Current Status of Cancer Diagnosis and Treatment in Nigeria

ABSTRACT

Introduction

Cancer has emerged as a leading cause of death worldwide, surpassing HIV/AIDS, tuberculosis, and malaria combined. Nigeria's cases and deaths continue to increase every year due to the high cancer burden that affects the country. There were 269,109 new cancer cases registered in 2022, with breast and prostate cancer being the most prevalent. Despite improvements made, several problems related to the diagnosis and treatment of cancer across the nation remain. This paper reviews these issues while discussing what is being done to establish an efficient system for managing cancer care in Nigeria.

Methods

This review utilizes publicly available sources such as GLOBOCAN, Google Scholar, PubMed, and other gray literature. The search was focused on challenges and efforts regarding the diagnosis and treatment of cancers, using Nigeria as one of the main filters.

Results

In the review, substantial obstacles to diagnosing and treating cancer in Nigeria included insufficient diagnostic equipment, high out‐of‐pocket healthcare costs, as well as delayed diagnosis due to the unavailability of health information and service delivery. With only 27 cancer treatment centers available for a population of 218.5 million people, patients encounter delays as well as financial burdens. Efforts have been made, such as establishing cancer centers, launching the Cancer Health Fund, and introducing policies to improve screening and treatment accessibility, like the National Strategic Cancer Control Plan. Also, the Nigerian Sovereign Investment Authority (NSIA) and Lagos University Teaching Hospital (LUTH) Cancer Treatment Centre, from its inauguration in 2019–2024, has treated more than 10,064 patients, providing 8528 radiotherapies, 6733 chemotherapies, and 215 high‐dose rate 3D brachytherapy sessions, revitalizing an industry previously unable to adequately address cancer in Nigeria.

Conclusion

Nigeria still faces immense challenges in improving cancer diagnosis and treatment. Although recent initiatives are encouraging, enhanced policies and funding are still needed. The provision of more diagnostic services, awareness concerning various types of cancers, and an increase in treatment facilities will be vital to improving cancer care in Nigeria.

1. Introduction

Cancer is the most common cause of death worldwide, with mortality rates from the disease exceeding those from HIV/AIDS, tuberculosis, and malaria combined [1]. It is 1 of the top 3 causes of death for people in developing nations and the second most prevalent cause of death in developed regions [1]. The Global Cancer Observatory (GLOBOCAN) 2020 estimate reveals that the burden of cancer is increasing and is anticipated to climb significantly quickly in emerging countries [2]. Africa accounts for around 6% of the global cancer burden; it is not a rare disease on the continent, as it is commonly assumed, and it imposes massive economic and social hardships on the populace [3].

According to the Global Cancer Observatory in 2021, Nigeria had 124,815 new cases in total in 2020, of which 51,398 were males, with prostate cancer being the most prevalent (29.8%) and 73,417 were females, with breast cancer being the most common type at 38.7%, followed by cervical cancer at 16.4% [4]. Also, an estimated 78,889 people died from cancer, 34,200 being men and 44,699 being women [4]. As of 2022, Nigeria recorded 269,109 cases of cancer within 5 years (2018–2022), with the total number of new cases and deaths of cancer in the year 2022 estimated to be 127,763 and 79,542, respectively. It was reported that breast cancer, prostate cancer, cervical cancer, colorectal cancer, and non‐Hodgkin lymphoma are ranked first to fifth, respectively, in the distribution of cancer, as seen in Table 1 [5].

Table 1.

Cancer statistics in Nigeria as of 2022.

