Early diagnosis of head and neck cancers can significantly enhance survival in Ghana. Still, a leading Ghanaian clinical researcher says the barrier of limited access to modern technological diagnostic capacities remains.
Dr. Clement Arthur, a Research Associate at the First Hospital of Shanxi Medical University in China, indicated that late diagnosis hinders treatment success for many patients with laryngeal and nasopharyngeal cancers in Ghana.
In an interaction with the Ghanaian Times, Dr. Arthur added that many patients only seek care when symptoms like persistent hoarseness, changes in swallowing, or breathing are, at the least, worse than they were before. “By the time most patients show up at the hospital, the patient has already lost their voice and/or has tumors that are infiltrating deep into tissues, making curative treatment extremely difficult,” he said. “This usually means that they will have to undergo very aggressive procedures like total laryngectomy that not only limit the potential for survival but completely take away their ability to speak like a human being.”
Dr. Arthur indicated that the burden of head and neck cancers is steadily increasing in Ghana, especially in urban and semi-urban centers, where exposure to environmental pollutants, tobacco use, and occupational exposure are becoming increasingly critical. Yet, over this period, a looming increase in incidence is only due to a lack of early detection tools and a lack of a systematic population screening program.
He also indicated that many health facilities in Ghana do not even have basic diagnostic equipment (e.g., flexible endoscopes) outside of urban areas, let alone; developed imaging systems that could assist in ”The unfortunate reality is that if you’re not in Accra or Kumasi, then it is likely advanced cancer will only be diagnosed when patients see significant symptoms,” he continued.
About innovative advances in technology, Dr. Arthur also discussed the promising potential of Narrow band imaging (NBI) and White Light Endoscopy (WLE) for lesion detection. “In a study of 114 patients I co-authored, we found that the white light and NBI modalities were better at picking up early-stage laryngeal carcinoma in the patients. These assumed blood vessel patterns- the first cancer indicators- were occluded through this imaging specifically because assumptions were generally seen through proper visual scope.”
He noted that a simple filter, aiming to filter wavelengths of light to describe illuminated superficial blood vessels, allows the physician to highlight abnormal changes in tissue, which are the first signs of cancer, especially for flat or non-pigmented lesions that are often picked up under white light imaging. Still, often, blips of holistic knowledge are missed.
Dr. Arthur stated these technologies are extremely valuable because they allow selective biopsies and minimally invasive body-focused operations. However, he acknowledged that in Ghana, many hospitals and tertiary institutions do not have access to enhanced imaging systems. “Most district and regional hospitals are depending upon rigid laryngoscopy or visual scopes that do not take into account early lesions,” he noted.
Dr. Arthur urged the Secretary of Health and the Ghana Health Service to “prioritize purchasing endoscopy systems compatible with NBI, for regional referral hospitals and university hospitals, specifically Tamale, Sunyani, Cape Coast, Ho, and Takoradi.” He argued that as legitimate efforts were being made to procure these technologies, investment in capacity building must coincide. He advocated for professional training on image-enhanced endoscopy for ENT surgeons, registrars, and residents on the Ni classification criteria for assessing lesions.
“The machines are only half the solution,” Dr. Arthur pronounced. “We must also be assured that they will have the expertise to operate these technologies ethically. A training partnership with firms or hospitals in China, Europe, or South Africa could help expedite and assure that Ghanaian surgeons can position themselves at the cutting edge of diagnostic excellence.”
Dr. Arthur stated that, “a viable strategy must not just be aimed at the tertiary hospital space” and asked to include screening for laryngeal cancers, with a collaborative effort across Ghana’s primary healthcare system, targeting groups at increased risk – teachers (those at risk because of voice use), industrial workers (exposure to chemicals) and heavy users of tobacco. “As we have screened for cervical and breast cancer, we can and should do screening for ENT cancers.”
To illustrate this, he shared the case of a man named Kwabena, a fifty-five-year-old radio presenter from Kumasi, who presented with persistent hoarseness that resulted in a diagnosis of vocal cord cancer in the early stages using NBI. Because we detected his lesion early, he underwent a minimally invasive laser surgery and went back to work with his voice.” That is the power of early detection. Just think of the voices we would save if every district had the technology.”
Dr. Arthur noted that without immediate action, Ghana will be able to continue the cycle, with patients forced into irreversible surgeries, abnormally high healthcare costs, and preventable deaths. “Delays in diagnoses are no longer just clinical failures; they are public health crises,” he said. He noted that while early detection saves lives, it is also the most cost-effective method of managing cancer. “The cost to treat a patient with early-stage cancer is a fraction of the cost of a late-stage disease case, which potentially includes surgery, radiotherapy, rehabilitation, and support for the rest of the patient’s life,” he noted. He added that for a developing country like In Ghana, preventing and intervening early reduces pressure on the NHIS.
Dr. Arthur and others have echoed the difference between being reactive and proactive regarding health in Ghana and cancer control. “We are too focused on curative treatment after patients are far too ill,” he noted. “We must proactively shift our minds to see prevention and early intervention as a sound investment.” Dr. Arthur also suggested that the government, medical faculties, teaching hospitals, and international partners collaborate better to establish a sustainable pipeline of trained specialists while securing donations or grants for ENT units to acquire proper diagnostic technology.
Additionally, Dr. Arthur indicated that there needs to be a greater focus on public education. “Patients need to know that persistent hoarseness, difficulty swallowing, or changes in quality and tone of voice are not normal,” he said. Campaigns to increase awareness of reporting early symptoms and destigmatize reporting clinical symptoms early must be launched.
Finally, Dr. Arthur called on national leadership to consider cancer control as more than just another medical condition; it should be included in Ghana’s developmental agenda. “Healthy citizens are productive citizens,” he said. “If we think about this in terms of early diagnosis and timely treatment, not only are we saving lives, we are also preserving our national human resource.”
Dr. Arthur invited all stakeholders in the health field to encourage research, policy makers, clinicians, public health supporters, and media organizations to work together to include modern diagnostic practices into normal clinical care. “Each day we delay is another voice gone and another life lost,” he concluded.
Source: Ghanian Times
