 1st Lashuwae 254. Mi nami Ram Aguqo. It is a pleasure being with you and to help us in this conversation when it comes to cancer screening and detection. I am with Dr. Asaf Kinyanjuwi. He is the chief executive officer, the CEO of Nairobi Hospice. Can we send a battery? Thank you very much. You're welcome. Very well. I almost lost track of the last time we met before we went on air. But how have we been since we last talked? I am very well. I am delighted January is over. It is now in a new month. I am happy also that 254 is looking at youth issues from a holistic perspective. There was a very informative discussion about investments. And you know mostly the youth look at life from the yellow perspective. And I am happy that this media house is also looking at helping the youth to live a very meaningful life. Yeah. And also violence is a month of love and it's quite interesting how youth are going all in. Yes. It's a month for the boy child to suffer. Yeah. For the boy child to suffer. Oh my God. Today we will talk about cancer screening and early detection. And I would like you to ask Dr. Rih any question you have. The hashtag is why in the morning. At Ram Agugo, at Y254 channel engage with us. Let us know where you're watching us from and we shall sample your feedback a bit later on during this morning conversation. Ask any question you want to ask and Dr. Rih is sure going to be able to answer all your question. Now Dr. Rih, first things first. When we talk about cancer screening what is it? What is cancer screening? Just by definition for somebody who may not understand what exactly we are talking about here. Yeah. So cancer screening is a modality or a way of looking at an individual to try and detect whether they could be having early stages of cancer or they could be at risk of developing cancer so that they can be able to guide them to make a very informed decision regarding their health and going forward. And why we are having this discussion about cancer screening is as a country we most are having about 42,000 43,000 Kenyans being diagnosed with cancer every year and we are losing about 27,000 Kenyans every year from this study which was done by WTO together with GlobalCan so it tells you there is a big burden and the reason why Kenyans need to and especially the youth need to take care of their health and need to go for screening early so that at least if there are early signs of cancer then interventions can be done early to get the required treatment and care. So it's just generally finding out whether you have or detecting whether you have any type of cancer. Now is there like so it's like a test, correct? Yes it is. So is there like a general test for all types of cancers or do we have specific tests for specific types of cancer? The challenge with cancer is that it's not a one disease cancer is multiple diseases but what we say is that any living organ in our body has a potential of developing cancer so it's very hard to come up with one modality or one test that you're going to subject an individual and say that it sort of rulers all the cancers in the body. So what we talk about in terms of screening is looking at there are some cancers which are screenable and the beauty about it is they are the common ones so if you're able to screen those ones then you're able to reduce on cancer in the country even in the population. So you can't do one test but there are several tests which have been approved that can be able to detect most of the cancers. So when you go to the doctor and you want to do screening take us through that whole process for somebody who has never gone there and it's going to be the first time for a man, is it different from a woman what do they do and what should they expect once they get into that particular room and they are saying doctor I want to get screened. Yes that's a very good question so what happens different cancers affect different age groups and also different cancers affect different genders so if you are lady for example walks into a doctor's room and say I want to be screened one of the things is the doctor will take them through the history and find out about their lifestyle remember in the previous discussion we looked at some of the predisposing aspects of our lifestyle that could push an individual to develop cancer so you look at firstly in terms of your lifestyle how you are living, are you active are you using tobacco are you taking alcohol are you even in terms of your sexual lifestyle how are you doing it so from that the doctor first will be able to guide you in terms of how do you adopt a very safe healthy lifestyle to avoid you getting to the disease So there are questions about how the foods you've been eating the family background so once they have taken all that history and they are able to look at your lists then they will now move to the aspect of now the screening again if you are looking at the lady one of the things we will be looking at some of the common cancers among women so in our setup we have seen cancers of the breast and cancers of the cervix are the commonest among women in our population so as a doctor I will be more interested in first of looking at those or that will be the first place you go for those are the first things you will go for and this is regarding cancer so for women if the woman is below the age of 35 the recommended test in terms of looking at her breast is what we call the clinical breast examination this is where a healthcare provider is trained to look at the breast examine them and when the healthcare worker is examining he is looking at whether there are any changes on those breast whether there is one any swearing on that breast whether there are skin changes on the breast and whether even when he expresses or presses on the nipu whether there is any sort of discharge that would also now help the healthcare worker to see whether he wants to subject this lady to more test