While unveiling a campaign against cervical cancer, the head of a non-profit organisation that works in education and health in Nigeria made a startling claim.
Of the “roughly 14,000 Nigerian women diagnosed with cervical cancer every year, just over 8,000 will die,” Dr Chris Ifediora was reported as saying in September 2019.
But do these statistics add up?
Newer cancer data ‘even worse’
Ifediora told Africa Check he was correctly quoted but had rounded off the figures as he was addressing a “lay audience”. He said he had used the “raw numbers” in recent presentations and publications.
His figures were based on “data from 2017, [that] a total of 8,240 of the 14,089 Nigerian women diagnosed with cancer died”. But newer data from 2018 showed “an even worse statistic”, Ifediora said.
“Current estimates indicate that every year 14,943 women are diagnosed with cervical cancer and 10,403 die from the disease.”
Data from World Health Organization
Ifediora referred Africa Check to a 2019 paper he wrote for the source of this data, which in turn references a 2017 paper, where he cited 2012 data from the World Health Organization, and a factsheet with 2018 data from the HPV Information Centre.
The centre is a project of the International Agency for Research on Cancer, a unit of the WHO, and the Spain-based Catalan Institute of Oncology. It focuses on preventing cervical cancer and other diseases related to the human papilloma virus (HPV).
Burden of cervical cancer in Nigeria
Published in June 2019, the factsheet said that in Nigeria “current estimates indicate that every year 14,943 women are diagnosed with cervical cancer and 10,403 die from the disease”, which is the same as Ifediora’s newer stat.
Cervical cancer was ranked as the second most frequent in the country, after that of the breast. The number of women aged 15 and older estimated to be at risk from cervical cancer was 50.3 million.
|What is cervical cancer?
According to the World Health Organization, HPV is the most common viral infection of the reproductive tract. The UN 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.
Most sexually active women and men will be infected at some point in their lives, some repeatedly. HPV is sexually transmitted, but penetrative sex is not necessary for transmission – skin-to-skin genital contact is a well-recognised mode of transmission.
While most HPV infections clear up on their own, there is a risk for all women that infection may progress to invasive cervical cancer. This can take up to 20 years, or quicker if the immune system is weakened, such as when there is untreated HIV infection.
In West Africa, Nigeria is ranked 11th of 16 countries that have the highest incidence rate for cervical cancer. Guinea, Burkina Faso and Mali have the highest rates.
How did WHO calculate Nigeria’s figures?
We asked the International Agency for Research on Cancer how it had arrived at the figures. “To estimate the incidence in Nigeria, the most recently observed regional incidence rates were applied to the 2018 population,” the agency’s communications office told Africa Check.
This, it said, was a weighted average of rates from cancer registries for Abuja (2013), Calabar (2009-2013), and Ibadan (2006-2009).
For the number of deaths, the agency directed us to its most recent factsheet on Nigeria, where it noted that it did not have sufficient data on Nigeria. It thus used models derived from the national incidence estimates and the comparison of cancer registry data from neighbouring countries.
Because the three registries cover only about 2% of the Nigerian population, the available data should be “interpreted with caution”, the cancer agency told Africa Check.
Why is the share of deaths so high?
Dr Kingsley Ekwuazi is a consultant obstetrician/gynaecologist at the University of Nigeria. He confirmed that the observed numbers “has to do with the number of deaths, not the risk of dying from cervical cancer”.
“Cervical cancer is preventable, but the issue is that a lot of women are not aware of the importance of screening, and that [few] cancer centres in Nigeria [have] radiotherapy machines.”
The WHO concurred, noting major preventive measures include HPV vaccination and screening, but in sub-Saharan Africa there are a number of barriers ranging from the cost and accessibility of the vaccine to weak healthcare infrastructure.
This means cervical cancer in the region is often diagnosed at a late stage, making treatment very limited and raising the death rate.
More cases, or more awareness?
Experts we spoke to had different takes on the observed trends in cervical cancer in Nigeria.
Datonye Alasia is a senior consultant physician at the University of Port Harcourt Teaching Hospital. He told Africa Check that poor prevention plans, late diagnosis and low access to cancer care contributed to the growing disease burden.
“Cervical cancer is unique in the sense that the cause is linked to infection from HPV in addition to other risk factors which are very common in Nigeria,” he said.
Such factors include early onset of sex, early marriage, multiple sexual partners, co-infection with HIV and cigarette smoking, Ekwuazi said. He said the government should reduce the cost of vaccines to increase access.
Dr Adegboyega Fawole, an obstetrician and gynaecologist at the University of Ilorin Teaching Hospital told Africa Check there was more knowledge following public campaigns.
“What I believe has happened over the years is that there is more awareness about cervical cancer. Every day, women are being encouraged to go for cervical cancer screening.”.
Conclusion: Publicly available WHO data shows heavier burden
As Dr Chris Ifediora launched a campaign to reduce cervical cancer in Nigeria, he highlighted the high burden of the disease.
Ifediora said that of the “roughly 14,000 Nigerian women diagnosed with cervical cancer every year, just over 8,000 will die”.
But the most recent data from the WHO shows a heavier burden: that 14,943 women are diagnosed with cervical cancer every year, while 10,403 die.
We thus rate Ifediora’s claim as understated.
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