A Ghanaian distinguished Professor of Surgery, Pathology and Neuro-Oncology Research at the Duke University School of Medicine in the USA and a member of the US National Cancer Advisory Board, Professor Francis Ali-Osman, recently visited Ghana. He speaks with The Ghanaian Time about his life, his school days at Navrongo Secondary School and plans on how to deal with the cancer problem, from research, diagnosis and treatment in the country, below is excerpt of the interview.

Ghanaian Times: Congrats on your nomination to serve on the US National Cancer Advisory Board, a panel of distinguished scientists and physicians mandated to advise the American government on Cancer, we are proud of you.

Professor Osman: Thank so much, I appreciate it.

Ques: Please, could you tell us about yourself?

Ans.  I am the son of a policeman and was born in Tamale in the Northern Region. I was a pioneer of Sakasaka Primary School in Tamale and, later, attended Gambaga primary, where my father was stationed. I was among the first batch of students enrolled in Navrongo Secondary School (NAVASCO) when the first President of Ghana, Osagyefo Dr. Kwame Nkrumah, commissioned the school in 1960, as part of the Ghana Education Trust school system. Those days had challenges. The science laboratories were ill-equipped, and we had to travel to Tamale Government Secondary School (TAMASCO), a distance of about 190 kilometres, for our final sixth form science practical exams. I enrolled in the Kwame Nkrumah University of Science and Technology (KNUST) and studied Pharmacy, graduating in 1970.

After a one-year internship at the Bolgatanga Central Hospital, I worked, briefly, at the erstwhile Ghana Drug House before going to Germany on a student exchange programme. I enrolled in the Free University in Berlin and graduated with Doctor of Science in 1982.I went on to the University of California San Francisco School of Medicine in the USA, where I continued with my training in neuro-oncology (the study of cancer of the nervous system) at the university’s Brain Tumor Centre, which, at the time was the world’s leading centre of its kind. After that, I worked at the Ohio Hipple Cancer Research Centre for two years before joining the University of Washington School of Medicine, as an Assistant Professor of Neurosurgery and co-Director of the Brain Cancer Programme. After six years, I moved to the University of Texas MD Anderson Cancer Centre as Professor and Chairman of the Department of Experimental Pediatrics. I came to Duke University School of Medicine in 2003 as a Distinguished Professor and Associate Director of the Duke Comprehensive Cancer Centre. I am, presently, the Co-Director of the Duke University Programme of Excellence in Brain Tumors.

 

Ques: You have a spent a better part of your life researching into cancer, could you explain to us more about the disease?

Ans: Cancer is a very complex disease and there are, approximately, 200 different diseases that qualify as cancer. All cancers come from the cells of the body, and are the result of changes, called mutations, that they acquire in theirDNA.DNA is what drives life, and, because our DNA is functioning normally, the genes they encode express themselves normally, making it possible for us to be alive and cancer-free. The human body is made of different types of cells, such as, nerve cells, skin cells, blood cells, muscle cells, to mention but a few. The cells come together to form tissues, tissues form organs and organs form the whole functioning human being. Unfortunately, some of these cells can go “haywire”. Just like human beings, some of whom may be good initially, but turn bad and become criminals, some cells start acquiring mutations in their DNA that lead to abnormal behavior and, ultimately, cancer. The cells in the cancer, also known as a malignant tumour, divide faster than the rest of the cells, resulting in a mass or a lump. Because of the mutated DNA, the cancer cells either no longer produce what they produce to sustain life, over-produce it to high levels, or, produce a deformed/abnormal type of it, all of which are damaging to the cell. The cancer cells eventually invade and spread to other parts of the body, a process known medically, as metastasis. This compromises the normal function and integrity of the tissues and organs and, ultimately, is what kills people!

All tissues of the body can develop cancer and, thus, there are many different types of the disease which is, often, named after the tissue or organ of origin, for example, breast or brain cancer; however, even with a particular type of tissue, such as, the breast, which have different types of cells, each cell type can have a cancer that is different from the other cell types.  This makes its diagnosis and treatment more complicated.