or not and also it is at this juncture that I would like to also ask you to head over to our YouTube channel because we had a particular interview about breast cancer go to our YouTube channel and check that particular conversation out because that is where we had yet another expert who was able to show us exactly how you can examine yourself as an individual so that's what the doctor does in the room and why we call it clinical breast examination we still encourage individuals to do this but we also encourage ladies on a yearly basis to help to visit a healthcare provider to conduct the clinical breast examination clinical means because as an individual you might miss some of those when you are doing yourself so an expert will be able to do it in a better way so if you are ready and you are 35 years and above then the recommended test is to do a mammogram so that is where you now do sort of an investigation that looks at a breast in a more specialized way to detect elements of cancer or not the other common cancer in women is cervical cancer which affects the productive organ so again what the healthcare worker will do is will look at the woman from if a lady is 25 years and below and she is HIV positive then she will be able to want to do some of the tests which are available the recommended test for cancer of the cervix is what we call the human papiroma virus test which we call the HPV why we recommend this is because it's able to detect the virus that causes the disease or how it's attributed to the disease and one of the things we are urging our governments is we know most of the public facilities don't have these tests they are still doing the visual inspection where the healthcare worker puts a spectrum and looks at the lady cervix but we have realized that it has some elements of margins of error and sometimes you might tell an individual you are okay when they are not okay so that's the reason why we are urging government to invest in some of this technology so should they be coming frequently or seasonally for the tests yes so that's a very good question so if a lady is 25 and HIV positive need to do that test at that age if there's a lady who is HIV negative then she needs to do cervical screening test from the age of 30 so what happens is that once you do that test and it's negative or there are no abnormalities detected then the healthcare worker might tell you based on again remember we talked about your history they might tell you that we might repeat this test in the next 2 years you know in Lattari there are some people because of you know we are Africans and someone will tell you but you went for screening and it was negative you want to go back again whatever you are looking for you will find it very true as some people say whatever you do you don't know does it kill you but from and as much as that on my daily on a day to day I see patients with advanced cancer from the hospice palliative care aspect I would really and when you ask the patients they tell you they wish they knew about issues of screening early because they would have gone for screening most of the disease would have been detected when it's still early they would have been able to get the required cure and to be less costy to them and also in terms of even not just a cost but even the impact on their body so idea is just to encourage individuals to go for screening as early as possible the earlier the better the prevention is better than cure yes so if that's mostly from the ladies perspective if we look at the common some of the common cancers but the cost of common cancers attaches on both which we will also look at let's go to the men what do you do so again remember breast cancer affects men it's not just women so the same sort of when you are doing the physical examination as a healthcare provider you also need to examine the men's breast and see whether they are in the changes because one of the things we have also noted is that men who develop breast cancer it has to be very aggressive but the time they are seeking treatment so you also want to look at whether there are any changes on their chest and be able to guide them effectively there are other common cancers which are again common in men so if a man is about 45 years and above they are at a higher risk of developing cancers of their GIT what we call the the digestive tract system so we want to look at whether there is any cancers which could be related from the rectum the waste product comes out or the wave to the mouth so one of the subjective tests we do for these individuals who are 45 years and above is to look at what we call the fecal blood test so we tell them to go to the lab submit a small sample of their stool and they are able to look at whether there are traces of blood in that stool or not if there are traces of blood in it then what we do is now subject them to a more aggressive test what we call a colonoscopy which is where the health care worker inserts a camera through the rectum looks at the unitestines and if there isn't any changes then he is able to take a biopsy for further investigation that sounds painful it is not painful and again most of the time because they are done by experts you hardly even feel the pain I have actually done it so I am just here from experience you will actually be able to do it and within an hour or two you can continue with your normal life you can sit well definitely so for the other cancer which is common in men is the cancer of the prostate again this is most of the time we subject men who are 40 years and above but what we advise is that for cancer of the prostate we don't advise or advocate for mass cleaning so I know in some instances especially now that we have political sort of season we are applying for political season we want to do some sort of screening so you might find saying all the men line up on this queue we are going to subject you to test for cancer of the prostate