Naija Docs Magazine issue 6

NIGERIA'S FIRST DIGITAL HEALTH MAGAZINE

FOR DOCTORS APRIL-JUNE 2021
ISSUE 6
CERVICAL CANCER- ₦0.00
NOT A DEATH
SENTENCE

CANCER
SCREENING-
DISPELLING
FEAR

THE THEME:
BENEFITS OF
CONTINUOUS CANCER
MEDICAL
EDUCATION

MUCH ADO ABOUT COVID 19

SCREENINGVACCINES

A STEP BEYOND
AWARENESS

Contents

page 04 A message from the editor
page 05 Health tips
page 12 Health talk
page28 Health Science
page33 The Sage's corner
page40 The Young shall grow

2

Patrons

Professor Kofo Soyebi - Lagos
Professor Lekan Gbotolorun - Lagos

Professor Shola Kushimo - Lagos
Professor Aminu Mohammed - Kano

Professor Wole Atoyebi - Lagos
Professor Christopher Lukong - Sokoto

Dr.Niyi Ade-Ajayi - London
Professor Adesoji Ademuyiwa - Lagos

Professor Kayode Adelusola - Ile-Ife
Professor Christopher Bode - Lagos
Professor Emmanuel Ameh - Abuja
Professor Augustine Agbakwuru - Ile-Ife

Professor Afolabi Lesi - Lagos

Cover photo: courtesy of Dr Seyi-Funmi

3

A MESSAGE FROM THE
EDITOR

4

Y                            ou are welcome to the sixth issue of the Naija One major armamentarium man has at his disposal
in his fight against cancers, in general, is screening.
                                Docs Magazine. This issue brings to the fore Screening entails using investigations to detect the
several burning issues. presence of or the predisposition to cancers in a
    Firstly, the global burden of cancer which, vulnerable population. The basis of screening is to
unfortunately, has taken backstage since much of nip cancer while it is yet in its fledgling phase of
the world's attention has shifted to the ravaging growth. Dr Shogade in her article 'Cancer is not a
coronavirus pandemic. The incidence of cancer has death sentence', has set the ball rolling with her
been on the rise in Africa and many experts have beautifully written piece that focuses on the role of
attributed this growing trend to the adoption of early Cancer screening.
Western lifestyle, the greater intake of genetically The most common cancers in males and females are
modified foods, the presence of extreme amounts of prostatic and cervical cancers, respectively. Many
environmental carcinogens. lives have been claimed by these sinister diseases.
Although cancers, in general, portend an abysmal Two seasoned medical doctors, Dr Banjo, a urologist,
outcome in sub-Saharan Africa, one thing common and Okunowo, a Gynaecological oncologist, have
to all cancers is that the prognosis is hinged on the done justice to these conditions, highlighting the
stage of presentation. Cancers picked up or challenges peculiar to each, and stressing the
diagnosed early in the course of the disease tend to importance of cancer screening in the prevention of
offer a far better outlook. advanced or overt disease.

"THE HEALTH PROFESSION The magazine would be incomplete without the
IS ONE AREA THAT mention of the COVID 19 pandemic. The ongoing
battle is far from over. While it appeared, the world
DEMANDS PERIODIC was gradually winning the war recent indicators
'SELF-REAPPRAISAL'..." prove the contrary. The entrance of new variants of
the virus has triggered new waves that have led to a
worsening of the situation in many parts of the
globe. Dr Elebute gives his perspective on the COVID
crisis, particularly as it imparts the nation.

Unarguably, the health profession is one area that
demands periodic 'self-reappraisal' in terms of
continuing medical education (CME) to be abreast
with the advancing trend in patient care. The
inherent benefits of CME are discussed by Dr
Adesanya, a Consultant Paediatric Surgeon working
at one of the tertiary health institutions in the
country.

Lastly, scaling the primary exams in Surgery is the
first step into residency placement in Nigeria. Those
who have attempted the exams share the same
story, its difficulty. Dr Nzemeke rounds up the list of
Contributions to this 6th issue with healthful tips to
pass this examination.   

"This issue brings to the fore the global burden
of cancer which unfortunately has taken

backstage since much of the world's attention
has been drawn to the ravaging coronavirus
pandemic."

5

Health
Tips

Cancer Dr Shogade is a Consultant
screening- Cardiologist with the University of
Dispelling fear Uyo Teaching Hospital. She holds a
Bachelor degree from Obafemi
Awolowo University. Shogade is a
Fellow of National Postgraduate
Medical College of Nigeria and has
more than 10 years of experience in
preventing, diagnosis and managing
medical conditions with special
interest in cardiovascular diseases.

Cancers are abnormal rapidly growing cells that can affect any parts of the body right from the head down to the
toes, though often fatal if not detected at the very earliest stage. The good news is, there are practices that can
prevent us from developing cancers, detect and cure cancers on time.
The most common types of cancer in Nigerian women are breast and cervical cancers, while in men, prostate and
colorectal cancers top the list.
There are potential risk factors that can increase the chances of developing cancers. These include modifiable and
non-modifiable risk factors.

