Dr Ola Idris Olasunmbo is the Chief Executive Officer of the Blue -Pink Center for Women’s Health, Nigeria, an organization using innovative strategies to achieve prevention, early detection, and control of cancers in Nigeria. In this interview by Hakeem Gbadamosi, he speaks on the need for early detection and awareness of bladder cancer.
Bladder Cancer, who is most at risk and are there genetic or lifestyle factors people should be aware of?
Cancer of the urinary bladder (or simply, bladder cancer) is a significant health concern that affects millions of people worldwide, and understanding the risk factors is crucial for prevention and early detection. Several lifestyle and genetic factors can increase the risk of bladder cancer.
Smoking is the most significant lifestyle risk factor. Smokers are at least three times more likely to get bladder cancer than non-smokers because the harmful chemicals in tobacco smoke can accumulate in the urine, damaging the lining of the bladder over time.
Occupational exposure to certain chemicals is another critical factor. Workers in industries such as dye, rubber, leather, textile, and paint manufacturing, as well as hairdressers exposed to certain dyes, have a higher risk of bladder cancer due to prolonged exposure to carcinogenic substances.
Chronic bladder inflammation and infections can also increase the risk. Conditions such as urinary tract infections, parasitic infestations like schistosomiasis, kidney and bladder stones, and long-term use of urinary catheters may contribute to this risk. Genetic factors play a role as well. While the majority of bladder cancers are not inherited, a family history of bladder cancer can increase an individual’s risk, suggesting a genetic predisposition. Additionally, certain inherited genetic mutations can increase susceptibility to bladder cancer. Other risk factors include sex and age. Although it can occur at any age, bladder cancer is most commonly diagnosed in older adults, with the majority of cases found in those over 55 years of age. In Nigeria, as in many parts of the world, men are particularly at a higher risk of developing bladder cancer and are about three to four times more likely to be diagnosed with the disease than women.
Given the high degree of risk, when and how often do you recommend screening?
Routine screening for bladder cancer in the general population is not universally recommended due to the relatively low incidence and the potential risks associated with invasive tests in the bladder. However, specific high-risk groups can benefit significantly from regular monitoring.
For high-risk individuals, such as long-term smokers, those with a family history of bladder cancer, or those exposed to carcinogenic chemicals in their workplace, more vigilant monitoring is necessary.
For these individuals, the frequency of screening can vary based on individual risk factors and medical advice. High-risk individuals, particularly smokers and those with occupational exposures, may benefit from annual screening. For those with moderate risk factors or a family history of bladder cancer, bi-annual screening might be sufficient. Even for those not undergoing specific bladder cancer screening, regular health check-ups that include urinalysis and other relevant evaluations are advisable.
Individuals at high risk should consult with their healthcare provider to develop a personalized screening plan that includes regular urine tests (i.e., a basic test to check for blood or abnormal cells in the urine); urine cytology (i.e., examining urine samples under a microscope to detect cancer cells); cystoscopy (i.e., a procedure where a thin, flexible tube with a camera (cystoscope) is inserted into the bladder via the urethra to look for abnormalities); imaging tests (i.e., ultrasound, CT scans, or MRI can help visualize the bladder and surrounding organs to detect tumors or abnormalities); and awareness of symptoms. This proactive approach can help detect bladder cancer at an early, more treatable stage.
What are the symptoms to look out for in the disease?
Bladder cancer can present with a variety of symptoms, which are sometimes non-specific, especially in the early stages of the disease. The most common and often first noticeable symptom of bladder cancer is blood in the urine. It may be visible (gross hematuria), causing the urine to appear pink, red, or cola-colored, or it may be detected only under a microscope (microscopic hematuria) during a urine test.
Changes in urination patterns might also be observed. An increased need to urinate, even when the bladder is not full, can be an early sign of bladder cancer. This symptom often mimics a urinary tract infection (UTI) but persists despite treatment. Frequent UTIs that do not respond to standard treatment could be a sign of bladder cancer, particularly in individuals who do not typically experience infections.
Pain in the lower abdominal (pelvic) area or lower back can occur if the cancer spreads to surrounding tissues. This symptom often appears in the more advanced stages of the disease.
Other symptoms can include swelling in the lower part of the abdomen, chronic fatigue that does not improve with rest and unexplained and progressive weight loss.
Since many of the aforementioned symptoms can be mistaken for some other diseases, early recognition of symptoms of bladder cancer has been a major problem hindering early diagnosis of the disease.
At what stage can it be termed cancerous and before then, is it treatable?
There are completely non-cancerous conditions such as infections, inflammations (cystitis), or non-cancerous masses called papillomas. These conditions are often easily treatable with medical or minor surgical treatments.
Before bladder cancer becomes invasive, there are also pre-cancerous changes that can occur in the bladder lining, such as dysplasia or carcinoma in situ (CIS). These changes are confined to the inner lining of the bladder and can be detected through urine tests or cystoscopy. Although these are not yet cancers, they have the potential to progress to full cancer if left untreated. Early treatment of these pre-cancerous conditions can effectively prevent the development of full-blown bladder cancer. In these very early, non-invasive stages, the disease is highly treatable with a favorable outcome. Once it progresses to higher stages, which means more invasion of the bladder and surrounding tissues, it becomes more difficult to treat, and the outcome becomes poorer.
How common is bladder cancer in Nigeria?
