Viewpoint: Cancer incidence in Nigeria and the S.S.S.D syndrome

Admin 09 Feb, 2016 Viewpoint

By Tope Akinnola

A day in the month of February is annually slated globally to generate much needed cancer awareness and whip up activities centering on the disease, which is in a vast amount of cases, preventable. Minimal but growing activities have been dedicated to beget awareness to break the cycle of ignorance, which invariably can go a long way in making people effect simple life style changes that most probably will minimize risk factors while enhancing protective factors against different types of cancer. Since medical and social scientists both agree that breast cancer is the number one cancer killer of Nigerian women today, we will use it as representative of other cancers in our discussion. These scientists have also agreed that the hallmark or major single characteristic feature of breast cancer incidence and mortality, in Nigeria (as obtainable in other types of cancer) is ‘late presentation’. Simply put, it occurs when a medical condition is presented too late for treatment.

By the time most of our women present themselves at medical facilities or to health care providers to receive medical help or treatment, it’s often too late. When people present themselves too late, it’s often impossible to give them the suitable solution and treatment that can produce a more lasting result in order to increase their survival rate, since the tumor would have grown beyond the curable stage. The key to putting it under control is early detection as well as early treatment. Malaria fever can kill if not detected and treated early. Same applies to cancer of the breast. If not detected and treated early, breast cancer or any cancer kills, mercilessly too. Once a person detects symptoms early, they must also present themselves early for treatment. That’s the way it works – early detection should lead to early presentation and then, to early treatment.

At this juncture it is paramount to discuss the story behind why many women in Nigeria and in most under-developed countries usually present themselves too late for medical help. I have taken the liberty to coin the vital composite reasons for this anomaly as the S.S.S.D syndrome. I arrived at this coinage or terminology after five years of carrying out breast cancer and prostate cancer awareness seminars and campaigns at both urban and rural areas and among both literate and illiterate people. The S.S.S.D syndrome is simply an acronym, which’s first ‘S’ stands for superstition. The second ‘S’ stands for stigmatization. The third ‘S’ stands for spirituality, and the ‘D’ stands for denial.

Many women present themselves too late at medical facilities to receive medical help often because of superstitions, which are surprisingly widespread even among educated and literate women in urban areas. When they begin to experience, notice, see, or feel symptoms of breast cancer, their initial response is to use superstition to try to explain the symptoms away, instead of quickly and immediately going for appropriate medical examination and treatment from a qualified health care provider. Superstitions are beliefs or notions that are not based on reason, logic or evidence-based knowledge. A superstition is the belief in some kind of supernatural causality – or the idea that one is not in control of events – or that external factors beyond human control are directing or influencing the course of one’s circumstances or events, and that one event causes another without any natural, or evidence-based logical process linking the two events. The odd thing about beliefs that are superstitious is that their complete irrationality does not seem to even stop the most seemingly brilliant people from having them. For instance, among the people of the south west of Nigeria, there is a superstitious belief that if a person’s left leg hits a stone on their way out of their residence it is taken to be a bad omen and the person is to cancel their journey or wherever they are going, otherwise they would meet with danger or misfortune. This notion is not evidence-based. It is just the figment of someone’s imagination, though widespread in the thinking of multitudes of people.

Another superstitious notion in the south west of Nigeria that has never stopped to amuse me is the idea that if a pregnant woman eats okro or snail, then her child would be drooling and sluggish after delivery. Nothing could be further from the truth. Evidence-based knowledge strongly suggests in no uncertain terms, and contrary to the aforementioned superstitious notion, that it is actually beneficial for the pregnant woman (and her unborn child) to actually eat a lot of okro and snails during pregnancy. The high amount of folate contained in okro is beneficial to the foetus during pregnancy since folate is an essential nutrient that improves the development of the foetus’ brain.