Non-modifiable factors are those that we
have no control over, but which we need to
be fully aware of so as to reduce our overall
risks or predisposition to cancers; These
include:
1. Age: As we grow older, we are more at risk
of developing most forms of cancer; thus, at
an average age of 40 years, experts advise
screening for common cancers to ensure
early detection.
2. Gender: Certain organs such as prostate or
testes that are unique to males could become
cancerous likewise ovary, uterus and cervix
found only in females.
3. Genetic makeup: Alteration in our genes
could be hereditary or acquired, could be
brought about by exposure to a certain
radioactive substance. This could predispose
the development of cancers. This also explains
the high incidence of skin cancers among
albinos.
4. Family history: A history of cancers in a
first-degree relative (parents and siblings),
increases the likelihood of developing certain
forms of cancers. Anyone with such a
background history ought to start screening
for such cancers at an early age.
Modifiable risk factors are those factors that
can predispose the development of cancers,
but which could be mitigated by voluntarily
minimizing exposure to them through the
practice of healthy lifestyles.

7

1. Tobacco: tobacco ingestion in whatever forms The knowledge of our unique risks can help in
either smoking, chewing, inhaling or snuff intake lowering our odds of getting cancer. We are
are practised harmful to our health. Tobacco has thus equipped to take necessary steps toward
many toxins that are damaging to the body. preventing cancers such as:
Studies over the years have shown the multiple 1. Eating a healthy diet that includes fruits and
harmful effects of tobacco ingestion on the vegetable daily, avoid consumption of red
body not only for lung cancers but also many meat, saturated fatty foods, excessive intake
other body cancers and chronic illnesses. These of carbohydrate and dairy products such as
effects are significant for both direct and passive egg, butter, cheese etc. Also, essential to
smokers. avoid food cooked with open fire like suya
2. Obesity or overweight: obesity is a risk factor and barbecued meat.
for chronic illnesses like hypertension, diabetes 2. Cessation of tobacco and alcohol intake will
mellitus, arthritis, and cancer. Diet (excessive significantly reduce the risk of cancers
consumption of fatty food and red meat), 3. Improved physical activities including
weight gain, and excessive body fat distribution regular moderate exercises such as brisk
are influencing the increased risk of walking, jogging, swimming and skipping for
malignancies. The commonest cancers about 30minutes daily at least 5days a week
associated with obesity are endometrial, 4. Avoid exposure to high-intensity sunlight
oesophageal, breast, prostate and renal. by wearing a wide-brim hat while under the
3. Alcohol: Consumption of alcohol is one of the sun.
most important preventable risk factors for 5. Imbibing safe practices such as screening
cancer, along with tobacco and excess body blood before transfusion, avoid sharing sharps
weight. Commonly affected organs are the or multiple sexual partners
mouth, throat, voice box, oesophagus, colon,
rectum, and breast.
4. Exposure to radiation: sources of radiation
are sunlight, X-ray, MRI etc. At high doses,
radiation therapy kills cancer cells or slow their
growth. Conversely radiation from the ultraviolet
light of the sun may cause DNA damage in
normal cells leading to serious side effects such
as cancers (melanoma, other skin cancers)
especially in albinos
5. Oral contraceptive pills: use for family
planning can predispose women to malignancy
especially when taken after age 35years.
6. Unsafe practices like multiple sexual partners,
sharing of sharps, transfusions of unscreened
blood can expose us to some viruses (human
papillomavirus, hepatitis B and C virus) which
increase our risk of developing certain cancers.

8

Screening for Cancer 2. Regular breast self-exams, mammography,
breast ultrasound or MRI
There are several tests that could be carried A monthly self-breast examination should be
out to detect the presence of cancers, at the done regularly by women, looking out for
earliest stage, before the development of changes in the skin, masses within the breast
overt symptoms. This presupposes those or armpit, abnormal nipple discharge and
cancers are easier to treat when picked up swelling of the upper limbs. If any abnormality
early in its natural history than when it has is detected, it is important to get it checked.
spread. Mammography or breast ultrasound screens
1. Colonoscopy, sigmoidoscopy, and stool for breast cancer has been shown to reduce
tests (high sensitivity faecal occult blood tests deaths from the disease among women ages
and stool DNA tests) 40 to 74, especially those over age 50. Breast
Colonoscopy and sigmoidoscopy not only MRI is often used for women who carry a
detect abnormal colorectal growth early but harmful mutation in the BRCA1 gene or
also help to prevent the development of the BRCA2 gene. Women with these mutations
cancer. These tests can detect abnormal have an elevated risk of breast cancer, as well
colon growths (polyps) that can be removed as an increased risk for other cancers.
before they become cancerous. Virtual 3. Pap test and human papillomavirus (HPV)
colonoscopy, which is non-invasive allows testing
the colon and rectum to be examined from These tests, which can be used both alone and
outside the body. Occult blood testing checks in combination, can lead to both early
for the presence of invisible blood in stool, detection and prevention of cervical cancer.
while stool DNA test detects abnormal cell They prevent the disease because they allow
that can be potentially cancerous. If any of abnormal cells to be found and treated before
these are positive, there is a need for further they become cancerous. Testing is
investigation with colonoscopy to confirm recommended to begin at age 21 and to end
colon cancer. Expert groups recommend that at age 65 in women who have had adequate
people who are at average risk for colorectal prior screening and are not otherwise at
cancer have screening with one of these considerable risk for cervical cancer.
tests at ages 50 through to 75years of age . 4. Prostate-Specific Antigen test
This blood test, which is often done along with
"We are thus a digital rectal exam, can detect prostate
equipped to take enlargement at an early stage; prompt
necessary steps treatment of which will prevent late-stage
toward preventing prostate cancer. This test is particularly
cancers" recommended for men above 40 years of
age.
5. Regular Skin examination
It is recommended, that people who are at risk
for skin cancer examine their skin regularly
and report any changes in their skin, such as a
new mole or a change in the appearance of an
existing mole to their doctor promptly.