why we don't advocate for mass cleaning is because the test which is usually done is to look at some hormones which we call the prosthetic specific antigen whether it is elevated or not but we find in men it can be elevated for many other reasons apart from the cancer if you find all the men who are elevated and they tell them they have prostate cancer then you might give them the wrong information you subject them to a lot of trouble so this imagine of error when you have to when you go for mass screening and especially for men so what we do is we individualize individual screening for men so if a man comes and look at their history from what we talked about even from their lifestyle, from their family and also look at their issues from the uninary symptoms when they are passing urine when they are passing urine and such things then I will make a decision whether I need to do the screening or not based on that aspect but what about the case whereby a man is younger than 45 below 40 but they are still experiencing such cases are they eligible for screening because you have mentioned issues doing the blood in this tool and the urine and so many others what if those are experienced by men below 45 yes if they are most of the time they are really below the age of 45 but we know in the field of medicine we have even seen very young people coming up with cancers which is experienced or see them in old ages so if they come with those symptoms again you still subject them to the same test just to ensure that they are not having that disease again and what also we need to also to advise is that people also again when you also go to the doctor apart from just looking at those specific cancers you also do a basic sort of a body examination when the doctor is doing those examinations is also looking at one how is your weight are you having challenges with your weight are you having challenges with your blood pressure are you having challenges with your even in terms of your blood sugars and such because again we got to some of the things we have realized things like obesity also but it is supposed to be just to having high cancers so apart from the screening we will also be able to guide you on healthy lifestyles that one needs to to take in place to ensure that we avoid having developing cancers okay but now that Thari you mentioned for the men and the women and I am really keen on the fact that you mentioned that different types of cancer you test based also on the age so are you saying that Thari that one of the initial things that a doctor needs to find out is the age of somebody and based on that age they will screen you for particular cancer but they will not screen for another exactly so does age matter and if somebody is 20 or younger should they be given all types of screening only they be subjected to some and others will be left out yes that's a very good question so one of the things if you remember in our previous discussion is that cancers are affected by some of the things we say they are non-modifiable one of the things is age so different ages have different sort of high risk of developing certain cancer so if you walk into a clinic one of the things a healthcare worker wants to know what's your age because that then you know what sort of screening is going to do so if you are 20 years and below you most likely we know your risk of developing some of these cancers are slightly lower than somebody who is probably 25 and above so you might not need to subject it to all the tests because most of the time what you will be doing and especially in our setup in Africa where we have limited resources will be actually exposing you to sometimes to harmful tests and also sometimes you may also be exposing you to costly tests so if we add in a clinic of value and might not even have any impact in terms of care so is there an age that once somebody gets to they have to get a full screen for all types of cancer the general if you look at any individual who is in the ages of 30 should should actually take the healthcare and should actually go for screening so from 30 years take a full screen every type of cancer again there are some cancers which are very hidden and they are not easy to do screening so some of those things you might not be able to do screening at the individual full body but what you do in our setup is do common screening for common cancers so you look at it already you want to look for their breast you need to look for their cervix again you also want to look at whether they have any cancers associated with tract and such if it's a man then you also look at the common cancers as we talk about the digestive system the prostate and from that perspective and I will down with the man before I move to the next thing now let's talk about blood tests how does blood test play a role in this whole process of cancer screening is it also involved in a way in how are the sources available the blood test is also involved as a possible form of screening there are some cancers which we know even when they are in other stages when you do some tests within the blood might be able to point those are some directions for example there are some of the cancers like the cancers of the pancreas or the cancers affecting the digestive tract even the stomach or the corollecto if you subject an individual to some blood test you will find some of the tumor markers at my point that this individual could be having some form of cancer and therefore could now provoke you as a healthcare provider to do more aggressive tests to just identify where this cancer is or where and probably even see if the cancer is there what type of cancer, how big is it and then because you cannot be able to guide the individual in terms of their management is it possible for someone to just go and say to the doctor that I just want a blood test and the possibility of them just bumping into a sign of a particular cancer