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Fact-checking 5 claims about Nigeria’s ‘second cervical cancer wave’

Africa’s most populous nation is experiencing an increase in cervical cancer cases because of the Covid-19 pandemic, said a prominent oncologist. We examined some of her claims.

  • The doctor was correct that cervical cancer is the second-most common cause of cancer deaths in Nigerian women, though it is the third-most common cancer in Nigeria overall.

  • However, her claims about the number of women who died from cervical cancer in 2008 cannot be proven, and her data from 2012 is incorrect.

  • Because of a lack of older data and changes in reporting methods, Nzelu’s identification of a spike in cases in 2018 is also unproven.

Because of the Covid-19 pandemic, Nigeria has stopped mass screenings for cervical cancer, oncologist Dr Abia Nzelu said in January 2020. 

Nzelu is the executive secretary of Mass Medical Mission, a non-governmental organisation in Lagos focused on preventive health care. She said the Covid-19 outbreak had disrupted her mission’s activities.

The organisation was therefore concentrating on educating people as it waited for the pandemic to ebb, she said, as she made a number of claims about the burden of cervical cancer in Nigeria. 

We took a closer look at five.

Claim

In Nigeria, cervical cancer is the second-most common cancer in females.

Verdict

Correct

This claim has been corrected to read “In  Nigeria,  cervical  cancer  is  the  2nd most  common  cancer in  females” as reflected in the press release.

The rating has also been changed to "correct" from "incorrect". Our error in assessing the claim is highly regretted.

Contacted for the source of her data, Nzelu sent us a copy of her press statement, which also confirmed she was quoted accurately. She said Nigeria was “experiencing a second surge of cervical cancer”.

According to the World Health Organization (WHO), human papillomavirus (HPV) is the most common viral infection of the reproductive tract. The international agency says that cervical cancer is “by far” the most common HPV-related disease and that nearly all cases of cervical cancer can be attributed to HPV infection.

While most HPV infections clear up on their own, there is a risk for all women that infection may progress to invasive cervical cancer.

The HPV Information Centre has estimates on the cervical burden in Nigeria. The centre is a project of the WHO’s International Agency for Research on Cancer and the Spain-based Catalan Institute of Oncology

In a factsheet published in June 2019, the centre found that “cervical cancer is the second-most common female cancer in women aged 15 to 44 years in Nigeria”. The data is from 2018.

So Nzelu is correct on this score.

Claim

Cervical cancer is the second-most common cause of cancer deaths in women.

Verdict

Correct

To estimate cancer deaths in Nigeria, the IARC used a model based on the mortality information derived from cancer registry data in neighbouring countries.

The agency said it did not incorporate data from any of Nigeria’s 13 population-based cancer registries or its 20 hospital-based registries.

“To our knowledge, there is no information about cancer mortality in Nigeria. Therefore, cancer mortality was estimated from the estimated cancer incidence and incidence to mortality ratios, obtained from a ‘Sub-Saharan Africa’ model,” Jacques Ferlay, an informatics officer at the IARC’s section of cancer surveillance, told Africa Check.

This model found that cervical cancer is the second-most common cause of cancer deaths in women, accounting for 10.1% of all cancer deaths in women in Nigeria. Breast cancer  is the most common, at 18.1%.

Claim

In 2008, cervical cancer killed 9,659 Nigerian women.

Verdict

Unproven

Nzelu lamented the country’s cervical cancer mortality rate in 2008, which she said was 66%. That year 9,659 Nigerian women died, she said.

But reliable data to check this is unavailable.

“We do not keep old data. We are not working on trends. Because the methodology is slightly different, we do not publish old data on the website as they are outdated,” Véronique Terrasse, an IARC communications officer, told Africa Check.

She said the data sources used to estimate incidence and methods used to calculate incidence and mortality and the burden of cancer in Nigeria for different years changed.

Dr Prebo Barango, the head of the WHO’s intercountry support team for East and Southern Africa, said the claim was off the mark.

“What is the source of her data? If she were referring to a local government in a state or a particular cancer facility, then she could be correct, but if this is for Nigeria, then the claim is incorrect.” 

Barago said getting hold of 2008 data would be a challenge because it was so old. In the absence of this data we rate the claim unproven.

Claim

By 2012, cervical cancer deaths had reduced to 8,070.

Verdict

Incorrect

Nzelu said this translated to a 57% mortality rate.

Barango directed us back to IARC data which showed that in 2012, cervical cancer deaths were 9,659. The mortality rate for cervical cancer in that year was 12.8%.

Claim

However, 2018 saw a new spike in cervical cancer deaths to 10,403, a 70% mortality rate.

Verdict

Unproven

Using 2018 data, the HPV Information Centre factsheet found that “every year 14,943 women are diagnosed with cervical cancer and 10,403 die from the disease”. The mortality rate for cervical cancer was therefore about 72%.

However, Barango described the claim as misleading. He said he would rather use the word “increase”.

“It would be wrong to say there was a spike if we don't have access to previous data. To ascertain that there was a ‘new spike’, we would need to ensure that the same methodology and scrutiny was used for a number of years in the collection of data around cervical cancer.

“The increase in cervical cancer deaths could have been due to better collection of data. If in previous years, due to poor data collection, Nigeria recorded 1,000 cervical cancer deaths, we can’t say there is a spike now if Nigeria recorded 10,000 cervical cancer deaths.”

Experts have also previously told Africa Check that the observed numbers are linked to the number of deaths, not the risk of dying from cervical cancer. There was also increasing awareness of the disease and therefore more people were being screened.

 

Photo: Luis TATO / AFP

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