CANCER IN NIGERIA
As an oncologist, cancer is the main focus of my clinical, teaching and research activities. The commonest cancers in Ngeria are, among females, breast and cervical cancers, and among males, liver and prostate cancers. For more go to the Cancer page (see the side panel)
BREAST CANCER CLINICAL TRIALS IN NIGERIA
An important way of generating new knowledge about cancer treatment is the clinical trials mechanism (http://www.cancer.gov/clinicaltrials/learning/page3). Clinical trials benefit patients and institutions in many ways including:
- Providing patients access to cutting edge treatment that is often not yet widely available
- Close and detailed follow-up
- Subsidizing treatment of patients
- Contribution to new knowledge that will benefit future generation
- Working with leading experts in the field and increasing local skills and expertise
At the Oncology Division of the Department of Surgery, University College Hospital, Ibadan, patients can enroll in any of the following clinical trials:
a. A multinational study of the benefit of oophorectomy (removal of the ovaries) at different phases of the menstrual cycle in addition to Tamoxifen for the treatment of patients with advanced breast cancer. This study is led by Dr. Richard Love of Ohio State State University, U.S. (http://www.ibcrf.org/index.html) abd is currently accruing patients
b. An International Breast Cancer Study Group (http://www.ibcsg.org/) clinical trial of the value of metronomic chemotherapy in the treatment of breast cancer patients whose tumors are hormone receptor negative (IBCSG Trial 22-00). The chemotherapy is used as an anti-angionesis agent in these patients for whom there is currently little evidence based gold standard treatment. Patient accrual into this study will start shortly so contact us if you are a clinician interested in referring patients or you are a Nigerian patient interested in participating in the trial.
c. An International Breast Cancer Study Group (http://www.ibcsg.org/) clinical trial of chemotherapy in the treatment of breast cancer patients whose tumors have recurred after initial treatment (IBCSG Trial 27-02, NSABP Protocol B37, BIG Trial 1-02). There is currently no gold standard for the treatment of these patients and studies like this will help us to know what to do for cush patients in future. Patient accrual into this study will start shortly so contact us if you are a clinician interested in referring patients or you are a Nigerian patient interested in participating in the trial.
d. We have just published our analysis of the molecular subtype of breast cancer seen in Ibadan and contrary to the often stated claims, there was no substantial difference in the pattern compared to the results from well conducted studies from other parts of the world. This finding is practice changing in many ways:
a. When the ER/PR status of patients is unknown, it is appropriate to treat as ER positive
b. We need to focus on other issues such as quality of care, early presentation, etc to reduce the poor survival of our breast cancer patients rather than assume that it is due to biology.
My work in epidemiology include:
a. Dietary intake of milk and teenage acne: Teenage acne is an important source of physical and psychological morbidity as well as occasional mortality in young people. In addition, acne provides a biological model to study dietary intake and its association with glandular tissue such as breast which shares close embryological and evolutionary origin with the sebaceous gland. Our retrospective (http://www.eblue.org/issues/contents?issue_key=TOC@@JOURNALS@YJAAD@0052@0002) and prospective studies (http://dermatology.cdlib.org/124/) showed a positive association between dietary intake of skim milk and teenage acne. The prospective study of association between milk intake and teenage acne in girls is one of the top ten most read articles in Dermatology in 2006 according to Medscape. We believe that this association is either mediated by IGF1 pathways or through bioactive molecules in milk. You can see the interest generated by this study at http://search.live.com/results.aspx?q=adebamowo AND acne&first=11&FORM=PERE.
The milk, hormones and human health symposium that held in Boston in October 2006 was a powerful setting for discussion of issues relating to the association between milk intake and various health and disease states. In bringing together experts from medicine, public health and veterinary sciences, it laid the foundation for future important cross talk among these specialists to further understanding on the health impact of milk intake in humans. The proceedings of the workshop will soon be available online at http://www.hsph.harvard.edu/cancer/workshops/milk/
b. Dietary antioxidants and breast cancer risk: There is a lot of interest in the potential benefit of dietary antioxidants intake and risk of diseases. I have been exploring this in breast cancer patients. Flavonols are a major source of the antioxidant content of fruits and vegetables so we looked at the association between dietary flavonols intakes and risk of breast cancer. Overall, there was no association, but we found a protective effect with intake of beans and legumes (http://www3.interscience.wiley.com/cgi-bin/abstract/109859016/ABSTRACT?CRETRY=1&SRETRY=0). You can read about interest generated by this work here - http://search.live.com/results.aspx?q=adebamowo AND beans&first=11&FORM=PERE
We continue to probe this question and at the upcoming AACR Frontiers in Prevention of Cancer Meeting in Boston, Nov. 2006, we will be presenting the results of our study of dietary antioxidants intake measured using FRAP technique and risk of breast cancer http://www.aacr.org/default.aspx?p=7166
c. Dietary patterns and risk of breast cancer: Most dietary epidemiology studies focus on one or a group of foods or nutrients and evaluate the association between these and risk of breast cancer or other diseases. Well, dietary intake usually consist of complex mixture of foods and nutrients. Therefore, we decided to use factor analysis to identify major dietary patterns and test the association between these patterns and breast cancer risk. Overall, we did not find an association possibly because the effect of the different food items cancel each other out. However, subset analysis showed an interesting inverse association between prudent dietary pattern and breast cancer risk among people who have ever smoked. This latter finding and our finding in the subset analysis of dietary antioxidants intake and breast cancer risk among smokers suggest that this subject requires further study.