Minister of Health, Dr. Isaac Adewole

World Cancer Day, a sol
emn day supported by the United Nations agency, World Health Organisation (WHO), takes place every year on February 4, and is the single initiative under which the world unites to provoke greater global awareness of how to prevent, detect, treat, and manage cancer.
Coordinated by the Union of International Cancer Control (UICC), based in Geneva, Switzerland, the World Cancer Day, this year was marked under the tagline: ‘We can. I can.’ And this focus runs through 2018. This theme strives to explore how everyone – as a collective or as individuals – can do their part to reduce the global burden of cancer. The reason for this theme is anchored on the fact that just as cancer affects everyone in different ways, everyone has the power to take action to reduce the impact that cancer has. This is why this year’s World Cancer Day was seen across the globe as a chance to reflect on what we can do, make pledges and take actions.
Of course, the World Cancer Day was established by the Paris Charter adopted at the World Summit Against Cancer for the New Millennium in Paris on February 4, 2000, and aims at promoting research for cure as well as preventing the disease, while spurring efforts at upgrading services provided to the patients, improving sensitisation of common opinion, and mobilisation of the global community against cancer. In its Article 10, the Charter states that, “Since cancer knows no boundaries, and individual countries cannot address the challenges of cancer in isolation, a new cooperative approach to research, advocacy, prevention and treatment must be established.
“The parties undertake to develop unprecedented global networks and alliances to further the goals of this charter. They further pledge to ensure that the objectives of this charter are not abandoned after its signing, by: Recognizing the declaration by all appropriate institutions that February 4 shall be marked as “World Cancer Day” so that each year, the Charter of Paris will be in the hearts and minds of people around the world; establishing standing committees that will produce annual reports, benchmarking progress against each of the articles of the Charter; forming a global network of advocacy groups to encourage grassroots support for charter articles within their communities; creating a global research organization made up of leading professional societies around the world. This group will be dedicated to ensuring that current knowledge is shared across borders, research gaps are identified and promising areas are explored; and rallying one million people around the world to sign the Charter of Paris by the year 2001, thereby showing their willingness to mobilize on behalf of those affected by cancer.”
There are many types of cancer in humans, and all gradually eat-up and destroy vital organs and parts and sometimes, fluids, in the body system. However, the 10 most common cancers include lung, breast, liver, colorectal, prostate, stomach, gallbladder, ovarian, pancreatic, bladder, cervical, endometrial, kidney, and oesophageal cancer. Whereas lung cancer is the most common cancer, with 1.8 million new cases, breast cancer is the second most common cancer, with 1.7 million new cases, diagnosed in 2012. Colorectal cancer is the third most common cancer, with 1.4 million new cases, while prostate cancer is the fourth most common cancer, with 1.1 million new cases diagnosed in 2012. Also, stomach cancer is the fifth most common cancer, with 952,000 new cases, with liver cancer as the sixth most common cancer, with 782,000 new cases, and cervical cancer, being the seventh most common cancer, with 528,000 new cases diagnosed in 2012.
Similarly, oesophageal cancer is the eighth most common cancer, with 456,000 new cases, just as bladder cancer is the ninth most common cancer, with 430,000 new cases, while pancreatic cancer is the 12th most common cancer, with 338,000 new cases diagnosed in 2012. But curiously, kidney cancer, feared by many, is the joint 12th most common cancer, with 338,000 new cases, with endometrial cancer, being the 14th most common cancer, with 320,000 new cases, and ovarian cancer, the seventh most common cancer in women worldwide, with 239,000 new cases, as well as gallbladder cancer, the 20th most common cancer, with an estimated 178,100 new cases diagnosed in 2012.
It is in line with the objectives of the Paris Charter, and desire of stakeholders to reduce, if not eliminate the burden of cancer in the world, that leaders in various public health circles, policy makers, and activists gathered across cities and towns on February 4, this year to reflect on the journey so far in the fight against cancer. And the events continue in various forms. At all the fora, public gatherings and other events, leaders expressed concern at the death toll unleashed on humanity by cancer, while also reckoning with the drop in incidence of the disease globally, due mainly to growing consciousness among citizens of the world, patients and healthcare givers.