 

What do you do at the US National Cancer Advisory Board?

Ans: We are a panel of experts appointed directly by the President of the United States and mandated to advise the government on the problem of cancer and related diseases. Cancer is a huge national problem in the US; it kills people and takes the lives of children, who are the future, as well as, those of the country’s human treasure in brain-and man-power; hence, the economic burden on the nation is enormous. My board is mandated to review the cancer problem and make recommendations to the government on how to tackle it, including, the type, scope and priorities in research, discovery, clinical trials and prevention, as well as, the policies, programmes and resources required to address the problem. I was appointed to the Board by former President Barrack Obama last September. Although, there has been a change of government in the US, President Donald Trump, has maintained us, so we still serve on the Board.

 

Ques: What are the causes of cancer?

Ans: This is a very important question and there is intensive research is ongoing to better understand and address it. We know from studies in carcinogenesis and cancer epidemiology, that cancer risk is associated with exposure to certain physical and chemical agents, including, ionizing radiation, heavy metals and reactive chemical wastes, many of which are found in the environment. In addition, some lifestyles and behaviour scan increase or decrease one’s predisposition to cancer. For instance, it is well established that both chewing and smoking tobacco cause lung and oral cavity cancers, and contribute to other cancers and diseases, such as emphysema. Also, there are certain diets that contain substances, such as, anti-oxidants that can provide some protection against cancer. These include fresh fruits and vegetables; thus, a diet low in fruits and vegetables, over a long period of time, can increase one’s susceptibility, not only to cancer, but also other diseases, including, heart disease. Another important factor in why we get some cancers, is genetics. This genetic component is in the genes that we inherit from and transmit in our families and can make one more susceptible than others to a particular cancer. Fortunately, inherited genetics account for less than 10% of all cancers. Notable cancers in this regard, include those of the breast and ovary which are the result of inherited mutations in either one of two genes, BRCA1 andBRCA2. Lastly, some cancers can be caused by infections, such as, with viruses or bacteria. These include, HIV, human papillomaviruses, hepatitis B and hepatitis C viruses and Helicobacter pylori, a bacterium associated with stomach ulcers. Fortunately, these types cancer, are preventable by treating the infections.

 

Ques: How do we prevent and control cancer?

Ans:  This is not an easy question, but advances in science are providing some answers. A major part of tackling cancer is in its prevention and early detection and we are getting better it. There are, thus, today genetic tests that can identify individuals at increased risk for developing certain cancers, such as, those of the breast, ovary and colon. The high-risk individuals can then undergo interventions and institute lifestyle changes that can reduce their risk of developing cancer. Appropriate lifestyles, especially, diet, exercise, and smoking can significantly impact an individual’s risk for cancer, particularly, if that person carries a predisposing gene. Modifying the lifestyle can significantly reduce the risk. Helpful dietary changes include, reducing the amount of carbohydrates, such as, starchy foods, and increasing intake of fresh fruits, whole grains and vegetables. Meat is good (fish is better) but over-grilling it, can produce carcinogens. Also, multiple recycling of oil used in frying is not a good habit, as it can also generate carcinogens. Similarly, food with fungus growing on them should be discarded, as the fungus, often produces aflatoxin, a potent liver cancer causing agent. Thus, there is, overall, a lot in our lifestyles that we can modify to reduce our chances of developing cancer. An important aspect of cancer prevention is vaccination. Thus, cervical cancer, very rampant in women in Africa and, specifically, Ghana, is caused by the Human Papillomavirus (HPV), a virus that is common among people who are sexually active. HPV also causes other cancers, including, those of the vagina, penis, anus, and the throat.HPV infection can be prevented by mass vaccination of young girls’ age between 11 and 12. Women between 12 and 26 may also benefit from HPV vaccination. HPV vaccines have been tested and proven to be effective. Because cervical cancer is such a devastating problem in Ghana and is killing a lot of our women, if I were advising the government, I would recommend there should be a national policy on cervical cancer screening and mandatory HPV vaccination for girls and boys age 11-14 years. Unfortunately, because of the association of cervical cancer with sexual activity, there is some stigma attached to HPV vaccination in children.

