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Cancer Not a Death Sentence; Early Detection and Prevention is Key

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Many healthcare practitioners today are beginning to allude to the (fact) that Cancer may just be a ‘lifestyle related disease’ of metabolic conditions, and not genetic – resulting only due to mutations. It becomes pertinent then to stress that due to modernisation it seems, mankind may just be paying a huge price for his sophistication and derailment from nature as it were. But what exactly is the cause of the dreaded plague – Cancer? Is cancer curable? Dr. Bindiya Chugani, is Centre Director, Lakeshore Cancer Centre – Lagos, while Dr. Oge Ilegbune is a family physician, and Head of Strategy Development and Outreach at the Centre. In this chat with PharmaTimes Editor, MORGAN NWANGUMA, they both try to lend answers to these questions while stressing the importance of awareness which is vital for early detection and prevention of this deadly scourge.
Excerpts: How can awareness be cultivated in the minds of the public so that they can take full control of their destiny as regards dealing with the issue of cancer?

We are trying to educate the health care practitioners about cancer – the screening, the referral systems, the diagnosis, etc. Not only do we think the patients need to be more enlightened, but it’s the healthcare practitioners on the other end too that does. And because of our background, this is what we do: we impart knowledge to other people so that even when patients go to the primary health centres they can get treatment with early diagnoses. Early detection is key. Right now in Nigeria we’re catching cancers at very late stages strictly due to none awareness on both the healthcare practitioners’ side as well as the patients’ side. There is also the lack of a pathway on what to do; once the cancer is there most people get overwhelmed and decide not to do anything.


I understand you can check cervical cancer for instance, through vaccination. But there is countless number of cancers out there; how many of them do we have vaccines for?


Cancer vaccination is an indirect thing; it is not really the disease we are vaccinating against, but we’re vaccinating against the virus that causes the cancer. In the case of cervical cancer, it is the human papilloma virus (HPV) which causes 99% of all cervical cancers. So, it’s a bit like immunisation for children so that before you get the infection you actually take the immunisation to increase the antibodies so you will be able to have the immunity to fight if you are exposed to that infection.

The same thing with the HPV vaccination: you want to give it at a certain time and at a certain age when people have not really had huge exposure to it. There is only one other cancer that has vaccination, that is the Hepatitis B virus – that causes cancer. It’s not as if anyone that has the virus is automatically going to come down with the cancer, but it’s just a risk factor, and so we just want to prevent it or mitigate the risk of getting cancer in the future. There may be some other ones, but these are the two main cancers we can vaccinate against the viruses that cause them.


I hear that cancer may just be connected to lifestyle behaviours. But most doctors are not inclined to advise their patients on lifestyle habits; they seem to just feel content administering drugs to their patients without advising them appropriately. What are you experts doing to further equip healthcare practitioners with these skills to further check the cancer scourge?


Even though we are an oncology unit, we know these things; we also know that before the patients come to us they’re already in stage 3 or 4. And we also believe that there is a lot that can be done at the primary healthcare levels. When patients come in to see their doctors, doctors and nurses should be empowered to be confident to discuss not just the malaria that they’ve come with, but also screening. So it’s important that wherever they are they should always talk people about screening and lifestyle modification. Most of what happens with cancer is risk factors and we need to think of all the different risk factors which are linked to lifestyle, genetics, etc. we also talk to the public and do a lot of community outreach events.


Chemotherapy comes along with it some terrible side effects; but is cancer actually curable?


Yes, it is very much treatable, curable as well as preventable. It is that misconception that we are out to debunk. A third of the cancers are curable, and that is why we’re doing regular screenings and vaccinations (such as the HPV vaccination), and talking about self examinations and lifestyle modifications so we can prevent cancer. Most cancers are curable at mostly the early stages.

But we have situations of people at stages 3 and 4 that have been cured; they have a stable disease and so can live for a long time. It’s just like having hypertension; if it is well managed the patient can live for a very long time. This means in this case the patient is not cured but you’re able to manage the symptoms to enable them have some quality of live, and that can be anywhere between a few weeks to many years. A patient can have stage4 cancer and can be palliated and managed very well; there is no disease progression, i.e. the disease is stable. Usually the problem is if anyone has cancer, they run away thinking it is a death sentence, and that is not true.

In the advanced world they’re catching cancer at stage1 and 2. The reason we are seeing more deaths than other countries is because we’re catching cancers at the late stages – 3 or 4, when it has spread to other parts of the body, and you know the treatment will not be as effective as it would at the earlier stages, and not cheap either. If for instance, breast cancer is caught at stage1 (which is as a lump), you just remove the lump, it might just end up with that one minor surgery with plus or minus chemotherapy, and you also watch your weight. Sometimes you may not even need chemotherapy. But if the lump remains there without active treatment and it becomes bigger; if it gets to stage3 we will be talking radiation, surgery and chemotherapy – all the different therapies that are expensive.