Leading this is the UICC, which said that ”Cancer will kill more than eight million people worldwide this year, which is equivalent to the entire population of New York. Half of these will be people of working age (30-69 years old). Preventing millions of unnecessary deaths and suffering from cancer is not outside of the world’s scientific or financial capabilities,” Chief Executive Officer, UICC, Dr Cary Adams, said.
The UICC also observed that “It has been estimated that the cost implications on world economies caused by cancer and the other non-communicable diseases (including mental health) could be as high as $47 trillion if no action is taken to reduce the anticipated growth in cases over the next two decades. This is a greater economic impact than the global financial crisis of 2008 and represents 75% of global GDP.”
It, therefore, called on the world to unite against this disease that knows no borders and represents one of humanity’s most pressing and financial concerns. Working under the campaign theme: ‘We can. I can,’ the UICC said that this year’s World Cancer Day represents a unique opportunity to draw attention to what can be done to address cancer, save millions of avoidable deaths and, in turn, support global economic growth and development. It urged corporations to focus their business on products and services that improve public health.
The leading global cancer non-governmental organisation, also took advantage of the World Cancer Day events to ask governments to urgently reaffirm their commitment to the following cost-effective cancer ‘essentials’ package that save lives, including implementation of vaccination programmes which prevent infections that cause cervical and liver cancer. Scale up access to early detection and screening programmes for cervical, breast and bowel cancers, and follow-on treatment, tighten tobacco taxation, regulation and control, while improving pain relief and palliative care services for all cancer patients.
With more than a third of all cancers (up to 4.5 million per year) preventable through lifestyle interventions, UICC also called on individuals to take responsibility for reducing their own cancer risk. It suggested simple measures such as stopping smoking, eating less red and processed meat, exercising regularly and reducing alcohol use. It said that these measures can extend a healthy life, and must be seen as the first-line of defence against cancer and other associated non-communicable diseases.
“It will, however, require collaborative action at both individual and collective levels – spearheaded by key leaders in society. Governments have made global commitments to priority actions for addressing cancer, we now need to see these converted to national investments in treatment centres, services and skilled health workers, as well as health promotion. Employers can play a crucial role also by investing in the well-being of their workplace and the wider environment which they impact,” Adams added.
Also speaking, UICC President, Prof Tezer Kutluk, said “World Cancer Day 2016 is a chance to reflect on what everyone can do to reduce the impact of this devastating disease, now, and for the future. We wish it to be a springboard for positive change. Take action for yourself, your organisation or your community/country, as everyone can make a difference and inspire others. ‘We can. I can,’ beat cancer.”
Indeed, there were more than 826 activities organised around cities, urban and semi-urban centres across all continents, and borders. In Geneva, the United Nations AIDS Programme, called for greater investment in the prevention and treatment of cervical cancer, and also underlined the additional benefits to be achieved for women and adolescent girls from a coordinated response to HIV and cervical cancer.
Explaining that every year, more than 500 000 women develop cervical cancer, which is caused by the human papillomavirus (HPV), and more than 250 000 women die of the disease, most of whom live in low- and middle-income countries, UNAIDS insisted that cervical cancer is a preventable disease that can also be successfully treated, if detected early. The relationship between HPV and HIV, it stated, offers significant opportunities to reduce the impact of both viruses, since existing HIV programmes could play an important role in expanding cervical cancer prevention and treatment services.
The UNAIDS Executive Director, Michel Sidibe, regretted that, “Women are dying from cervical cancer unnecessarily,” adding that, “We must take advantage of the synergies that exist in responding to HIV and HPV to provide integrated and expanded quality prevention and treatment services and ensure that all women and adolescent girls have unrestricted access to quality health care, including to sexual and reproductive health-care services.”
