Hundreds of people gather in Abuja, Nigeria’s capital, to mark World Cancer Day on February 7, marching to raise awareness about cancer and the importance of early diagnosis. The World Health Organization cites Nigeria as a country with a rapidly increasing number of cancer cases. Emmanuel Osodi/Anadolu/via Getty Images hide title toggle title Emmanuel Osodi/Anadolu/via
Hundreds of people gather in Abuja, Nigeria’s capital, to mark World Cancer Day on February 7, marching to raise awareness about cancer and the importance of early diagnosis. The World Health Organization cites Nigeria as a country with a rapidly increasing number of cancer cases.
Emmanuel Osodi/Anadolu/via Getty Images
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When Titilayo found a lump in her left breast, it felt like a death sentence.
“My world was falling apart,” he says. “I had no hope, I had no life.”
Titilayo, who asked NPR to share only his name to speak openly about his cancer and its impact on his life, lives in a small town in southern Nigeria. To find out if the lump was malignant, he had to wait weeks for a biopsy sample to be sent to Abuja, the capital of Nigeria.
When she received the news that the lump was cancerous, the doctor recommended that she undergo a mastectomy and several rounds of chemotherapy.
But the chemotherapy infusions he needed weren’t always available where he lived, forcing him to find them in another state and bring them to the hospital.
“The burden of receiving chemotherapy drugs fell on me,” Titilayo recalls.
But his three daughters were young. They needed her. So he decided that, no matter what happened, he would continue treatment.
“If I die from this, who can take care of my children?” Titilayo says. “I discovered that my life is worth fighting for.”
One in five people alive today will face cancer in their lifetime. But while cancer treatments and survival rates are improving in rich countries, that’s not the case in places where the rate of cancer diagnosis is increasing most rapidly.
The World Health Organization projects that by 2050, cancer cases in sub-Saharan Africa will double; the highest expected rate of increase in The six regions designated by the WHO. The eastern Mediterranean region, which includes much of North Africa and the Gulf, comes in second.
Cancer predictions
In Abuja, radiation oncologist Dr Basira Hanafi Lawal sees this first-hand.
“We asked ourselves: Are we raising more awareness among people and that’s why they’re coming, or are the numbers just going up?” she says.
Lawal points out several possible risk factors for a rise in cases: Nigeria’s older population is growing. And more and more people drink alcohol, smoke tobacco and lead urban, sedentary lifestyles, he says.
It is seeing many patients who arrive in the early stages. She attributes this to preventive screenings and public awareness campaigns promoted by nonprofit organizations and religious groups.
There’s also another trend line: patients delaying arrival until their symptoms are so severe they can’t be ignored. “It’s really heartbreaking,” Lawal says. “Especially in the later stages: what do you do for them? And they ask you: what do I do?”
She estimates that 70% of her patients are diagnosed at stage 3 or 4, when the tumors have spread from the original site to surrounding tissues, lymph nodes, or even other organs.
Then there are the cases that don’t fit the patterns she would expect. As in other parts of the world, colorectal cancer, once associated with older people, has become more common in young people. He remembers a 19-year-old young man who was diagnosed with this cancer.
Crowds in waiting rooms
For all of these patients, simply finding a cancer doctor can be overwhelming. Lawal is one of 80 oncologists in a health system that serves 242 million people. (For comparison, there are approximately 27,500 oncologists in the United States for a population of 340 million.) It is not uncommon for doctors to receive their training in Nigeria but move abroad to work elsewhere. And although more than half of cancer patients worldwide need radiation, there are only 15 radiation centers in Nigeria.
So when Lawal comes to work, he says he often sees crowds of patients waiting.
“Sometimes there are patients who travel, maybe eight hours,” he says. “There are still many areas and regions that lack radiotherapy centers, so access will be quite limited.”
The WHO report shows that cancer patients in Nigeria are also disproportionately likely to have to pay for their care. In 2022, patients were responsible for more than 80% of cancer care costs in Nigeria, according to data from the WHO global health expenditure database.
Abigail Simon-Hart is all too familiar with these discouraging trends. She is a Nigerian breast cancer advocate and survivor, who is credited as a reviewer on the WHO report.