yes it's actually sometimes a diagnosis of cancer sometimes is done what you probably say it's out of probably as a result maybe if somebody walks into a clinic and they say probably have a chest issues I'm coughing a lot and probably the healthcare worker is thinking probably could this individual be having asthma or TB but when in the process of doing the investigation then you realize this individual probably has having cancer so sometimes it's discovered in causes of home of accident I've even seen instances where even for like the cancers we are talking about the prostate or even the cancers of the pancreas you are running some tests and you find some signs within the test or some results within the test which are normal just to start provoking you looking at this individual from could they be having this or form of cancer and therefore now you advise them to do different tests to just identify so one of the things we are hoping even as we continue with this discussion is that our governments will also equip our public facilities so that at least even these individuals can also be able to get this sorts of specialized investigations within the facilities because what I've seen is that for example if you walk into your subcounty hospital and you say you want to be screened if a health care worker maybe does even for a lady and finds like they have no more changes in your, this is the cervix the next thing they tell you is just we will now go to your higher level facility what we realize is that majority of the individuals when they are now referred to a higher facility because of the issues of cost then they are not able to seek for that required care but then how much does it cost to do cancer screening in Kenya one of the things is that there is a lot of support from the government like for cancer screening of the cervix for example it's usually free in most of the government facilities what we call the visual inspection but if you want now to go do the most specialized tests like what we talked about the human papiroma virus test cervix goes for about 3000 and above and most is done by the private practitioners you mentioned the mammogram if you go for mammogram again mammogram you are looking at individuals spending about 10,000 and above which again is not usually affordable to most of the individuals and again you find even a health care system even from the insurance perspective sometimes they don't even cover for some of these investigations so that's usually very expensive yes and as you mentioned earlier on for the women does it apply for the men that you have to go back again for screening after a while yes so depending in most of the instances depending if your results are negative that they are not traces of papiroma or science showing that you could be having cancer the health care worker would advise you for routine sort of follow up they might give you a schedule of one year schedule of two years or a schedule of three years depending with the other sort of risk for both men and women yes so don't do one test and then you go and relax at home for the next 10 years and then thinking everything could be okay because sometimes people do that then by the time they are going back to the health care facility they have already probably developed the disease and it's already in advantages so it's very good to once the health care worker gives you a schedule please try and comply with that schedule and if you look at the HPV tests that are being done in the country I'm so much interested in looking at the numbers specifically when you look at the age difference the age gap somebody above 45 and this person who is around in their 20s is there a cause of alarm for when you are at a particular age and you have this particular condition of this particular signs and symptoms yes so the older you grow the higher the risk of you developing most of these cancers so the individuals who are probably 35 and above but now for HPV so even for HPV so if you are younger remember one of the things about HPV is it's usually sexually transmitted virus as you grow older one of the things you also think you realize is that some of these individuals will be exposed to the virus more frequently because probably they have a partner and such so therefore the risk of even getting that infection and continuous infection is higher so that's the reason why you realize especially for individuals probably above 35 and they might even actually be needing to do that test on an yearly basis so that at least you are able to closely monitor and ensure that you know any changes one of the things probably even just to touch on HPV is that we are now having a new technology that is helping to sort of scale up access to these services one of the things from the private practitioner and I've actually even seen the government also trying to introduce it in the public these are a small budget that already can be able to get it in a health facility be able to do that get a sample in the comfort of our house or in the comfort of our office repackage that tune bring it to the lab and for analysis so you can do home cancer screening for the Savaiko you can for the Savaiko cancer you can do that HPV DNA testing the kit actually is very convenient and that's one of the things we are trying to add the government to adopt so that we can be able to scale up the numbers so if one of the things because even one of the things we are looking at at the community we have community health volunteers who sort of know the community are able to educate the community if they are given these kits then they can be able to even spread among the women within the allocation and be able to do the screening support the government in terms of screening for human papiroma virus I hope and believe that if the government adopts that model will be able to have higher numbers of women being screened and be able to get the required intervention