Archives for March2015


PREVENTING CANCER: THE ROLE OF VACCINES

WELCOME TO CECP-NIGERIA'S BLOG

WELCOME TO CECP-NIGERIA’S BLOG

The 2015 theme for World Cancer Day (February 4) is ‘Not Beyond Us,’ which takes a proactive approach to the fight against cancer, highlighting that the solutions are available and accessible.

According to the World Health Organization (WHO), one-third of cancer is preventable, another one-third is curable and the last third can have good quality of life with appropriate care. Vaccination is one of the most equitable low-cost, high-impact public health measures, when programs are implemented on the national level. Eradicating the main viruses associated with cancer worldwide by implementing widespread immunization programs could lead to a 100% reduction in viral-related cancers in 20 to 40 years, said Graham Colditz, of the Washington University School of Medicine, Missouri at the Union for International Cancer Control (UICC) World Cancer Congress 2012.

gardasil-ad1

Hepatitis B (HBV) is major risk factor of liver cancer, which kills 11,663 Nigerians every year. Fortunately, HBV vaccine is now part of Nigeria’s National Immunization Programme (NPI), with the first dose being given at birth.

 hbv_vaccine1

 HepatitisB vaccine- child

Human Papilloma Virus (HPV) is the root cause of more than 5% of cancers, including nearly all cervical cancers and a substantial percentage of cancers at other sites such as vagina, vulva (the outer part of the female genital organs), penis, scrotum, perineum, anus, head/neck, mouth, throat, nose, tonsil, skin, nail-bed, and conjunctiva (eye). HPV is the most common sexually transmitted infection (STI) in the world, with the highest prevalence in sub-Saharan Africa; 26% of women in Nigeria are positive for the virus. Almost all sexually active people get HPV at some point in their life. Although most HPV infections resolve spontaneously, about 10% persist and may progress to cancer.

ORAL CA    PENILE CA

There are three types of HPV vaccines – a bivalent vaccine (Cervarix), a quadrivalent vaccine (Gardasil) and a 9-valent vaccine (Gardasil 9).  The bivalent vaccine protects against only 2 types of HPV (16 and 18) and is recommended for females alone for prevention of cervical cancer. The quadrivalent vaccine protects against 4 types of HPV (6, 11, 16 and 18).

 220px-Gardasil_vaccine_and_box_new

Gardasil 9 protects against the same 4 types of HPV as the quadrivalent vaccine, plus 5 other high risk types: 31, 33, 45, 52 and 58. The Gardasils thus prevent most cases of cervical cancer, and other cancers caused by HPV infection, including a proportion of genital, anal, oral and throat cancers. The Gardasils also prevent genital warts and Recurrent Respiratory Papillomatosis (RRP). The Gardasils are approved for both males and females. Vaccinating boys against HPV might also help protect girls from the virus by decreasing transmission.

new_gardasil

Recurrent Respiratory Papillomatosis (RRP), most often linked with HPV types 6 and 11, occurs when warts grow in the breathing tubes and lungs. This is usually due to transmission of HPV from a pregnant woman with genital HPV to her baby during birth. RRP causes deadly asthma-like symptoms in children. It may rarely progress to cancer of the voice box. As mentioned earlier, Gardasil helps to prevent RRP.

RRP

HPV vaccine is given in three doses over six months. The protection from the vaccines is expected to be life-long. The vaccines are best given before the start of sexual activity and therefore, exposure to HPV. The recommended age-range for routine immunization against HPV is 9 years to 26 years. However, studies have shown that Gardasil also protects women between 27 years and 45 years.

HPV vacuna_ninacarre

Ian Frazer launches the  Gardasil vaccine in 2006

Ian Frazer launches the Gardasil vaccine in 2006

The HPV vaccines have been taken by millions of people worldwide and have been found to be safe. The US Centre for Disease Control (CDC) recommends that people should get the same vaccine brand for all three doses i.e. Cervarix and Gardasil should not be used interchangeably. Because of the significant advantage of the quadrivalent vaccine over the bivalent vaccine, the former (i.e. the quadrivalent vaccine or Gardasil) is currently given free to teenagers, under the NPI of several developed countries including Australia, the UK, Singapore and New Zealand.

Unfortunately, the cost of the vaccine is prohibitive and out of the reach of the poor in developing nation. HPV vaccines cost about US$130 per dose in developed nations, excluding the cost of giving the injections. Fortunately, in 2013, the vaccine manufacturers offered the Global Alliance on Vaccines and Immunisation (GAVI) a reduced price of US$4.50 per dose. This reduction was made in order to ensure access for developing countries, who need the vaccine most. All countries with Gross national income (GNI) per capita data equal or below US$ 1,580 are eligible to apply for support from GAVI. However, for GAVI new vaccines support, only countries with three doses of diphtheria, tetanus and pertussis vaccines (DTP3) coverage levels greater than or equal to 70%, may apply.