“Many times people arrive late. Sometimes they have detected it before and they don’t know where to go. Sometimes they know where to go but they don’t have the money,” he says.
Many health insurance plans in Nigeria do not include comprehensive cancer care, forcing many families to pay for care out of pocket. Local crowdfunding websites are full of posts from cancer patients trying to raise money for surgeries and medications. That financial burden is being felt not only in Nigeria, but in all low- and middle-income countries where the WHO expects to see the biggest increases in cancer rates.
“I’ve seen people sell everything they have and still lose their loved ones,” Simon-Hart says. “It’s a huge burden on the average family.”
“We have to resort to loans: bank loans, loans at our workplace or request funds from friends and family,” says Regina Fisayo Akinola, a breast cancer survivor and advocate in Ado Ekiti, Nigeria.
Akinola completed one round of treatment in 2014 and another in 2020, when she discovered another tumor in her right breast. She regularly encourages others to have regular mammograms to detect breast cancer as early as possible. She attributes her survival to this awareness and the support of her family.
But Akinola says other patients are not so lucky and are abandoned by friends and loved ones.
“They’ll look and say, Oh, this person is going to pass away soon. There’s no reason to waste time or money on them. They can’t last,” Akinola says.
For some, these challenges are enough to make the decision to stop treatment altogether.
“We’re not dying because our cancer is worse. It’s because our system is failing us,” says Ethel Olomu, a breast cancer survivor from Rivers State in southern Nigeria.
All of these factors reduce the likelihood of the average cancer patient in Nigeria surviving after their diagnosis. In Data collected by the WHO Global Health Observatory. Between 2017 and 2021, only 28% of women diagnosed with breast cancer in Nigeria were still alive five years later. The overall average rate was 78%.
feel alone
During treatment, and even afterward, many survivors report social isolation and even rejection from their partners and the community.
“I lost my hair and my eyebrows, my skin changed… and people said, ‘Oh, you look like a witch,'” recalls Olomu, who was diagnosed with stage 4 breast cancer at the age of 31. “Because people didn’t know that’s how cancer develops.” [treatment] works.”
Olumu had no family history of cancer. After her diagnosis, her doctor taught her about the disease and what to expect during treatment. He even shared his personal contact information so she could ask questions about her symptoms at any time.
This inspired Olumu to create the Engraced Life Foundation, to support cancer survivors after treatment and advocate for change. A women’s support group in Rivers State includes more than 200 people, she said.
“And we share all“says Olomu. “It was founded from a gap that I myself experienced.”
The Nigerian government has set a goal of reducing cancer cases by 30% by 2030. In 2020, it created the Nigerian Cancer Health Fund to help low-income patients. And leaders are working with international organizations to improve access to cancer care, including purchasing additional radiation machines to install in local hospitals.
“The government is actually investing in infrastructure that is very expensive,” says Jennifer Dent, executive director of BIO Ventures for Global Health, a nonprofit that works with businesses and governments in low- and middle-income countries to improve access to cancer treatment.
Another focus of attention is prevention.
For example, a human papillomavirus (HPV) vaccine can prevent cervical cancer, which is one of the most common cancers diagnosed in Nigeria, Kenya and other African countries. In 2019, Kenya added the HPV vaccine to its routine immunization program. In 2023, Nigeria followed suit.
“There is a lot of mistrust in vaccines in Nigeria, but there are some very influential cervical cancer advocates in the country who I think are doing a phenomenal job raising public awareness,” Dent says.
In another project in Ivory Coast, BIO Ventures helped create a public awareness campaign with video ads on commuter buses, encouraging men to get regular screenings for prostate cancer. Measures like these, Dent says, can help countries prepare for a future in which cancer diagnoses become increasingly common.
An optimistic perspective
Titilayo, a mother of three, says she hopes to inspire others to watch for the early signs of cancer and seek treatment if diagnosed. She says it is not an easy task; Cancer survivors in their community face stigma, gossip, and rejection, especially if they have had a mastectomy. Others face financial difficulties and difficulties returning to work.
But now he shows no evidence of illness. Her daughters are older and she is optimistic about the future.
“I still insist that my life is worth more than any trauma or emotional problem,” says Titilayo. She wants to make sure the women around her feel the same way.
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