and public hospitals in the country.

Onama never smoked all her life according to her relatives; she was finally diagnosed with lung cancer barely weeks to her death.

“She was very sick and weak then. The doctor told us the disease was already at a late stage. We were surprised because she doesn’t joke with her health at all.  She has been going to the hospital all this while and taking her drugs very well. But none of the doctors or facilities discovered she had the disease till when she was close to death and the treatment cannot help,” said one of her close friends who craved anonymity.

Al-Hassan Yakubu went for regular checkups at the hospital but was never diagnosed beyond cough, malaria and chest pain. He kept falling ill on and off until he decided to travel for a holiday to the United Kingdom.

His daughter narrated that he fell ill again and was diagnosed with lung cancer. He died barely two months after that.

Narrating his experience with lung cancer,  Julius Akinyemi, 59, said it took six months of tests and changing hospitals for him to be diagnosed with lung cancer.

He said he spent over N5 million on tests and scans  alone, adding that despite the time frame his current doctors told him, he was very lucky  to have been diagnosed with the disease early enough to receive treatment with expected good outcomes.

Akinyemi said he was first misdiagnosed of having chronic obstructive pulmonary disease (CPD) at a tertiary hospital in Abuja for which he received treatment to no avail.

He had before then been treated at a private facility where he was just diagnosed with cough.

He said, “It all started when I started having a cough and fatigue. I used to walk to the gym to work out but suddenly I couldn’t walk to the gym anymore. Also whenever I got to the gym or tried to jog, I panted seriously and began to find it difficult to climb the staircase in my  house – a storey building.”

He said he visited a private hospital and was prescribed tests and scan but the diagnosis and treatment were mainly for the cough.

After doing many tests and scans and he was not getting better, the hospital referred him to the National Hospital Abuja, where he was diagnosed with CPD.

He said, “When I was diagnosed with chronic obstructive pulmonary disease, I accepted it since I have been a smoker for most part of my life. I smoke cigarettes; not other stuff.

“I was told it is not curable. You can only manage it, okay, but I didn’t get better despite my investments in drugs and tests and all of that.”

He further said that after being with several doctors, he didn’t still get better until he met one cardio thoracic surgeon in Abuja who decided to do more comprehensive tests including biopsy and another one which cost him more than a million naira. These tests led to his diagnosis for lung cancer.

The diagnosis of lung cancer meant he could no longer continue treatment under the National Health Insurance Scheme ( NHIS)  , and he  had to  start paying out of pocket.

Akinyemi said the tertiary public facility couldn’t manage his condition either so he had the option of travelling abroad for treatment and he luckily found an oncologist who is now managing him.

He said his resolve for quick diagnosis and treatment helped, as he has so far done three out of the seven chemotherapy sessions prescribed for him.

He added that he has stage one lung cancer , and has not had adverse effects with the treatment.

“I consider myself lucky for it to be found this early in my case. While I have the tell-tale signs such as losing my hair due to the  treatment, I have been okay so far.  People react differently to it. The treatment is very expensive. However, the care from my mum and wife has been very helpful. My doctor says I am a miracle, because of the rate of recovery,” he narrated.

 

Reasons for increased mortality, misdiagnosis

Prof. Okonta, who has done extensive research on lung cancer and chest trauma and injury, told Daily Trust that there are factors fuelling misdiagnosis and increased mortality from lung cancer in the country.

He said, “First, lung cancer awareness among our people is not really high in the sense that, because there are other diseases like tuberculosis, chronic asthma and other respiratory tract infection that can mimic  it,  the first thing some physicians think is that it may be tuberculosis or any of these diseases.”

He highlighted that diagnosing lung cancer requires having a very high index of suspicion.

“Based on the work that I presented at the University of Toronto in 2024,  we have started outlining  four symptoms,  called tetrad of symptoms, that will be a kind of red flag for physicians to quickly bring their attention to the fact that it may be lung cancer. In some cases, lung cancer presentation may not be typical, that is another thing.

“Some of the things we put together from the study is that when somebody starts complaining of chest pain, weight loss, and breathing problem, if you rule out tuberculosis. The next thing you should look at in our environment is lung cancer. The other problem is that even establishing the diagnosis of lung cancer is becoming difficult because you have to take tissue. It is not everybody that has the competence to take tissue and subject it to  pathological analysis,” he said.

