“It was in 2013. I had this swelling under my armpit, so I went to a private hospital and was wrongly diagnosed there. Then, I was really big… the doctor told me it was a fatty tissue.”
Those were the words of Caroline Obayuwana, a breast cancer survivor, as she recounted her excruciating experience in the hands of the ailment.
She had come for her regular screening at the Lagos University Teaching Hospital (LUTH) in April which this time was organised by Cancer Aware, a non-governmental organisation that advocates for early detection and treatment.
Obayuwana looked stoic, her mien absolutely gently, yet this was the most dogged fighter, a woman who had battled breast cancer and is still winning. A woman still battling the financial challenges of after treatment care, but is resiliently ensuring her four kids thrive.
She, however, noticed that the lumps were not going away and decided to consult another doctor.
“I went to a different private hospital and they (also) told me it was a fatty tissue and that over time it will melt away.” she said.
This narration fits the World Health Organisation’s (WHO) observation of inaccessible diagnosis, especially in low and middle-income countries, being the the bane of cancer treatment.
“Less than 30% of low-income countries have generally accessible diagnosis and treatment services, and referral systems for suspected cancer are often unavailable resulting in delayed and fragmented care,” WHO says.
“In 2015, approximately 35% of low-income countries reported that pathology services were generally available in the public sector, compared to more than 95% of high-income countries.”
It was a whole two years after, in 2015 precisely, that Obayuwana noticed the lump was getting harder and painful.
She decided to see one of her uncles, a radiologist at LUTH, who recommended a mammogram. It was after the mammogram and then a biopsy, that Obayuwana found the lumps in her right breast was cancerous. Sadly, it was far gone, the third stage of four stages of cancer; so she needed a surgery.
Obayuwana was told by her doctors that her treatment would include a surgery (mastectomy) – her right breast had to be removed, six doses of chemotherapy to be taken in two batches and then radiotherapy.
These treatments were expensive, costing up to N250,000 for one dose of chemotherapy, money that Caroline, a widow with four children, could not afford.
She resorted to seeking the goodwill of people, former bosses, friends, families, her local church and then a non-governmental organisation – Cancer Aware, that now ensures it carries the message of screening and early detection to Nigerians wide and far.
Obayuwana’s story of exorbitant cost of treatment of cancer collaborates the statement of Etienne Krug, director of WHO’s department for the management of noncommunicable diseases.
During the last world cancer day, Krug had advocated for prompt treatment of cancers, especially colorectal, cervical and breast cancers. Detecting cancer early greatly reduces its financial impact, he had said.
“This will result in more people surviving cancer. It will also be less expensive to treat and cure cancer patients.”
“Not only is the cost of treatment reduced in cancer’s early stages, people can also continue to work and support their families if they can access effective treatment on time,” he said.
Obayuwana had six sessions of chemotherapy and described the treatment as “too painful”.
“I lost my hair on all parts of my body, my nails and my skin became black.”
She told TheCable that she was really weak, tired and really nauseous. “The pain was almost unbearable,” she said and added that it took about a month for her hair to start growing and in that period, she felt a sense of loss that let depression set in.
After chemotherapy, it took almost two months for her radiotherapy to commence. Since there are only two functioning radiology equipment in Nigeria, there was a long line of people -about 100- waiting for the treatment before her.
Obayuwana said this is usually the case – so many people needing radiotherapy and so few machines.
And after radiotherapy, her skin peeled, she developed a sore in the area and she started her journey to healing.
Cancer takes a toll on family too
But it was not only Obayuwana who had a gruelling time. It was a tasking period for her four children, especially for her oldest, who at 13-year-old, had to be burdened with caregiving and management of scarce resources.
WHO advised governments should provide people living with cancer “access to safe, affordable and effective treatment including pain relief, without incurring prohibitive personal or financial hardship.”
Tolulope Falowo, executive director, CancerAware, a Lagos-based cancer intervention non-profit, says majority of the cancers reported in hospitals are usually at a late stage.
“Late presentation! so for different reasons, people come late. If cancer is caught early, chances of survival are actually very high. Unfortunately, most of the cases presented to our hospitals are usually late stage, so the fatalities are high.”
Falowo said prevention and early detection of cancer is key.
“Diagnosing cancer early is vital in its treatment and we actively propagate this in our campaigns,” Falowo said.
“At Cancer aware, the focus is on breast cancer and cervical cancer because those two have the highest incidences among women in Nigeria. Breast cancer is the most common while cervical is the second most common cancer, yet it is almost 100 percent preventable.
“There is a vaccine and if you go for early screening, you can detect and treat, yet it is the second most common cancer so that means something is wrong.”
Education is key
Falowo said education is key in preventing and early detection of breast cancer, the reason cancer aware organises free breast and cancer screenings.
“We educate, we inform and we organise trainings to reach the city dweller of 20 – 45 and we have people in rural communities,” she said.
“The first group we reach through social media to get the message across.
“The people in the rural communities, you have to go the communities, take the screening to them. A lot of people in those communities have a lot to think about and there is a lot of myth. people think cancer is a death sentence but early detection can prevent deaths.”
Falowo advised women to do regular breast exams.
“If you are 40 and above, talk to your doctor about a yearly regular mammogram,” Falowo said.
“Women should do regular breast cancer and if you are 40 and above, talk to your doctor about doing yearly mammograms. It is difficult in Nigeria, and though the narrative is changing, people are more receptive, because more people know people who have cancer.”
Falowo talked about the challenges of running a non-governmental organisation that caters to the prevention and early detection of breast and cervical cancer.
“Funding is tough and Nigerians are not used to giving NGOs,” she said.
But the work has to be done, cancers need to be prevented and diagnosed early, NGOs like Cancer Aware help by taking screening to rural and indigent women who would otherwise be excluded.
Data credit: Code for Africa