More than being a mere disease condition, cancer is a major public health issue that poses a heavy economic burden, and a high chance of mortality. Even more agonizing than the mortality is the physical and emotional suffering that accompanies its diagnosis. At present cancer kills more than 7million people per year; a value higher than that resulting from tuberculosis, malaria and Acquired Immunodeficiency Syndrome (AIDS) combined.1 The fact that the last two decades recorded the greatest advances in cancer prevention and control is undeniable; however, the success is still infinitesimal if matched with the global impact of this scourge. With the current global health status, to say the possibility of a woman cancer free world is a reality is being too optimistic, and to say it is a mirage is being too pessimistic. Historically evidence of the first cancer was documented in the Edwin Smith papyrus about 3000 BC; however, it was not called cancer until around 400 BC when Hippocrates coined the term from karkinos (Greek for a crab).2 While Percival Pott, a British surgeon, was the first to pin point an environmental cause of cancer, linking scrotal cancer to chimney soot; Sir Rudolf Virchow, using microscopic pathology, founded cell mutation as the root cause of cancers.2 Although Egyptian papyrus stated that cancers have no treatment, advances in biotechnology had nullified this as the twenty-first century came with a myriad of prevention and treatment measures for cancers, ranging from health education and health promotion to various excision surgeries, radiotherapy, combination chemotherapy, hormonal therapy, and immunotherapy.3 Dorland’s illustrated medical dictionary defines cancer as a group of diseases caused by an uncontrolled division of abnormal cells in the body, the natural course of which is fatal. Cancer is only second to cardiovascular diseases as the leading cause of death in developing countries. 4 A study of the global economic burden by the American Cancer Society, and livestrong suggested that approximately $895 billion is lost each year as a result of premature deaths, and morbidity caused by cancers.5 According to estimates from the world cancer research fund international, approximately 14.1 million cancer cases were diagnosed worldwide in 2012; of which about 6.7 million women were affected. By 2035 the global burden of cancer is expected to rise to about 24 million new cases. 6 Of all cancers diagnosed in 2012, breast cancer alone accounted for about 25%, and together with colorectal and lungs cancer accounted for about 43%, cervical cancer cases contributed nearly 8% of all, while stomach, endometrial, ovarian, thyroid, and liver cancers constituted a total of 20.1%; ranking fifth to ninth commonest women cancers respectively.6 While age, race, sex and genetic make-up have been identified as predisposing factors to most cancers, other factors seem to be peculiar to some cancers. For instance, a woman who starts menstruation at an early age, had first pregnancy at a late age, above age 30, and uses combined oral contraceptive pills (COCP) is more likely to develop breast cancer than others. Moreover, a women exposed to sex at an early age, has multiple sexual partners and smokes is at a higher risk for cervical cancer. Smoking, on its own, is a major risk factor for lung cancer, and together with intake of low fiber diet, vegetables, and fruits increase the chances of gastric, colon, and ovarian cancers. Obesity has been associated with breast, endometrial, and gall bladder cancers. Common signs and symptoms of cancers include: unexplained weight loss, loss of appetite, constant fatigue, abnormal vaginal bleeding, offensive vaginal discharge, breast ulceration, and swollen legs and arms to mention a few. Patients and their relatives often ask: “when will there be a cure for this scourge?” while ignoring the fact that prevention is always better, and cheaper than cure. Research as shown that one-third of cancer deaths are due to preventable causes including viral infections, poor nutrition, alcoholism, and widespread tobacco use.1 Thus, an effective cancer control strategy should strive to prevent development of risk factors for cancers, detects cancer cases early, treat, and hopefully cure the disease to increase the survival and quality of life of the patients. Breast cancer is the most frequently diagnosed cancer in women worldwide, with an estimated 1.4 million new cases and 458,400 deaths in 2008. 7 While the efficacy of life style modification, breast feeding, healthy diet, and regular physical activity in decreasing the incidence of breast cancer cannot be undermined, experts opinion also support mammography as a useful screening tool. Meta analysis of outcomes of mammography conclusively shows a 25 – 30% reduction in the chance of dying from breast cancer with annual screening after age 50.8 However, for women in low and middle-income countries, where mammography may not be readily available, the recommended early detection strategies are self and clinical breast examination as well as knowledge of the early signs and symptoms of the disease. Like cancer of the breast, colorectal cancer is another common cause of women death. It accounted for about 8% of all cancer-related death in 2008. 