Impact of health system challenges on prostate cancer control: health care experiences in Nigeria.

Unlabelled: Prostate cancer is the second most frequently diagnosed cancer of men (913 000 new cases, 13.8% of the total) and the fifth most common cancer overall. Prostate cancer is the sixth leading cause of death from cancer in men (6.1% of the total).The incidence of prostate cancer in Nigerian men is believed to be on the increase and it had become the number one cancer in 1999, constituting 11% of all male cancers in the population served by the Ibadan cancer Registry. Studies from Ibadan and from other sites in Nigeria (Benin, Calabar, Kano, Lagos, Maiduguri, and Zaria) have shown an increasing incidence of prostate cancer accounting for anything between 6 and 12 % of total cancers in these centres and up to about 18% of prostatic neoplasms in some. Most patients present in late stage disease, and the mortality is high.It is uncertain whether there is a biophysical component to the increased incidence of prostate cancer in Nigerian and other West African men although a few studies point in this direction.It appears there is inadequate information regarding the incidence and mortality of prostate cancer, and that health care professionals do not routinely provide information regarding the importance of screening for prostate cancer before age 50 for high-risk populations.The Revised National health Policy for Nigeria (Sept 2004) has as its long term goal 'to provide the entire population with adequate access, not only to primary health care but also to secondary and tertiary services through a well functioning referral system' and also "Ensuring equitable distribution of human resources for healthcare delivery between urban and rural areas, including difficult terrain, such as mountainous, riverine and inaccessible areas of the country."At the moment however, Public expenditure on health is less than $8 per capita, compared to the $34 recommended internationally. Private expenditures are estimated to be over 70% of total health expenditure, most of this from out-of-pocket. Yet there is endemic poverty. The National Health Insurance scheme (NHIS) is presently severely limited in its allowances and certainly so for cancer care.

Conclusions: The following recommendations are therefore made:* Establishment of community outreaches for education and screening.* Improved completeness of records to understand the real burden of disease and funding studies to explore biophysical components that may be important in racial differences for this disease.* Increased access by increasing numbers of specialists required for clinical assessment and management.* Increase laboratory diagnostic support* Improved availability of drugs for the treatment of prostate cancer cases.