Cancer	Incidence N (%)	5‐year prevalence N (prop/100,000)	Mortality N (%)
Breast cancer	32,278 (25.3)	74,779 (70.0)	16,332 (20.5)
Prostate cancer	18,019 (14.1)	32,906 (30.0)	11,443 (14.4)
Cervical cancer	13,676 (10.7)	28,320 (25.5)	7093 (8.9)
Colorectal cancer	8114 (6.4)	17,270 (8.0)	5912 (7.4)
Non‐Hodgkin lymphoma	5194 (4.1)	12,620 (5.8)	3414 (4.3)
Others	50,482 (39.5)	103,214 (44.6)	35,348 (44.4)

Aside from the increase in the prevalence and mortality rate of cancer in older individuals in Nigeria, there has been a rise in the cases of childhood cancer. According to the Federal Ministry of Health and Social Welfare's National Cancer Control Programme, children currently account for 7.2% of Nigeria's 127,000 yearly cancer cases, with juvenile leukemia being the most common type [6]. However, Nigeria is having difficulty addressing issues related to the country's increasing number of child cancer cases. According to a BusinessDay investigation, Usmanu Danfodiyo University Teaching Hospital, Sokoto (UDUTH), LUTH, and National Hospital Abuja diagnose at least 6–10 new cases of childhood cancer each month, for a total of 120 new cases annually, children aged 0–4 years old contributing the most, with the majority of them dying during treatment [7].

Cancer incidence is found in most regions of the world, though incidence rates remain highest in more developed regions, but mortality is much higher in developing regions like Nigeria due to a lack of early detection and access to treatment facilities. A multitude of variables contribute to the unfavorable outcomes associated with cancer in Nigeria, such as an inadequately funded healthcare system, poverty stemming from the high expense of cancer treatment, lack of knowledge about cancer, scarcity of highly skilled medical professionals, and inadequate infrastructure for research [8]. Therefore, there is an enormous need to examine the infrastructure availability in the diagnosis and treatment across Nigeria. This study focuses on characterizing the effort made and the challenges associated with cancer screening, diagnosis, and treatment services in Nigeria, as the findings shall influence planning, policy, and programming of cancer prevention and control in the country.

2. Methods

The data for this study were gathered from Google Scholar, PubMed, and African health journals. Gray literature from WHO, GLOBOCAN, and other cancer‐related organizations was utilized. The search criteria include cancer, diagnosis, treatment, prevention, efforts, challenges and Nigeria. All articles relevant to this study were reviewed and used to write this quality paper pointing toward the current status of cancer diagnosis and treatment in Nigeria.

2.1. Cancer Diagnosis in Nigeria

2.1.1. Challenges in Cancer Diagnosis

Nigeria, a nation with a population of 218.5 million people and an annual cancer death figure of about 72,000, faces many issues in its cancer diagnosis [9, 10]. Though the likes of the Federal Ministry of Health's (FMoH), 2006 National Cancer Control Plan (NCC) were put in place to ease these challenges, the inconsistent show of its effectiveness has made sustained efforts to improve cancer diagnosis across the country a necessity [1, 11]. A study highlighted decades of 72.81% late presentation of cancer cases in the country amidst all efforts; hence, one of the challenges of cancer diagnosis is Nigerians' habit of waiting for symptoms to worsen before seeking medical attention often negatively impacts the chances of cancer curative treatment [12].

Another is that the 2024 Federal Healthcare Budget of ₦1.48 trillion by headcount would equal ₦6400/person, so it is not surprising that data showed almost 90% of Nigerian healthcare expenditure is paid through out‐of‐pocket sources [13, 14]. The problem, however, is that only about 5%–32% of Nigerians can afford the cost of cancer diagnosis and/or care out‐of‐pocket without experiencing catastrophic healthcare expenditure (CHE) [15]. Also, the unavailability of key screening and diagnostic equipment is a challenge. Both governmental and nongovernmental organizations have intermittently introduced breast and cervical cancer screening programs, primarily in urban areas. For instance, 1336 healthcare facilities provide breast ultrasound (US), with 47.8% (639 of 1336) being public facilities. However, only 218 facilities offer mammography, of which 45.4% (99 of 218) are public. Furthermore, just 2.5% (33 of 1336) of the facilities that provide breast US also offer US‐guided breast biopsy, a crucial diagnostic procedure for confirming cancer. However, with 50% of Nigerians residing in rural regions, the vast majority of people in the region are symptomatic when they present with sickness owing to the unavailability of screening tools in the rural area [16].