as early as possible the cost for Savaiko cancer for the two in the government probably I would say there are three models of screening one is what we call the visual inspection screening where they ready cost to health care facility the health care worker sort of puts a die on the cervix and looks at any abnormalities or not you'll find in public facilities that test is usually mostly free the government usually sort of meets the cost of it the biggest challenge with this test is that it's not very specific so sometimes individuals can be health care workers can meet elements of the disease in it the other test which is a bit specialized is what we used to call the pap smear so where you go to health care worker he puts a small brush and takes some sample on the cervix and goes to analyze it so you'll find that test for the pap smear again in most of the facilities the cost is about a thousand Kenya shillings if you move to the what now you're moving the WHO is sort of advocating what we call the HPV DNA testing using the kit I mentioned is now that which is more costly because most of the health care facilities that are doing it they're charging the cost of three thousand and above yes but at least individuals can base on their pockets and the resources available within their location they have options they can work into the government they do the vision inspection which is free if they have resources then they can go out for these more advanced tests what's even making me bothered is the fact that sometimes you can miss it and it's common you can miss it which begs the question for cervical cancer of course I know I've asked this so many times about how frequent it should go now for cervical you miss it the first time you miss it the second you miss it the third how many times it's a lady supposed to go for this cervical cancer testing and is there an age at which you can say now from this time stop so that's not a very good question so if you are 30 and below if you do the test and it's negative most of the health care worker will tell you why need to repeat this test after 2 years or after 3 years if you are 35 years and above most of the health care worker will advise to do this test on a yearly basis if you get to the ages of 60 the risk of you developing things like cervical cancer are very low so then the health care worker will probably even tell you this test probably even if you have to go and do it probably will be doing it after every 5 years so the frequency of some of these depending on your age will change even for breast cancer if you hit the ages of 60 the risk of developing the breast cancer is usually lower so for ages below 60 you might be doing mammogram on a yearly basis but once you hit the age of 60 about 2-3 years kwa the risk is lower so the younger you are the higher the risk the higher the risk in most of his success so ladies grow old quickly fun intended but there is a question here before I forget because of time Agnes is asking about let me get 1, 2, 3 is asking about the mammogram is mammogram testing painful it's not painful I thank you Agnes for asking that question it's not painful but it's a bit might have a bit of discomfort but I tell individuals that the discomfort is what the risk so kindly do not avoid going for mammogram because of that discomfort because the gains are higher than that discomfort but it's not painful because it's just that you're going to have your breast exposed it's going to be placed on a surface and probably slightly placed so that the machine can be able to look at the breast from a very holistic sort of a plane that is so informative I want to give you just a chance to have a final word because now I believe we've talked about cancer screening and we've talked on a lot but still the conversation cannot end today mafa final final word when it comes to cancer screening that is your camera within just 30 or so seconds what should be our take home for the day thank you the take home is that we are at risk of developing cancers the earlier we start getting to have facilities for screening the better because one of the things we have appreciated is that people who adopt a very healthy lifestyle and go for screening even when they are detected with a disease they are detected early and the disease is able to be cured and managed effectively and it's also less costly to the family so let's not ignore this but let's also encourage even our neighbors our friends and especially for the youth to go for screening on a yearly basis thank you very much thank you so much Bakhtari that is Dr. Kenyan Jewi he is giving us his thoughts in regards to cancer screening and early detection according to statistics at the ministry of health the national uptake of screening stands at 16% while data from the Kenya Cancer Network indicates that there are about 40,000 new cases of cancer each and every year in the country that is Kenya where we are today that leads to 28,000 deaths annually this is statistics based on last years filings I believe it may have changed by now we are still now doing the studies for 2021 and we will be able to give the results but what you have read is the studies which was done in 2020 but most likely the figures will be slightly higher because we are still having more aggressive tests we have seen the government investing a lot in healthcare but also you are also seeing a lot of community still adopting the sedentary lifestyle that would be disposed of individuals to cancer looking forward to seeing how the numbers change for last year for 2021 and of course it is you it is up to you and me let's go there let's get screened let's ensure that we keep ourselves healthy a big thanks to Nairobi Hospice and Dr. Tari, thank you so much for coming it's a pleasure, a big thanks to each and every person that ensured this show was a success we are taking a short break in a bit with more right here on Why In The Morning