At what stage really does a patient require surgery; and is it all types of cancer that are amenable to surgical operation to totally get rid of them?
Actually, there are three (main) modes of treatment for cancer: Radiation, which is localised treatment using a machine whence the radiation goes straight to the site of the tumour. There is Chemotherapy, which is drug-based treatment; it’s systemic, it goes throughout the (human) system. And the other is Surgery.


But Chemo is a big problem: as it destroys the harmful cancer cells, the drugs also destroy alongside normal cells – leading to horrible side effects?
In terms of chemotherapy, it’s risk versus benefit. There is a debate out there about chemotherapy because the drugs destroy the harmful cancer cells as well as the normal cells. But the issue is whether the treatment is more beneficial than harmful, and considering also if they’re in the hands of the right people. When an oncology unit is in charge we have a protocol on how we manage patients when they are about to start therapy; it’s not like taking paracetamol or panadol, or giving somebody a drip; we follow and monitor the patient. In fact the patients are educated before chemotherapy begins so that the patients are as comfortable as they can be throughout the period of therapy.


It has been a puzzle over the decades, and medical experts don’t seem to be able to come to terms with the real cause of cancer. What exactly is the cause of cancer?

It is a heterogeneous disease, so it can happen to anyone, and basically it is due to mutation of the cells of the DNA. And any of those risk factors mentioned can lead to a mutation. These include smoking, alcohol consumption, etc. Obesity also can lead to mutation because we know that fat cells produce hormones that are dangerous to the cells. Sometimes too it is a combination of the factors, and depending on your immune levels too to be able to withstand a meld of risk factors that come together to form the mutation. That is why we preach a lot about risk factors.


I know that chemotherapy can be so expensive apart from its serious side effects. Most orthodox practitioners do not want to hear about alternative medicine, but some experts are looking to natural cures, and even sometimes, marrying the two for more reliable and safer solutions to cancer. What do you think?


That may be your opinion. But rather, I think conventional medicine and alternative medicine need to actually come together to see where there is commonality because …for instance, something like acupuncture was seen as alternative for a very long time. But now conventional orthopaedic surgeons are prescribing acupuncture for back pains, etc. The difference especially in our environment is that there are a lot of anecdotal claims from all manner of practitioners.

But what we in the conventional practice are saying is – just provide us with the evidence; show that the treatment you’re talking about has gone through studies/ research and trials such that at the end of the day you have the numbers, and the publication stating that this treatment is very good and we have the statistics to show. But what’s happening with the alternative therapists as far as I am concerned is that they are playing with stories, and people’s ignorance; people are not asking for statistics and that is the problem. For me, I think there should be a common ground for both to actually work together.

We live in the 21st century and so it’s about evidence medicine, not .., stories. One thing we’re also concerned about – whether it’s orthodox or traditional medicine, they go through the same detoxification method: they both go through the liver and the kidney. If you overdose on any of the two, or they interact, you end up having a situation where you’ve over-tasked your liver and your kidney, etc. so you have to be very careful. You can’t take chemotherapy and traditional medicine at the same time also; you may shut down your liver or kidney, whether it’s cancer or not. What we need is information; in Nigeria people are not doing (enough) research.

rious side effects. Most orthodox practitioners do not want to hear about alternative medicine, but some experts are looking to natural cures, and even sometimes, marrying the two for more reliable and safer solutions to cancer. What do you think?
That may be your opinion. But rather, I think conventional medicine and alternative medicine need to actually come together to see where there is commonality because …for instance, something like acupuncture was seen as alternative for a very long time. But now conventional orthopaedic surgeons are prescribing acupuncture for back pains, etc. The difference especially in our environment is that there are a lot of anecdotal claims from all manner of practitioners.

But what we in the conventional practice are saying is – just provide us with the evidence; show that the treatment you’re talking about has gone through studies/ research and trials such that at the end of the day you have the numbers, and the publication stating that this treatment is very good and we have the statistics to show. But what’s happening with the alternative therapists as far as I am concerned is that they are playing with stories, and people’s ignorance; people are not asking for statistics and that is the problem. For me, I think there should be a common ground for both to actually work together.

We live in the 21st century and so it’s about evidence medicine, not .., stories. One thing we’re also concerned about – whether it’s orthodox or traditional medicine, they go through the same detoxification method: they both go through the liver and the kidney. If you overdose on any of the two, or they interact, you end up having a situation where you’ve over-tasked your liver and your kidney, etc. so you have to be very careful. You can’t take chemotherapy and traditional medicine at the same time also; you may shut down your liver or kidney, whether it’s cancer or not. What we need is information; in Nigeria people are not doing (enough) research.

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