Managing cancer, once a person gets it, is more complex, difficult and expensive and requires technology and expertise, some of which are not readily available in Ghana. However, if diagnosed early, many cancer, including prostate cancer, can be effectively and less expensively treated. Screening and early detection programmes can help with that.

 

Ques: How far have you gone with efforts to establish a cancer centre in Ghana?

Ans: Establishing a cancer centre is a huge undertaking and not one for a single individual. There are active initiatives in the form of a Public-Private-Partnership to set up a comprehensive cancer centre in the country. These initiatives are in the early stages, but, hopefully, will be realizable.

In view of the enormity of the cancer problem in Ghana and the lack of infrastructure, paucity of expertise and inadequate knowledge   about the disease, I believe that, it should be possible for individuals like me, who are experts in the field, to give back to Ghana in the fight against the disease, working with others, local colleagues, government and other stakeholders. Cancer is best treated at comprehensive cancer centres, where the technologies and multidisciplinary scientific and medical expertise required to treat the disease can be brought together. I have been working with the Noguchi Memorial Institute for Medical Research (NMIMR) in this regard for a while. I believe the NMIMR should have a formal Division of Cancer Research, working with the teaching hospital at Legon and in other regions of the country.

On this note, it was refreshing to see that cancer features prominently in the manifesto of the New Patriotic Party and, that the government has singled out cancer as a problem to be addressed. I am very encouraged by this, given that, overall, cancer kills more people than malaria, HIV/AIDS and tuberculosis combined and, yet, receives only a small fraction of the attention and resources these communicable diseases get. Although, malaria is still a major health challenge, unlike cancer, there are effective, affordable medications for treating it, malaria. Thus, for most people, a cancer diagnosis is a hopeless situation, but it does not have to be so. We can work to make cancer treatment affordable, just as with HIV/AIDS or malaria.

Ques: What are some of your fond memories of your alma mater NAVASCO?

Ans: My formative years at Navasco were great times, indeed. It was a unique experience to be part of the beginning of the school. There were challenges, of course, as pioneers without ever having any seniors, but that gave us the opportunity to become men faster. It was a small group and we were close; some of my best of friends to this day, are from those times. I, therefore, fondly remember the days at NAVASCO. I was active in sports, which I continued to KNUST, where I set a new record in discus throwing and at the national level, in the Ghana Academicals team, participating in the Ghana-ivory Coast and other international games.

 

Ques: Academic standards appear to have fallen; NAVASCO is no more like before, I guess this does not sound pleasant to your ears?

Ans: Actually, after we left the school, those who came after us, continued to improve the school’s academic performance and to set records at the GCE Ordinary Level and Advanced level. I know that, in general, academic standards have fallen in schools in Ghana. The President of the Old NAVASCAN Union, Alhaji Mohammed Cambodia Haroon, brought to my attention the need to equip the science laboratories and a few other things in the school. I believe this will contribute to improving performance and raising standards. We all need to chip in to help. Nonetheless, to change the situation, the students should be encouraged to dream big, to set high goals for themselves and to work hard towards achieving those goals.They should be hungry for knowledge and know that their dreams can be realized and, that, if they work hard, he rest will follow. I started from   humble beginnings in Sakasaka and Gambaga primary schools and I worked my way up. Everything is possible with goals and hard work!

 

Ques: What are your comments on the Sustainable Development Goals?

Ans:  Rather than pursuing sustainability per se, I believe at if the basic infrastructures are in place and the people have the right education, sustainable development will be achieved; things will evolve and society will become   better. Presently, in Ghana, there is very little impact of science in the society, we use the products of science, but we do not make them. The training in science at our schools is, overall, not very strong. We should be well-grounded in the principles of science in our societal organisation with a vibrant media to disseminate knowledge. We should make our young people curious, curious in asking questions and in problem solving, and they will solve a lot of problems for the society. If we are well-grounded in the sciences, sustainability will follow.

 

Thank you Prof Osman for your time!