Nevertheless, countries who have not attained DTP3 coverage levels of up to 70% may apply to GAVI for HPV demo. The HPV demo means that poor countries that have not yet established the ability to deliver HPV vaccine could be supported by GAVI to implement a two-year demonstration programme.

Nigeria, with DTP3 coverage of 41% does not qualify for full GAVI support. However, Nigeria is eligible for the HPV Demo programme. How are we taking advantage of this golden opportunity to include HPV vaccine into our NPI? Uganda, Tanzania, Kenya, Ghana and many other developing nations are trailing the blaze. For instance, Uganda achieved 89% coverage for Gardasil prior to its incorporation into their NPI. Our children deserve as much!

We must note that in spite of the importance of HPV vaccine in preventing cervical cancer, women who have been vaccinated still need to have regular cervical screening. This is because none of the vaccines currently available can protect against all the 14 types of HPV known to cause cancer. Other protective measures include sexual discipline, non-smoking and optimal female hygiene (details on blog page of www.cecpng.org).

Cervical screening is a way of picking up abnormal cells in the cervix before they progress to cancer. According to UK National Health Service (NHS), even without vaccination, early detection and treatment of cervical abnormalities detected by screening can prevent three-quarters of cervical cancers. Vaccines do not treat HPV infection and should not be used as treatment of abnormal cervical changes. Given the fact that cervical cancer is the easiest of all cancers to prevent, it is sad to note that it remains the leading cause of cancer deaths in African women. Cervical cancer kills a Nigerian woman every hour. The rural woman is worse off, because of the near total absence of facilities for screening and treatment.

 ncpp logo1

To combat this cancer menace, the mass medical mission pioneered community-based mass cervical cancer screening campaign in Nigeria, known as the National Cervical Cancer Prevention Programme (NCCPP). This initiative was renamed the National Cancer Prevention Programme (NCPP), following the inclusion of other cancers. In spite of its limited resources, since its establishment in 2007, over 100,000 Nigerians have been directly screened and treated and through the awareness created, the NCPP has helped to protect millions of Nigerians from cancer. Furthermore, the NCPP has been in the forefront of advocacy for universal & free availability of HPV vaccine.  In fact, the launch of Gardasil in Nigeria took place at the NCPP centre in 2009 by the late Prof. Dora Akunyili.

LAUNCH OF GARDASIL BY DORA

The monumental effort of NCPP has significantly contributed to a 15% reduction of cervical cancer deaths in Nigeria, from 26 women dying daily to 22 daily, between 2008 and 2012 (WHO data). The improvement is proof positive that if we could scale up the present effort, then victory in the Big War against Cancer, is not beyond us!

The current focus of the Committee Encouraging Corporate Philanthropy (CECP-Nigeria) is to acquire and deploy Mobile Cancer Centres (MCC), which will energize the impact of NCPP. The MCC is a veritable tool that could potentially improve the immunization coverage of Nigeria, thereby facilitating the full support of GAVI in providing nationwide free HPV vaccination for Nigerians.

mobile cancer centre

The CECP hereby invites all public-spirited people to participate in the upcoming National Cancer Week (June 7- 14, 2015) which is dedicated to fund-raising for the acquisition of the MCC.

This article was publish on page 17 of the Guardian Newspaper of the 4th of February, 2015

© 2015 Committee Encouraging Corporate Philanthropy (CECP- Nigeria)

CERVICAL CANCER AS AN ICON OF HOPE AND HOPEFULNESS

WELCOME TO CECP-NIGERIA'S BLOG

WELCOME TO CECP-NIGERIA’S BLOG

January is Cervical Cancer Awareness Month. Cervical cancer epitomizes the cost-effectiveness of investing in preventive health care.

cervical cancer awareness

 Cervical cancer is the easiest of all cancers to prevent. Cervical screening is the best cancer screening test in the history of medicine and most cost effective of all medical screening tests. The screening is painless and takes only about 5 minutes to perform. The tissue changes that lead to cervical cancer usually develop very slowly (over a period of about five to thirty years). Screening can find these changes before cancer develops. Pre-cancer changes are easy to treat by outpatient procedure lasting 15 minutes.