Also speaking on the challenges of lung cancer diagnosis in Nigeria, Caleb Egwuenu, a Lung Cancer Patient Research Advocate, and Executive Director of Move Against Cancer Africa (MACA), said lung cancer in Nigeria and in Africa is like a can of worms.

He said, “You know, when you have worms in a covered can, and  you remove  the covering, you see plenty of worms coming out. What happens is that when the can of worms is covered, you  see a little bit of worms coming out but when the covering is lifted you now see the main thing. So I believe that lung cancer in Nigeria and in Africa is a can of worms  that is covered by tuberculosis, chronic obstructive pulmonary disease, pneumonia, among others.”

He explained that these diseases  have the same symptoms as lung cancer, and may appear same with lung cancer on a scan, or X- ray.

He said, “So when they see that, the first thing that comes to their mind is either tuberculosis, because most of the time, the person might be coughing or having shortness of breath.  They may also say it is COPD. They hardly  think it might be lung cancer. Most of the time when it is diagnosed, the person is dead or it is already too late.”

A cancer survivor and   founder of Nest of Hope Advocacy and Support Community, Engineer Dozie Akwarandu, said instances of hospitals and medical doctors managing people for cancer instead of referring them for requisite tests and experts abound.

“Some of them are very reluctant to refer patients for further investigations. As a result of the ‘japa syndrome’ so many public hospitals lack experts and  even diagnostic equipment. Some doctors in public hospitals know good private hospitals that can diagnose and manage cancer patients but they refrain from it saying it is against their policy. This worsens the cases of patients and even leads to preventable deaths,” he said.

 

Way out

On the way out, Prof. Okonta  called for  special lung cancer clinics,   lung cancer registries and government’s   support for tests and treatment.

He said the government should provide specialised equipment and facilities for diagnosis and treatment, adding that electricity is also important for such  high level equipment and facilities.

Asked the specialist required for early diagnosis and treatment of lung cancer, he said, “Lung cancer care is multi-disciplinary and team work. But there are leaders, there are many unqualified people delving into lung cancer care, because they got a grant or stumbled on it. It shouldn’t be so. First, you should have interest. You are dealing with the lungs. It starts from there. So, the experts required are pulmonologist or chest physician, then thoracic surgeon.

“A thoracic surgeon is that surgeon who operates on the chest.  Why it is important to incline more to the thoracic surgeon is that he quickly gets tissue for biopsy, if there is a need for it depending on the location of the tumour. Then you now move on to the oncologists so that they  quickly put the patient on drugs if he or she has lung cancer.

“So when patients  come to the hospital and you suspect tuberculosis or lung cancer, depending on the age of the patient, quickly book the patient for investigation, and immediate treatment by the cardio thoracic surgeon. When this is done you have good outcomes. There is also a need for a good lung cancer registry.”

Prof. Okonta said training, enhancement, and the ultimate development will complement ongoing oncologic service efforts and facilitate the formation of high-capacity multidisciplinary teams within local institutions with attendant benefits.

He said research efforts through deep multi-institutional collaborations, locally and internationally, should be encouraged.

“This has a huge potential to close some of the research, human capacity, and funding gaps towards the attainment of qualitative and comprehensive lung cancer care in the country,” he added.

Also, Egwuenu, the advocate , said there is need for sensitisation of the populace on lung cancer as some have erroneous belief that it only affects people who smoke.

He said, “Lung cancer still has a stigma attached to it. The first thing people think is that the person suffering from the disease  smokes, so he, or she caused the disease by himself or herself.’ Not knowing that some people that have lung cancer never smoked. “ While smoking tobacco contributes to   lung cancer, there are still many other causes such as radon  gas, a naturally occurring  gas in the soil,  asbestos etc.”

He added that there was a need for training and retraining of medical professional, and provision of diagnostic equipment across health facilities. He said, “If doctors are educated more, they will be able to think this might be lung cancer. ‘Let me send for further screening’ instead of what obtains now.”

He said it is also important for governments at all levels to pay more attention to lung cancer.

He stressed that it is important for the National Institute for Cancer Research and Treatment (NICRAT) to prioritise lung cancer. He explained that at the moment, breast, cervical and prostate cancers are prioritised in the country. He said while these cancers are prevalent, he added that the survival rate from them  far exceeds lung cancer that a large percentage of those suffering from it often die because of the issues bedeviling its diagnosis and treatment in the country.