At other events, experts said that one way to reduce this burden is the new initiative aimed to make the fight against breast cancer a global priority. It is to achieve this goal that, “Breast Cancer Initiative 2.5”, a global campaign to reduce disparities in breast cancer outcomes for 2.5 million women by 2025, was launched on February 4. This new campaign represents a new commitment to unite the global breast cancer community behind a common goal and make breast health a global priority.
“On World Cancer Day, we have an opportunity to collectively examine cancer control strategies to identify winning formulas that will accelerate progress. The goal for all of us is to ensure fewer people develop cancer, more people are successfully treated and that there is a better quality of life for people during treatment and beyond,” said Heather Bryant, VP, Cancer Control, Canadian Partnership Against Cancer.

According to the latest analysis released on World Cancer Day by Cancer Research, United Kingdom, cancer death rate has fallen by almost 10 per cent in the last 10 years. In 2013, 284 out of every 100,000 people in the UK died from cancer – around 162,000 people. A decade ago, this was 312 in every 100, 000. Similarly, the World Hepatitis Alliance said that 80% of liver cancer deaths can be prevented, saving hundreds of thousands of lives each year globally, and called for the establishment of comprehensive hepatitis strategies to help prevent the 800,000 liver cancer deaths each year.
While marking the World Cancer Day, The Hope Light Foundation launched the “Beacons of Hope” project to unite lighthouses throughout the world to work together in the fight against cancer, just as the Irish Cancer Society used the occasion of the celebration to call on the public to support its message: “We can shape policy change” by working with influencers to close the cancer gap.
The Health and Environment Alliance (HEAL), also called on Europe’s most influential cancer societies to urge governments to put an immediate ban on glyphosate, a chemical used as a herbicide. In a letter sent on World Cancer Day, HEAL’s President, Dr Peter van den Hazel, reminded leading national cancer groups that a ban on glyphosate represents a significant opportunity in cancer prevention.
In Nigeria, a litany of events have been held in different cities, including Port Harcourt, Lagos, Abuja, Enugu, Asaba, and elsewhere, to draw attention to the rampaging effects of cancer, and how, as a people, we can prevent its spread through early testing, detection, treatment and care. More events are still being organized to enhance public awareness on the disease.
At an event in Abuja, National Coordinator, Cancer Control Programme, Dr Ramatu Hassan, said that the Federal Government has concluded plans to upgrade the programme to National Agency for Control of Cancer. In addition, Chairman, National Committee on Cancer Control, Prof Francis Durosinmi-Etti, emphasized the need for more private-public partnership to boost access to cancer care across the country. Both also called for greater awareness amongst Nigerians of the urgency for concerted action to curb the menace of cancer in our national life by committing to early preventive care, testing, detection, treatment and support for survivors.
In Rivers State, Chief Medical Director, Hospitals Management Board, Dr Dorathy Oko called for synergy among all stakeholders to increase awareness, boost testing and detection, and encourage requisite treatment, further stressing that there was need to use knowledge to demystify cancer. She listed free cancer screening and testing centres in the state to include the Braithwaite Memorial Specialist Hospital (BMSH) and University of Port Harcourt Teaching Hospital (UPTH).
For the avoidance of doubt, it is important to note the link between lifestyle and cancer risk. According to WHO, four non-communicable diseases (NCDs) – cancers, cardiovascular diseases, respiratory diseases and diabetes – are responsible for 80% of all deaths from NCDs worldwide. This is despite the fact that there is a clear link between lifestyle and non-communicable diseases. Indeed, about a third of the most common cancers can be prevented through diet, maintaining a healthy weight and taking regular physical activity. Therefore, behaviour change is key to the prevention and control of non-communicable diseases, particularly as the number of cancer cases are expected to rise globally over the next two decades.
However, there are 10 cancer prevention recommendations generally accepted by experts globally. There cover body fatness; physical activity; foods and drinks that promote weight gain; plant and animal foods; alcoholic drinks; preservation, processing, preparation; dietary supplements; breastfeeding; and cancer survivors.