Also, a survey reported that there are 58 magnetic resonance imaging (MRI) machines for use in Nigeria, which is small, but worse is that all of them are located in urban areas [17]. This is a major concern as rural communities are left to suffer, resulting in a greater distribution of late diagnoses and untreated cancer cases.

2.1.2. Efforts in Cancer Diagnosis

In improving cancer diagnosis in Nigeria, there have been contributions made to cancer diagnosis by the government and other nongovernmental organizations within the country. For instance, the Raise Foundation reported having screened 7400 women for cervical and breast cancer as of 2021 since its launch in 2016 [18]. Similarly, Oncopadi, a telemedicine platform, has been offering cancer patients virtual consultations and support since the launch of its app in 2020, bridging geographical or financial barriers to care [19].

Moreover, Nigeria's government has made a significant contribution to cancer diagnosis following the establishment of the National Institute for Cancer Research and Treatment (NICRAT) in 2023 and the setting up of a National Strategic Cancer Control Plan (NSCCP) 2023–2027. Nigeria is currently running NSCCP Phase I, and goal 2 of 8 is “to improve access to quality, cost‐effective, and equitable diagnostic and treatment services for cancer care“ [11]. February 2024 has seen the National Health Insurance Authority (NHIA) make moves to imbibe universal health coverage and ultimately more cancer services under its insurance policy through the NHIA Act of 2022 [20]. This would increase access to cancer screening and early detection, reducing the burden of late diagnosis.

With a significant N37.4 billion grant from the Federal Government, FMOH Oncology is committed to improving access to oncology care and support services nationwide. To ensure fair access to cancer care in Nigeria, the FMOH has identified the underlisted teaching hospitals in various geopolitical zones to be outfitted with modern medical infrastructure. The proposed medical infrastructure for these teaching hospitals includes linear accelerators, iridium brachytherapy machines, computed tomography (CT) simulators, positron emission tomography (PET) scanners, and cyclotrons. This comprehensive strategy ensures that all participating hospitals have the necessary tools to accurately diagnose and manage cancer cases. NSIA has been tasked with carrying out the FMH&SW's Oncology Initiative [21]. Building on the success of three key projects—the NSIA‐LUTH Cancer Centre (NLCC), NSIA‐Umuahia Diagnostic Centre (NUDC), and NSIA‐Kano Diagnostic Centre (NKDC)—the NSIA is expanding its healthcare program. This expansion aims to establish 4 oncology centers, 23 advanced diagnostic centers, and 7 catheterization centers across Nigeria's 6 geopolitical zones [21].

2.2. Cancer Treatments and Risk Reduction

2.2.1. Available Cancer Treatment Options

Surgery remains one of the main methods of treatment for many solid tumors, including breast, cervical, and prostate cancers in Nigeria. Tertiary institutions across the nation, such as teaching hospitals and Federal medical centers, often situated in cities, offer surgical oncology services, often as the first line of treatment, especially in cases that were diagnosed early. This often goes hand in hand with chemotherapy, another widely used method in Nigeria [22]. Hence, most tertiary hospitals and designated cancer treatment centers have chemotherapy units where cancer patients receive care. Each chemotherapy session costs between 600,000 naira and 1.5 million naira each [23].

Radiation therapy is a cancer treatment option available in a few specialized centers across Nigeria. As of recent estimates, fewer than 10 functional radiotherapy centers are serving a population of over 200 million. Each radiation therapy machine, which ordinarily should treat appropriately 500 people/annum, has to carry the burden of 124,000 yearly cancer patients; hence, patients often have to deal with expensive waiting times and accessibility issues for rural populations [22].

Access to targeted therapies and immunotherapies is extremely limited in Nigeria due to high costs and inadequate diagnostic infrastructure for molecular profiling. Some urban private hospitals offer targeted treatments for select cancers, such as HER2‐positive breast cancer, but affordability remains a barrier [24]. Cultural attitudes toward palliative care services are gradually getting more accommodating, as patients are gradually taking advantage of several tertiary institutions' pain management and end‐of‐life care services [25].