The second ‘S’ in the S.S.S.D syndrome is stigmatization, which is the act of describing or regarding something or somebody in a way that shows strong disapproval. To stigmatize is to characterize, or brand, or label something or someone as disgraceful or unacceptable. Stigmatization breeds or leads to discrimination. The fear or anxiety associated to being labeled or branded as having breast cancer prevents most women from presenting themselves early for thorough medical examination. This delay invariably endangers their lives in the long term. We all have a psychological need to get approval and acceptance from our friends, peer groups, community, relatives, work or professional colleagues and society at large. That is why we are always anxious or scared of anything, event or information about ourselves getting out to others that may make them think in a disapproving manner towards us. This fear of stigmatization, causes thousands of people from coming out early for cancer treatment.

The last ‘S’ in the S.S.S.D syndrome is spirituality, which I would simply define as the quality or state of being deeply concerned with religion or religious matters, religion being a specific set of organized beliefs and practices, usually shared by a community or a group of people. The mind that is deeply cast in religious dogma will give over-rated emphasis and priority to ‘spiritual healing’ above medical care, even when it does not have the ‘faith’ to attain that ‘spiritual healing’. The person with such a mindset believes that ‘God’ is the source of healing in one breath, but in another refuses to recognize that “God” has given men and women in the medical profession the ability, knowledge, understanding and wisdom to help preserve human lives. This has given rise to situations whereby when multitudes of women see, observe, or feel an early symptom of breast cancer which might be just a small but persistent painless lump on the breast or dimpled nipple, they would rather go to a religious leader to smear or ‘anoint’ it with oil, instead of going to get examined appropriately at a medical facility. But if these same women observe or feel a pimple or small lump on their faces, they would go to a nearby chemist or pharmacy store to buy Nizoderm or something, which they know have or possess chemical properties that can help to clear their beautiful faces of the pimple or small lump. They would not go to a religious leader to smear or ‘anoint’ the pimple or small lump on their faces.

The last letter in the S.S.S.D syndrome is ‘D’, which as earlier highlighted, stands for ‘denial’. Denial is the refusal to believe in something or admit that something exists. As oddly as it may appear, there are countless people in Nigeria who are still in denial of the existence of breast cancer, and of the high incidence rate and vast burden of it, in the country. Aside rural women, I have met for instance, a school principal of an upscale urban private secondary school who is a master’s degree holder and who denies the existence of breast cancer in the country. This highly educated school principal believes that it is merely propaganda. It shocked me to my marrow. But these are the kind of things we meet and confront in the field while carrying out breast cancer awareness seminars among diverse groups of people.

Denial is usually a psychological defence mechanism we all use when we choose to pretend that an uncomfortable thing, condition or event does not exist, or did not happen. Denial can also be linked to superstitious beliefs or notions, such as the thinking that what we call cancer of the breast is actually ‘ata’ in Yoruba (literally ‘pepper’) which implies a cosmic or supernormal dispersion of horrifying wound on the breast of a woman who has offended a witch, wizard or someone with powers of sorcery. The individual instead of seeking immediate medical help decides to go after ‘spiritualists’ because of wrong notions that are not evidence-based.

Finally, it must be stated in unequivocal terms that the first major killer punch for breast cancer prevention, which is also the very first key to early detection of breast cancer symptoms, is for the woman from age 18 to 55 to carry out monthly breast self examination, and after the age of 50 to do the mammogram at least once every three years. This is the holy grail of breast cancer prevention. In like manner, the ultimate jigsaw that solves the puzzle of the growing prostate cancer incidence in Nigerian men today, is also early detection, through annual PSA or prostate antigen test, which is strongly advised to be started at age 45 upwards among men of African ancestry, as a result of their higher genetic predisposition to the disease compared to their Asian or European counterparts. The PSA test costs only between one thousand and three thousand naira in most public hospitals across the country today, and men should take advantage of this for the sake of their health, and their loved ones who would be indirectly affected if they fall stricken with the disease.

Akinnola sent in this piece

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