Bladder cancer, though not as prevalent as some other cancers, is a significant health concern in Nigeria. The prevalence of bladder cancer in Nigeria reflects a growing public health challenge, influenced by various risk factors and often compounded by limited awareness and diagnostic capabilities. Bladder cancer is becoming more common in Nigeria, although precise national statistics are scarce. According to the Global Cancer Observatory (GLOBOCAN 2020), bladder cancer ranks as the 13th most common cancer in Nigeria, with an estimated 1,013 new cases annually.
However, the actual burden is likely higher due to underreporting and diagnostic challenges. Besides the common risk factors highlighted earlier, a significant contributing factor to bladder cancer in Nigeria is the high prevalence of schistosomiasis (bilharzia), a parasitic infection linked to an increased risk of bladder cancer. Nigeria has one of the highest rates of schistosomiasis in Africa, which contributes to bladder cancer cases.
The biggest challenges to combating this disease in Nigeria include a low level of public awareness about bladder cancer symptoms and risk factors, which contributes to delays in seeking medical attention. Access to specialized medical care, including diagnostic facilities and cancer treatment centers, is limited, even in urban centers.
In terms of awareness, is there any programme or orientation by government or organizations to spread awareness on bladder cancer in terms of educating the public?
In May 2024, our organization, the Blue-Pink Center for Women’s Health, in collaboration with the World Bladder Cancer Patient Coalition (WBCPC), undertook a comprehensive series of public awareness activities for bladder cancer. Our approach combined both online and offline strategies to reach a wide audience effectively.
Online campaign: We engaged in a robust online campaign across social media platforms, including Facebook, Twitter, Instagram, and LinkedIn. We used infographics to educate the public on the prevalence of bladder cancer, its symptoms and signs, prevention methods, early detection, and treatment options. One of our standout initiatives was the “Spot the Drop Challenge,” a fun online game developed by WBCPC. This interactive game measured how quickly participants could recognize blood in the urine, the most common symptom of bladder cancer.
Public symposium and radio outreach: On May 25, 2024, we organized a virtual Cancer Prevention Symposium attended by a diverse group, including the general public, health workers, medical students, and other health students. This event, themed “Understanding Bladder Cancer: Causes, Risk Factors, and Prevention,” facilitated a deep dive into bladder cancer awareness and prevention through a detailed explanation by our guest speaker, Dr. Samuel Alaba from the Urology Unit, Department of Surgery, Lagos University Teaching Hospital.
Following this, on May 28, 2024, we hosted a 30-minute radio presentation on bladder cancer awareness during the popular Ilera-loba health program on Miliki FM, Ogun State. This broadcast, presented by Dr. Oluwatoyin Oluwatomiloba of the Lagos State Primary Healthcare Service, reached a broad audience and provided crucial information about bladder cancer.
Printed materials and posters: We produced and distributed 1000 informational posters featuring bladder cancer awareness messages translated into Hausa, Yoruba, and Igbo. These posters were strategically placed in about 70 hospitals across Lagos to ensure they reached a diverse population. Additionally, we created an online video featuring eight different bladder cancer messages in ten Nigerian languages, further broadening our reach.
Community engagement: Throughout the month of May, our dedicated volunteers engaged in one-on-one conversations and educational sessions about bladder cancer at our office in Lagos. These personalized interactions allowed us to directly address individual concerns and provide tailored information about bladder cancer.
Multilingual awareness video: To maximize our reach, we created an online awareness video featuring eight different bladder cancer messages delivered in ten different Nigerian languages. This video helped to bridge language barriers and ensure that critical information was accessible to non-English-speaking Nigerian populations.
Through these multi-faceted efforts, we significantly increased public awareness about bladder cancer, emphasizing the importance of early detection and treatment, and ultimately contributing to better health outcomes for more than 40,000 estimated beneficiaries of our campaigns in Nigeria.
What’s the attitude of Nigerians to bladder cancer awareness and prevention during this period?
Before our awareness campaign, bladder cancer awareness in Nigeria was virtually nonexistent outside clinical settings. Most Nigerians had little to no knowledge about the disease, its symptoms, or preventive measures. Bladder cancer, often overshadowed by more prevalent cancers like breast and cervical cancer, had not received the attention it needed in public health discourse.
However, during and after our awareness activities in May 2024, we observed a significant public interest in bladder cancer awareness and prevention. The response was overwhelmingly positive. People were eager to learn more about the disease, understand their risks, and know what steps to take if they noticed any symptoms, such as blood in the urine.
Despite this positive change, there is a need for continuous and sustained public awareness campaigns to solidify this shift in attitude. Regular educational initiatives, community engagements, and media coverage will be essential in keeping bladder cancer awareness information accessible to people. Achieving long-term success in cancer awareness and prevention will require ongoing support from local stakeholders, including government agencies, healthcare institutions, and non-profits. Their collaboration and investment are crucial in maintaining momentum and expanding the reach of awareness activities.
Any feat recorded by your organization towards the eradication of bladder cancer?
While it may be premature to claim significant strides towards bladder cancer control in Nigeria, the Blue-Pink Center for Women’s Health’s recent efforts in May 2024 yielded promising results in raising awareness and fostering proactive attitudes towards the disease. During our campaign, we successfully reached and engaged over 40,000 individuals across various communities. This achievement underscores our organization’s capability to mobilize widespread awareness and education about bladder cancer, a crucial first step towards eventual control. We are committed to sustaining this momentum and expanding our impact, similar to our ongoing efforts to address other prevalent cancers in Nigeria. With sustained efforts and support from our stakeholders and partners, we are optimistic about making substantial progress towards bladder cancer prevention and control in Nigeria.
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