Interview: Seychelles drafts cancer control, prevention policy, plans colon cancer screening
File Photo: Gina Michel, the Seychelles Health Ministry’s programmes manager for mental health and cancer. (Seychelles Nation)
(Seychelles News Agency) - Cancer is a disease affecting people in countries all over the world. Seychelles is no exception as the island nation has recorded a spike in cancer cases and cancer related deaths in recent years.
The month of October was dedicated to cancer awareness. The Ministry of Health and partners have increased efforts to relay information about the disease and offer screening to the population.
SNA spoke to the Health Ministry’s programmes manager for mental health and cancer, Gina Michel, to know a bit more about the state of cancer in Seychelles, contributing factors, care available to patients and ongoing initiatives.
SNA: Seychelles created a national cancer registry in 2008. What does the statistics show about cancer cases among men, women and children in recent years?
GM: In 2011, we had 118 new cancer cases. The following year it rose to 164 new cases. There was a slight decrease to 132 new cases in 2013, but the figures increased in 2014 and 2015 when we recorded 211 and 234 cases, respectively. Cancer related deaths stood at 122 in 2011, while 111 people died of the disease in 2012.
A slight decrease was recorded in 2013 when there were 100 cancer related deaths. For 2014 and 2015, the number of people who died of cancer stood at 125 and 151 respectively.
The most common cancers in men in order of incidence are prostate, colorectal, oral, larynx and stomach cancer. In women the most common cancers are breast, colorectal, cervical and ovarian.
In children, leukemia is the most common type of cancer followed by lymphoma and bone cancer. The same prevalence is being observed internationally.
SNA: What do these statistics indicate about the cancer situation in Seychelles?
GM: They indicate there is an increase in cancer cases, but this is not restricted to Seychelles. Globally the World Health Organization (WHO) has predicted that by 2030, there will be a 45 percent increase in the number of cancer cases. New cases will increase by 15.5 million by 2030 and half of the cases will be in developing countries, with one million occurring in Africa.
SNA: What would you say are the main factors leading to cancer in Seychelles?
GM: Research has shown that there is a link between our lifestyle and cancer. For example people who smoke a lot, drink too much alcohol, do not adopt a healthy diet and who do not exercise are more prone to develop cancer. Some people are also exposing themselves to infectious agents such as the HIV [Human Immunodeficiency Virus], HPV [Human Papilloma Virus], Hepatitis B and C and pollutants such as asbestos, which I am glad to say are no longer used in construction, because of its adverse effects on a person’s health.
SNA: There are complaints that cancer cases are often detected at an advanced stage, thus reducing patients’ chances of survival. What is your professional views about this?
GM: There are people who are reporting early. We always advise patients to report any abnormal symptoms to their doctors. A person should be concerned if he or she detects a lump on his or her body, experiences abnormal bleeding, a persistent cough and back pain, sudden weight loss, bowel changes, rectal bleeding or urinary changes.
Some might say they reported the symptoms early but these were not picked up by the doctor. If you are not satisfied please seek a second opinion. Make use of the various private clinics around the island, which offer a wide range of tests. In the event that you return to the same clinic do not be afraid to see another doctor until you are satisfied that you do not have cancer.
SNA: Can there be cases where no symptoms are observed?
GM: At the earliest stage there might not be any symptoms and a person will feel fine, but once the disease progresses you will definitely experience and see the changes in your body.
SNA: Would you say there is an active screening programme in Seychelles or is this more visible during the month of October which is dedicated to cancer awareness?
GM: We screen patients throughout the year. Seychelles commemorates International Cancer day on February 4 same as the rest of the world, but also dedicates the whole month of October for cancer awareness coinciding with breast cancer day, which falls on October 22. During this month we increased our screening programme and have had special clinics on all three main inhabited islands -- Mahe, Praslin and La Digue, where people have had the opportunity to do comprehensive tests and we also conducted talks about the disease. During the cancer awareness month we go a bit further by taking the services to the workplace and in the communities where we can target more people. Tests offered include mammogram, Pap smear, breast examinations and we will soon introduce fecal occult blood test to screen patients for colon cancer.
SNA: What are the types of care being provided for cancer patients in Seychelles?
GM: Once a person is diagnosed with cancer, depending on how the disease has progressed, the person can be operated on either in Seychelles or overseas. Chemotherapy is offered locally whereas radiotherapy is done overseas namely in India and Reunion island. We also have a hospice at North East Point which provides end of life care. We are presently conducting a palliative care programme to teach our staff how to administer palliative care either in a hospital setting or at home. However I personally believe that a cancer patient should spend his remaining days at home, surrounded by his family, where he or she will feel more comfortable.
SNA: Do you feel there’s enough sensitization about the disease in Seychelles?
GM: We have an ongoing sensitization campaign to educate people about the different types of cancer and what to look out for to ensure early detection. We also educate them on how to lower their risks of getting the disease. We have observed that there is a proportion of the population that is concerned and aware of the disease, but there will always be a small percentage that will not pay much attention to what is being said.
SNA: How does cancer affect families and the society?
GM: When a person suffering from cancer, is the sole breadwinner, be it a father or mother, there is this financial burden on the family. Emotionally it is difficult for the family to cope especially as you witness the person’s transformation, from a healthy individual to a sick person who is unable to go about his normal routines, as a result of the treatment. On a national level, we lose our workforce. It is also a financial burden to the government as chemotherapy is an expensive treatment. Each medication can cost between $200 and $400 dollar. And of course in chemotherapy a number of medications are used over a prolonged period of time. That is why the Ministry of Health receives the biggest portion of the annual national budget.
SNA: A national study is underway to assess whether the cancer spike in Seychelles is genetic. How will the study be beneficial to Seychelles?
GM: We are still collecting data from patients who have been chosen for the study. We have completed data collection on Praslin and La Digue and we are now on Mahe. Once the study is completed we will be able to see whether cancer is hereditary. The findings will help patients and their immediate relatives to make informed decisions about their health, carry out their early tests and undergo treatment if necessary.
SNA: The health ministry is also presently drafting a National Cancer Control & Prevention Policy. What is the purpose of such a document?
GM: This will be Seychelles’ first National Cancer Control and Prevention policy, and it going to be a binding document. Seychelles is getting the assistance of the World Health Organization to draft the document. The first draft is nearing completion. Once completed, it will be validated in a workshop conducted by an international consultant. The policy covers a number of topics such as the types of cancers, prevention, screening, palliative care, cancer registry, research, evaluation and monitoring.