‘Don’t ignore the warning signs’: A message pays off in Nigeria - CNN

EDITOR’S NOTE: This story was reported in collaboration with the Global Health Reporting Center and support from the Pulitzer Center.

The small business owner was diagnosed with appendicitis. The university lecturer and the government clerk, both struggling with stomach pain for more than a year, were told they had ulcers. In each case, the real problem turned out to be colorectal cancer. By the time they were diagnosed, all three required major surgery and nearly a year of debilitating chemotherapy treatments.

These patients live in and around Ile-Ife, a city in southwestern Nigeria, where they shared their stories with CNN. All three were ultimately treated at the Obafemi Awolowo University teaching hospital by Dr. Olusegun Alatise, a professor of surgery.

When he began surgical training in the early 2000s, Alatise was taught that colorectal cancer was rare in sub-Saharan Africa. But it didn’t match what he saw with his own eyes.

“It was supposed to be very rare, but we [the teaching hospital] were seeing a case every week,” he said. “We are talking about an exponential increase in the incidence of colorectal cancer.”

The picture in Nigeria is starkly different from that in the US or western Europe, where 2 in 3 colorectal cancer patients survive at least five years beyond their diagnosis. In Nigeria, it’s just 1 in 5. The biggest reason for the discrepancy, said Alatise, is that patients in Nigeria tend to seek treatment much later in the course of the disease.

“A majority only come to the teaching hospital for treatment when the disease has spread,” he said. “They have symptoms that were neglected. They’d be having rectal bleeding for a year, but everybody would be treating them with other medicines.”

With its aging buildings and visibly worn exam rooms, the OAU hospital doesn’t fit central casting’s idea of a state-of-the-art cancer center, but Alatise has helped build partnerships that are shaping care not just in Nigeria but around the world.

That part of Alatise’s journey started in 2009, when he secured a spot in a program to train international physicians to modernize cancer care in their home countries. It was based at Memorial Sloan Kettering Cancer Center in New York City. Alatise was the first African surgeon to apply.

In the months he spent in New York, Alatise learned new surgical techniques and formed a fast friendship with Dr. Peter Kingham, an American surgeon who had previously worked in Malawi, South Africa, Tanzania and Sierra Leone, and who himself was just finishing a surgical oncology fellowship. In 2011, after returning to Nigeria, Alatise invited Kingham for a visit of several weeks, in what would soon become an annual routine. By then, Kingham had helped establish the Global Cancer Disparities Initiative at Memorial Sloan Kettering. In 2013, the two men founded the African Research Group for Oncology (ARGO), to improve training programs and expand opportunities for Africa-based research.

“The goal is to do clinically meaningful research,” Kingham said. “At MSK, we do a ton of esoteric research, most of which is important, but it’s also a luxury. [In Nigeria] we don’t have the same luxury. Everything we do, we have to ask, ‘Can this really change the course of what happens to a patient?’ ”

The effort has grown to encompass more than two dozen sites in Nigeria, with more than 60 staffers and nearly 10,000 patients taking part in various research programs. At least four grants from the US National Institutes of Health have supported work by ARGO, with colorectal cancer as a major focus.

Globally, as a killer, colorectal cancer ranks second only to lung cancer. What’s more, its incidence is steadily increasing, driven by a surge of cases in young adults. Colorectal cancer rates are higher in the US and Europe than they are in Africa or South Asia, but the gap is shrinking.

Genetics, smoking and alcohol use are risk factors, but Kingham says changing diets are the biggest cause of the global increase. “A Western diet is strongly associated with colorectal cancer, and so are processed foods. That’s the curse of development,” he said.