2.2.2. Challenges in Cancer Treatments

Cancer diagnosis and treatment constitute vital areas in cancer control. Baby steps are still being taken in the diagnosis, treatment, and control of cancer in Nigeria. Considering over 206 million people living in Nigeria, the 27 cancer treatment facilities are insufficient to meet the country's needs [26]. Most women cannot afford the cost of treatment options; in a nation where 77% of people live on < $2/day, the average cost of a six‐course chemotherapy treatment is $2300. People who can afford it are also forced to fly abroad to receive treatment owing to waiting lists at treatment centers [26]. Nigeria's patients find it difficult to pay for the cancer treatments provided at hospitals since the National Health Insurance Scheme (NHIS), now the NHIA, does not cover cancer care, despite the government of Nigeria having made large investments to build new facilities and upgrade those that already exist. According to a review of the NHIS benefits package conducted in October 2020, cancer care is not included in the benefits that the program provides [27]. Most cancer sufferers in Nigeria pay for their treatment out of pocket.

A study on cancer care in sub‐Saharan Africa showed that 72%–89% of Nigerian patients with breast cancer pay for their care out of pocket, which contributes to the disease's highest death rate among all malignancies in the country's population [28]. NHIS representatives reported that the major reasons for the partial or complete exclusion of cancer care from the program are the enormous financial impact that providing coverage for cancer care would require and the limited resources available to address other high‐prevalence, communicable diseases in the nation. Nonetheless, Nigeria's out‐of‐pocket costs for cancer treatment are far greater than those of other sub‐Saharan African nations [27]. Even though the GDP per capita of all three countries is comparable, the same study found that 45%–79% of Ghanaians and just 8%–20% of Kenyan breast cancer patients pay for their care out of pocket, as seen in Figure 1 [27].

Figure 1.

A diagram showing a comparison between three sub‐Saharan countries on cancer care [16, 27, 29, 30].

One of the problems with cancer therapy is the delay in getting access to drugs and the price increases. Manufactured medications must pass through multiple distribution channels, including the primary distributor and numerous subdistributors, before they are delivered to Nigerian patients. Distributors increase the price of the pharmaceuticals by up to 10% at each stage of the supply chain [27]. Furthermore, because third‐party wholesalers are typically used by pharmaceutical manufacturers to bring pharmaceutical products into Nigeria, costs are sometimes exaggerated due to foreign exchange problems [27]. Additionally, patients are frequently referred to retail pharmacies in the private sector, where supply chain markups are even more noticeable when hospital pharmacies run out of prescription drugs [27]. These supply chain problems frequently result in extremely high costs for patients and unpredictable drug quality [27].

The use of radiotherapy as a treatment option has been challenging owing to a lack of human resources, including radiation oncologists, medical physicists, dosimetrists, oncology nurses, radiation therapy technologists, and linear accelerator (LINACs) maintenance engineers. A major technological organization has been working on processes to train staff in low‐resource countries to generate experts to operate these advanced machines used for treatments. The National Health Authority (NHA) has two LINACS that are capable of intensity‐modulated radiation therapy and volumetric‐modulated arc therapy. However, because of inadequate training, there is an inability to perform advanced radiation treatment techniques while using these machines [31].

2.2.3. Efforts in Cancer Treatments

The Chemotherapy Access Partnership was initiated by the Nigerian Federal Ministry of Health in October 2019 in collaboration with Pfizer Inc., the Clinton Health Access Initiative Inc., the American Cancer Society, Worldwide Healthcare, and EMGE Resources Limited. The initiative provides chemotherapy to seven teaching hospitals across the nation, allowing thousands of additional patients to receive care and helping Nigerian patients save up to 50% on treatment costs [27].