The first is to be as lean as possible without becoming underweight. In fact, research shows that there is strong evidence that weight gain, overweight and obesity increases the risk of a number of cancers, including bowel, breast (postmenopause), prostate (advanced cancer), pancreatic, endometrial, kidney, liver, gallbladder, oesophageal (adenocarcinoma) and ovarian cancers. Therefore, maintaining a healthy weight – through a balanced diet and regular physical activity – helps reduce the risk of developing cancer. Thus, ensure you are as lean as possible within the normal range of body weight. It is vital to ensure that your median adult body mass index (BMI) is between 21 and 23, depending on the normal range for different populations. Also ensure that body weight through childhood and adolescent growth projects towards the lower end of the normal BMI range at age 21. Maintain body weight within the normal range, and avoid weight gain and increases in waist circumference throughout adulthood.
The second is physical activity. Experts advise physical activity for, at least, 30 minutes every day. Be moderately physically active, equivalent to brisk walking, for at least, 30 minutes every day. As fitness improves, aim for 60 minutes or more of moderate, or for 30 minutes or more of vigorous, physical activity every day. Limit sedentary habits such as watching television.
The third is to avoid foods and drinks that promote weight gain. In fact, it is necessary to limit consumption of energy-dense foods, especially foods that are high in fats and/or have added sugars and/or low in fibre) and avoid sugary drinks. Ensure that the average energy density of diets are lowered towards 125kcal per 100g, just as you consume energy-dense foods sparingly, particularly “fast foods”, if at all.
The fourth is to eat more of plant foods, especially a variety of vegetables, fruits, whole grains, and pulses such as beans. Specifically, it is advised to eat, at least, five portions/servings (at least 400g or 14oz) of a variety of non-starchy vegetables and of fruits every day. Eat relatively unprocessed cereals (grains) and/or pulses (legumes) with every meal, and of course, limit refined starchy foods. However, those who consume starchy roots or tubers as staples should also ensure intake of sufficient non-starchy vegetables, fruits, and pulses (legumes).
While the fifth is to avoid animal foods, and if not possible, limit consumption of red meats (such as beef, pork and lamb) and also avoid processed meats, the sixth suggests drastic reduction in the intake of alcoholic drinks. In fact, if alcoholic drinks are to be consumed at all, limit consumption to no more than two drinks a day for men and one drink a day for women.
It is also necessary to limit consumption of salt and avoid mouldy grains and cereals, by limiting intake of salty foods and foods processed with salt (sodium). Minimise exposure to aflatoxins from mouldy cereals (grains) or pulses (legumes). Particularly avoid salt-preserved, salted, or salty foods; preserve foods without using salt, and limit consumption of processed foods with added salt to ensure an intake of less than 6g (2.4g sodium) a day.
Furthermore, do not use dietary supplements to protect against cancer, but aim to meet nutritional needs through diet alone. This is because dietary supplements are not recommended for cancer prevention. Also, breastfeeding is best strategy to prevent cancer. It is best for mothers to breastfeed exclusively for up to 6 months, and then, add other liquids and foods as complementary thereafter. Reasons: Breastfeeding protects both mother and child from diseases, including cancer. Lastly, after treatment, cancer survivors should strictly follow the recommendations for cancer prevention, and ensure they receive nutritional care from an appropriately trained professional. If able to do so, and unless otherwise advised, aim to follow the recommendations for diet, healthy weight, and physical activity.
To achieve a cancer-free society, therefore, it is vital that we inspire and take action; make healthy lifestyle choices; prevent cancer; understand that early detection saves lives; challenge perceptions; and ask for support. Besides, we must create healthy environments; support others to overcome; help improve access to cancer care; take control of our individual cancer journey; help build a quality cancer workforce; pursue love, and be loved; and mobilise our networks to drive progress. We also have to have confidence in ourselves; work assiduously to shape policy change; return to work when we are fit; make the case for investing in cancer control; share our story; work together for increased impact; and speak out against those things that promote cancer epidemic.
Let’s go for counselling, and follow up with testing. That will enable detection, treatment and care that we desperately desire.

Susan Serekara-Nwikhana