Anatomy for cervix

 

cervix

 Furthermore, there is now a vaccine (Gardasil) for human papillomavirus (HPV). Human papillomavirus is the root cause of more than 5% of cancers, including nearly all cervical cancers and a substantial percentage of cancers at other sites such as vagina, vulva (the outer or external part of the female genital organs), penis, scrotum, perineum, anus, head/neck, mouth, throat, nose, tonsil, skin, nail-bed, and conjunctiva (eye). Gardasil prevents most cases of cervical cancer, warts, Recurrent Respiratory Papillomatosis (RRP) & a proportion of other HPV cancers. It can be given to males and females from the age of nine years (see the blog page of www.cecpng.org for details).

gardasil-ad1

For these reasons, cervical cancer is now a disappearing disease in the western world. Unfortunately, cervical cancer has the ignoble status of being the cancer with the greatest disparity in its incidence between developed and developing countries. Debbie Saslow, Director of Breast and Gynecologic Cancer,  American Cancer Society stated in 2013 that, “Sadly, this disease (Cervical Cancer) threatens to undermine the important gains worldwide that have been made in sexual and reproductive health, maternal and child health, HIV/AIDs and other infectious diseases. For women in many countries in Africa, Asia, and Latin America, cervical cancer is often detected late, when there is little hope for successful treatment. And it can be devastating to the whole family, both emotionally and financially.”

Cervical cancer, although highly preventable and curable with early detection, remains the leading cause of cancer deaths among women in the developing world. There are roughly equal cases of Maternal Mortality & Cervical Cancer annually- about 0.5Million cases/year worldwide). 83% of cervical cancer deaths occur in developing countries because, compared with women in industrialized countries, they have far less access to screening and virtually no access to treatment. Cervical Cancer kills more 24-35years old women in developing countries than any other cancer in any other part of the world.

In Nigeria, most women are NOT aware of the need for cervical cancer screening; most have never had cervical cancer screening in their lifetime. As a result, cervical cancer kills about one woman every hour in Nigeria. The rural Nigerian woman is worse off, because of the absence of adequate medical facilities for screening, diagnosis & follow-up. Cervical cancer is the commonest cause of cancer-related death in women in parts of Nigeria. A strong risk factor for cervical cancer is early age at first sexual intercourse and first child birth. The practice of child marriage in parts of the country therefore contributes to a higher incidence of cervical cancer.

A case that underscores the importance of cervical cancer prevention is that of Mrs. M.S., a well- known Nigerian philanthropist, who died of cervical cancer on September 18, 2014. Thirty- six million naira had just been raised by her well-wishers, in a last minute attempt  to save her life. At the time she died she owed twenty-five million naira in hospital bills in Germany. Meanwhile cervical cancer is virtually 100% preventable. 

cervical cancer- hope

Here is a ray of light at the end of the tunnel. In 2007, the mass medical mission, a non-governmental initiative, pioneered community-based mass cervical cancer screening campaign in Nigeria, known as the National Cervical Cancer Prevention Programme (NCCPP). This initiative was later renamed the National Cancer Prevention Programme (NCPP) following the incorporation of other cancers. In spite of its limited resources, the NCPP has been at work since 2007; over 100,000 Nigerians have been directly screened and treated so far, and through the awareness created, the NCPP is helping to protect millions of Nigerians from cancer.  NCPP is the current operational partner of the Committee Encouraging Corporate Philanthropy (CECP-Nigeria)

ncpp logo1

This sacrificial effort has contributed to a 15% reduction of cervical cancer deaths in Nigeria from 26 women dying daily to 22 daily between 2008 and 2012 (World Health Organization data). This improvement is significant given the fact that the World Health Organization had projected a 25% increase in cervical cancer death rate within ten years, in the absence of widespread intervention. However, we can do better in Nigeria.

The fact that 22 women still die of cervical cancer every day in Nigeria, is not acceptable. Each of these women is somebody’s precious wife, mother, sister and aunt. However, the recently reported improvement in cervical cancer survivorship in Nigeria is a proof that we can win the BIG WAR against Cancer if we could scale up the present effort. According to Dr. Christopher Wild, Director of International Agency for Research on Cancer (IARC), “These findings bring into sharp focus the need to implement the tools already available for cervical cancer, notably HPV vaccination combined with well-organized national programmes for screening and treatment,”.

The current focus of CECP-Nigeria is to acquire and deploy Mobile Cancer Centres (MCC), which will energize the impact of NCPP particularly on the poor in our country through three separate, yet related interventions, viz: Intensive Awareness created by reaching every Local Government Area at least once a year; Screening for cancer & Cancer-related killer diseases (Diabetes, Renal Disease, Malaria, Schistosomiasis, Helicobacter pylori, Hepatitis, HIV/AIDS, HPV and Hypertension); and Prompt treatment of early cases, combined with an efficient referral of advanced cases. Each MCC costs about ninety-five million naira.

mobile cancer centre

To actualize this vision, the CECP is currently involved in a fund-raising campaign, known as the #GivingTide. The #GivingTide is managed by a team made up of some of Nigeria’s most trusted and dedicated corporate leaders, led by Prof. Pat Utomi (See www.givintide.org, for details).

GIVINGTIDE AD

This article was publish on page 17 of the Guardian Newspaper of the 22nd of January, 2015

© 2015 Committee Encouraging Corporate Philanthropy (CECP- Nigeria)

 

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