9 Almost all cases of colorectal cancer begin as asymptomatic precancerous polyps in individuals at risk for the disease. Accepted colorectal cancer screening methods include: fecal occult blood test (FOBT), flexible sigmoidoscopy, double-contrast enema, and colonoscopy. FOBT, though not satisfactorily accurate, is inexpensive and easier to perform; thus the most practical screening method in many areas of the world. However, studies have shown that one-time flexible sigmoidoscopy screening between ages 55 and 64 reduces colorectal cancer incidences by 33%, and mortality by 43%.10 Against this back drop the American cancer society suggests annual FOBT screening and flexible sigmoidoscopy every five years starting from age 50. According to the world health organization (WHO) 2014, cervical cancer is one of the deadliest, but most easily preventable cancers. It accounts for more than 270,000 women death annually, 85% of who live in developing countries.11 Since the high risk type Human Papillomavirus (HPV) acquired mainly via sexual contact, is the primary cause of the disease, cervical cancer is almost never found in virgins, nuns and orthodox Jews. The pap smear screening test which is about 90 – 95% accurate in detecting both precancerous lesions and early cancers has solely reduced the mortality rate due to cervical cancer by 50% in the past 30 years.12 However, many low resource countries lack the infrastructure to support its use; in which case visual inspection using acetic acid and HPV DNA testing are useful alternatives. Immunization of reproductive age women with HPV vaccines which protect against more than 70% of HPV is another invaluable newer trend in the prevention of the disease. Worldwide lung cancer is only second to cancer of the breast as the commonest cause of women cancer related death. 13 Cigarette smoking is the most important risk factor accounting for more than 50% of cases in women; 13 though passive smoking, exposure to radon, asbestos, and radiation have also been implicated. Reduction of smoking initiation among adolescents and increasing smoking cessation among adults has been advocated as an effective control measure. At this juncture, an appropriate question is “if all the aforementioned preventive and control measures are already in place, why is there no commensurate decrease in the incidence and prevalence of cancers? An appropriate answer is that cancer control strategies are not without their own challenges, some of which include: Industrialization and westernization that encourages harmful lifestyle, unhealthy diet, and production of carcinogens, inequity in health care delivery, lack of modern cancer screening methods and gross underutilization of available ones, poor skills of health providers, inadequate or ineffective treatment option, inadequate manpower, low national income, poor political will, weak intersectoral collaboration, poor monitoring and evaluation to mention a few. Health education and promotion strategies should be developed to increase public awareness of cancer risk factors and how to avoid them. Efforts should be directed at discouraging actions injurious to health and promoting healthful practices including smoking and alcohol cessation, dietary fat reduction, fruits and vegetables consumption, healthy sexual practices as well as regular physical activity. Unscreened individuals within the underserved population groups should be identified and enlightened on the risks and benefits of avoiding or taking the procedures. Data from the Centers for Disease Control (CDC) 2008 revealed that through routine screening and early detection, incidence of breast, colorectal and cervical cancers can be reduced by 20 – 60%.14 Organized screening method should be developed, implemented, and appropriately delivered at an affordable cost to enhance early diagnosis, prompt treatment, and follow up. Infrastructures at rural, district, and provincial health facilities should be improved to support cancer screening, diagnosis, and treatment services. In the same vein regular recruitment, training, and retraining of health care providers should be undertaken to improve manpower and skills, and update them on current trends in cancer related service delivery. Also interdisciplinary collaboration and intersectoral partnership should be strengthened to ensure synergy of actions. While many great interventions can be made at local level to improve cancer care, significant improvement is only achievable via good political will. A national cancer control plan should be drawn, and integrated within a broader multisectoral noncommunicable disease action plan, with timebound benchmarks and targets, effective governance and accountability, adequate and sustainable financing for program implementation, monitoring and evaluation. In conclusion, despite the immense advances in the area of research oncology over the years, various national and international cancer control programs, and contributions from numerous non-governmental bodies, the dream of achieving a woman cancer free world is still far from reality. Considering the dreadful impact of this scourge on mankind, and to save the forthcoming generations, the need for more concerted proactivity at all levels of cancer prevention and control is strongly advocated, and should be rigorously pursued by all if a woman cancer free world stated as our aim is to be achieved.