The Nigerian Cancer Health Fund (CHF) was established in the first quarter of 2020, led by a private‐sector alliance headed by Roche, with support from the International Finance Corporation (IFC) of the World Bank and Nigerian public authorities. The CHF ensures that patients at treatment centers can afford their medications and is a crucial component of the country's efforts to achieve universal health coverage by providing access to funding of up to 2 million naira (roughly $4865) for medication, chemotherapy, and radiation therapy services for people with breast, cervical, and prostate cancers in 6 public health institutions—1 in each geopolitical zone of the nation [32]. As of December 2024, the CHF has disbursed ~2 billion naira, benefiting 1616 indigent cancer patients, though challenges remain in scaling access nationwide as the program is operational in only 6 tertiary hospitals in the nation, with the National Hospital Abuja having the highest number of enrolled patients [33].

The Nigerian NHIS has committed to a cost‐sharing mechanism under the 2021 Memorandum of Understanding, covering part of oncology medication costs, while Roche subsidizes a smaller portion. As a result, Nigerians now spend as little as 20% of their salary on cancer treatment, a significant reduction compared to prior costs [23]. The impact of the Fund is being evaluated through patient enrollment data, treatment completion rates, and financial relief metrics, monitored by the Federal Government instituted CHF Implementation Committee and the NICRAT. Ongoing evaluations aim to assess cost‐effectiveness, patient outcomes, and equity of access, ensuring the fund delivers measurable benefits and informs future cancer care strategies in Nigeria [34].

The NSIA and LUTH Cancer Treatment Centre, inaugurated in 2019, are outfitted with Varian's cutting‐edge cancer therapy technologies, facilitating effective treatments within Nigeria [35]. As the largest facility in terms of equipment, expertise, and faculty, it operates under a public–private partnership model that ensures continued efficiency. Over the past 5 years, the center has treated more than 10,064 patients, providing 8528 radiotherapies, 6733 chemotherapies, and 215 high‐dose rate 3D brachytherapy sessions, revitalizing an industry previously unable to adequately address cancer in Nigeria. The initiative entrusted NSIA with deploying linear accelerators, iridium brachytherapy machines, CT simulators, PET scanners, and cyclotrons at selected hospitals [36]. The NSIA‐LUTH Cancer Treatment Centre acquired Varian's Halcyon, a state‐of‐the‐art cancer therapy system designed to enhance patient capacity and treatment accuracy while reducing electricity and water usage by 50%, making it well‐suited for challenging infrastructure environments. Additionally, Varian will establish a training center at the institution to support radiotherapy skills development across the region [35].

In Nigeria, digital health efforts provide cancer patients with correct information, navigation, and welfare care. Many of these efforts are spearheaded by self‐starters who discover difficulties in cancer care and then devise remedies to mitigate the burden of cancer. These developments include Notitia, MobiPINK, mDoc, and Oncopadi. Oncopadi is the leading web and mobile app for cancer care access in Nigeria, connecting patients to the resources and services they need for treatment and survivorship [19].

2.2.4. Efforts in Cancer Risk Reduction

Nigeria incorporated the human papillomavirus (HPV) vaccine into its regular immunization program on October 24, 2023, to immunize 7.7 million females—the greatest number of girls in Africa to receive HPV vaccinations in a single round—against the virus that is responsible for almost all cases of cervical cancer [37]. With assistance from Gavi, the Vaccine Alliance, the United Nations Children's Fund (UNICEF), the World Health Organization (WHO), and other partners, the Federal Ministry of Health is offering the vaccine for free through the National Primary Health Care Development Agency. To date, over 35,000 health workers have received training in advance of the campaign and the subsequent vaccination delivery in all healthcare facilities. To guarantee that no eligible female is left behind, vaccination facilities have been set up in all 4163 wards throughout the 16 states covered in the phase one rollout. To guarantee that isolated areas can receive the vaccine, mobile immunization units have also been established. Cervical cancer is one of the few diseases that may be completely prevented with a vaccine; thus, now is a critical time for Nigeria's attempts to reduce the incidence of the disease [37].

The Nigerian government has received ~15 million HPV vaccinations from UNICEF. In addition, the children's agency has created educational resources to refute myths and false information, such as radio and TV jingles in several local languages. UNICEF provided two rounds of readiness evaluations to academic institutions and researchers to better understand the public's attitudes toward HPV and vaccination as part of their outreach efforts. Furthermore, UNICEF has provided cold chain supplies for vaccine preservation and coordinated logistical support for immunization campaigns [37]. In < 2 years, Nigeria has vaccinated over 12 million girls nationwide against the HPV, reaching a 71% national coverage rate for females aged 9–14 [38].

