Not so many years ago, a friend of mine died of ovarian cancer. I’m not old. Neither was she. She was in her early twenties. Cancer is not just affecting the elderly; it is also taking our youth. From her ovaries, the cancer spread to other organs in her body and she passed on.
This story is becoming commonplace not just here in Kenya but the world over. According to the ministry of public health and sanitation and the ministry of medical services’ national cancer control strategy 2011 – 2016, cancer ranks as the third cause of death in Kenya. It comes in third place after infectious and cardiovascular diseases. The annual incidence of cancer stands at an estimated 28,000 cases with annual mortality at 22,000. My friend Esther and former "N-Soko Property Show" (it airs on Nation TV) presenter Janet Kanini Ikua diagnosed with stage four lung cancer this year reverberate this statistic. Early this November, a concert was held for Mrs. Ikua to raise funds for her treatment. In her case, the cancer has spread from the primary lung site into her lymph nodes. Why is cancer becoming so prevalent?
There are over 100 types of cancer. Cancers are categorized into groups according to the type of cell they start from. The five main cancer groups are carcinomas, lymphomas, leukaemias, brain tumors and sarcomas. Cancer is characterized by abnormal cell growth; abnormal cells divide in an uncontrolled way and may spread into other tissues. Normally, cells grow and divide to form new cells as one’s body requires. If cells grow old or become damaged, they die, and new ones take their place. With cancer this orderly process is destroyed. Old or damaged cells do not die and new cells are formed when they are not needed. These extra cells then divide without stopping and may form growths called tumors. A cancerous tumor is malignant. This means it can spread into or invade nearby tissues. If a tumor is benign, it will not spread into or invade nearby tissues.
The American National Cancer Institute (NCI) tells that cancer is a genetic disease. It arises when there are changes to genes that control the way our cells function and more specifically how they grow and divide. The genetic changes that cause cancer may be inherited. They can, in addition, surface during one’s lifetime as a result of errors that occur as cells divide or because of damage to DNA caused by certain environmental exposures. Cancer causing environmental exposures comprise substances such as the chemicals in tobacco smoke and radiation such as ultraviolet rays from the sun. Other risk factors for cancer include excessive alcohol intake, physical inactivity and obesity, unhealthy diet, environmental pollution, viral and other infectious conditions such as hepatitis and HIV/ AIDs, parasitic infestations such as schistosomiasis and sometimes lack of awareness here in Kenya especially at the grassroots level. These are some of the reasons why cancer has become so common even amongst the younger generation.
The principal reason for the increased risk of getting cancer today as opposed to thirty or forty years ago however ties back to age. With the life expectancy of populations increasing so have cancer rates. The longer one lives, the longer the room for cancer causing errors to build up within cells. The other principal reason for increased prevalence is that more sophisticated equipment has become available to detect cancer. In other words our ability to detect cancer has increased and so cases which were previously undiagnosed are now adding to the statistics.
For public figure Janet Ikua, her diagnosis began as deep vein thrombosis (DVT). In an interview on Nation TV’s The Trend, she also tells that her father was diagnosed with lung cancer stage four almost eight years ago. When first diagnosed she was shocked and thought she might have less than a year to live. Her faith in God keeps her strong through this battle and her husband had to play the dual role of mother and father while she was in India for treatment she told the interviewer. She encourages others on social network site Facebook and believes that you shouldn’t let disease define you rather learn from it and let it strengthen you. As a wife and mother she has drawn inspiration from the fact that her husband and children need her.
Key to warding off cancer is early diagnosis. Cervical cancer which is the number one cause of cancer deaths in Kenyan women would no longer be a death sentence if it is diagnosed early. Diagnosis can be done through a pap smear test. Some women do not go for this test because of lack of awareness about it while others may think the recommendation to have one done regularly once you have been sexually active is irrelevant. Second to this is leading a healthy lifestyle. This involves eating a healthy balanced diet, maintaining a healthy weight, consuming less alcohol, avoiding smoking (tobacco control) and protecting one’s skin from the sun. In Kenya, non-adherence to a healthy lifestyle may be attributed to a growing middle class; with more money available people are, for example, indulging in more alcohol. Although the correlation between eating certain foods and the prevention of cancer can be arguable, research has shown that indulging in fruits and vegetables, starchy foods, meat, fish, eggs, beans, milk and a small amount of foods and drinks high in fat or sugars whether cake, crisps or biscuit can lower one’s risk of developing cancer.
The control of environmental exposure to carcinogens which are chemicals that account for 1-4 percent of all cancers is yet another method of prevention. Exposure to these chemicals within the environment may occur through drinking water or pollution of indoor ambient air as noted by the Kenya National Cancer Control Strategy. Exposure occurs when food and water are contaminated by chemicals such as aflatoxins, dioxins and asbestos. Simple practices take for instance ensuring that food and water are covered or out of the way of exposure from these chemicals are encouraged. Work related exposure to substances like asbestos can be prevented through the use of protective equipment such as face masks. Other preventive devices for occupational carcinogens include hand gloves, laboratory coats, boots, goggles, ear plugs and respirators. Indoor air pollution from coal (charcoal) fires doubles the risk of lung cancer. The use of coal is very common in third world countries like Kenya especially in rural areas. Alternatives such as the use of solar power and ethanol biofuels should be sought. Prevention of viral and bacterial infections that can cause cancer is another way of warding off this disease. This can be done through vaccination, early detection and treatment of such infections.
The government here in Kenya also needs to come in and give hospitals a boost as far as equipment. Kenyatta National Hospital stands alone where adequate cancer screening equipment is found particularly for its’ children’s cancer ward. Poorly equipped hospitals translate to many cancer patients remaining undiagnosed. Janet Ikua had to go for treatment in India for example because there is no Positron Emission Tomography (PET) scan equipment in Kenya because of the expense involved in purchasing this equipment. A PET scan is a diagnostic tool which uses radiation to analyze the entire body at one go. In Kenya there are only ultrasounds, Magnetic Resonance Imaging scans (MRIs) and Computed Tomography scans (CTs) which keep on checking different body parts or areas at a time.
The government can perhaps further move toward subsidizing the cost of drugs for cancer treatment so that more patients can afford such drugs. Mrs. Ikua in her TV interview also advocated for making healthcare more accessible and affordable not just as the onus of the government but others too. “We are capable of so much without kuomba serikali (begging the government),” she advised. More training for doctors in this field is also necessary given low doctor-patient ratio.
Increasing levels of awareness from the grassroots upward can then go a long way in the battle against cancer. Janet mentioned on The Trend that she has realized that many people don’t know about DVT and while in India about cancer and so it is important to share one’s experience. The World Breast Cancer Awareness month held in October is one such excellent initiative. The establishment of the National Cancer Prevention and Control Act in 2012 by the government is another excellent initiative. This act makes Kenya one of the few countries in Africa with legislation for cancer but has not yet been fully implemented. The Act stipulates the establishment of a National Cancer Institute to support the fight against cancer in Kenya.
One day on my way to Nairobi town I witnessed a mob beat and burn a man alive. I suspected he was a thief. I also want to beat and burn a thief alive. That thief is cancer. It is robbing this world of lives mercilessly. It is my hope that this article, in trying to raise awareness, is one member of the mob, stoning ugly cancer to death. Let’s all join together and raise that placard that declares: burn cancer alive!