3. Conclusion

The high level of cancer burden in Nigeria is primarily a factor of the poor healthcare system, which impacts the early diagnosis and treatment of cancer in Nigeria. The country is regarded as one of the most cancer‐affected nations, with a prevalence rate of 269,109 cases within 5 years as of the year 2022, which is not as high as those reported in high‐income countries. Because of limited cancer care in Nigeria, an alarming mortality rate has been reported not just among adults but also among children. The major factor impacting the diagnosis and treatment of cancer is the poor healthcare system of the country, which has been inadequate in ensuring the distribution of cancer diagnostic and treatment tools across the country, especially in rural areas, which might be experiencing a high burden of cancer. Also, there have not been well‐established cancer comprehensive care centers in Nigeria. Also, lack of funding and the socioeconomic status of Nigerians affect the available services, which are of high cost. However, several collaborative efforts between governmental and nongovernmental agencies contributed to improving cancer diagnosis and treatment plans, with funding going into procuring cancer care tools and also strengthening hospitals in delivering adequate cancer care. Also, with cancer care costs being a challenge, the NHIA has also acknowledged cancer‐related plans to reduce the burden on the patients and the establishment of CHF has also helped patients to have access to cancer care without bearing much cost To better improve the challenges to cancer diagnosis and treatment, we recommend prioritizing collaboration and fostering partnerships with both governmental and nongovernmental organizations.

3.1. Recommendation

Cancer diagnosis in Nigeria is inadequate, most especially in the screening for breast, prostate, and cervical cancer, which are the most common types of cancer in the country. There is an urgent need for the establishment of an organized screening program for the predominant cancers in the country and the prioritization of cancer research that addresses key policies. Due to the increasing rate of cancer patients in the country, government agencies should create more comprehensive functional cancer care centers with adequate and advanced medical devices for diagnosis and treatment, such as MRI machines, CT scanners, operating rooms equipped for cancer surgeries, a pathology laboratory for tissue analysis, molecular diagnostics equipment, a palliative care unit, and a clinical trials unit. To address the increasing demand for oncologists and cancer specialists, there is a need to allocate resources for the ongoing training and retraining of healthcare staff to ensure a proficient workforce capable of effectively addressing the rising challenges in cancer care and further educational advancement with sponsorship and research grants should be provided for the oncologists to widen their scope in cancer care to come up with a policy that will help to reduce the burden of cancer in Nigeria. Also, the government needs to implement a nationwide screening program in primary healthcare centers, as this will improve the quick detection of cancer. Finally, with the high rate of cancer cases in children, there is a need to create a pediatric oncology program filled with experienced oncologists who can diagnose and treat childhood cancer, and in establishing this, subsidized cancer care should be prioritized.

Author Contributions

Tolulope Joseph Ogunniyi: conceptualization, writing – original draft, validation, writing – review and editing, project administration, data curation. Boluwatife Samuel Fatokun: conceptualization, validation, writing – original draft, writing – review and editing. Kafayat Omolara Isah: writing – original draft, writing – review and editing, validation, conceptualization. Asmau Abdulbaki: writing – original draft, writing – review and editing, conceptualization, validation. Adeola Roqeebat Emiola: writing – original draft, writing – review and editing, validation. Kesaobaka Batisani: conceptualization, visualization, writing – review and editing, validation, writing – original draft, formal analysis. All authors have read and approved the final version of the manuscript.

Conflicts of Interest

The authors declare no conflicts of interest.

Transparency Statement

The lead author Kesaobaka Batisani affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

Data Availability Statement

Data sharing does not apply to this article as no data sets were generated or analyzed during the current study. The corresponding author had full access to all of the data in this study and takes complete responsibility for the integrity of the data and the accuracy of the data analysis.