9

6. Low-dose helical computed tomography
This test to screen for lung cancer has been
shown to reduce lung cancer deaths among
heavy smokers ages 55 to 74.
7. Genetic and genomic tests
These tests look for changes in genes that
can predict the presence and behaviour of
cancers to treatment such as a test to look
for BRCA1 and BRCA2 genes. Women with
one or both genes have a much higher risk
for breast and ovarian cancers.
8. Transvaginal ultrasound
This imaging test, which can create pictures
of a woman’s ovaries and uterus, is
sometimes used in women who are at
increased risk of ovarian cancer (because
they carry harmful BRCA1 or BRCA2 mutation)
or of endometrial cancer (because they have
a condition called Lynch syndrome).
9. Biomarkers.
These are substances found in blood, urine,
and other body fluids that sometimes signal a
predisposition to or presence of cancer. They
can also predict how you might respond to
treatment. These include alpha-fetoprotein
(liver cancer), ALK gene (non-small-cell lung
cancer:), Thyroglobulin (thyroid
cancer), Hepatitis (B or C) virus (liver cancer)
and CA125 (ovarian cancer). Biomarkers can
be elevated by other diseases besides cancer
when a positive patient ought to do a further
test to confirm cancerous growth.

10

Vaccines to prevent cancers

1. The HPV vaccine is highly effective when
given to children between the age of 12 and
14 years. It protects against the development
of HPV-associated cancers.
2. Hepatitis B vaccine prevents hepatitis B
infection, which if present increases odds of
developing liver cancer.
3. Sipuleucel-T (Provenge) vaccine, treats
prostate cancer.
In conclusion, cancers are no longer death
sentence, we need to take proactive steps to
prevent them, screen for them on time and
treat them promptly.

Work-Cited

1. New Cancer Screening and Prevention Methods,
https://www.webmd.com/cancer/detect-treat-cancer-
17/cancer-prevention-screening.

11

THaea

aallthk

Oluseyi Banjo is a Consultant Urologist
at the Federal Medical Centre and a
Lecturer at the Federal Teaching
Hospital, Ido-Ekiti, Ekiti State, Nigeria.

WHAT YOU NEED
TO KNOW
ABOUT
PROSTATIC
CANCER

Prostate cancer begins when cells in The size of the prostate can change
the prostate gland start to grow out as a man ages. In younger men, it is
of control. The prostate is a gland about the size of a walnut, but it can
found only in males. It makes some be much larger in older men.
of the fluid that is part of semen.

The prostate is below the bladder
(the hollow organ where urine is
stored) and in front of the rectum
(the last part of the intestines). Just
behind the prostate are glands
called seminal vesicles that make
most of the fluid for semen. The
urethra, which is the tube that
carries urine and semen out of the
body through the penis, goes
through the center of the prostate.

14

EPIDEMIOLOGY INCIDENCE

Prostate cancer (PC) is the second most The incidence rate of prostate cancer
frequent malignancy (after lung varies across regions and populations [2].
cancer) in men worldwide, counting In 2018, 1,276,106 new cases of prostate
1,276,106 new cases and causing cancer were registered worldwide,
358,989 deaths (3.8% of all deaths representing 7.1% of all cancers in men [1].
caused by cancer in men) in 2018 [1, Prostate cancer incidence rates are highly
2].    It has become the number one variable worldwide. The age-standardized
cancer in Nigerian men and constitutes rate (ASR) was highest in Oceania (79.1
11% of all male cancers. The median age per 100,000 people) and North America
of patients is 67.5 years (variance 5.6), (73.7), followed by Europe (62.1).
and the mean age, 71.4 years (variance Conversely, Africa and Asia have
14.3). [3] incidence rates that are lower than those
from developed countries (26.6 and 11.5,
The world’s highest incidence is among respectively) [2]. The worldwide variations
African Americans and Jamaican, and in prostate cancer incidence might be
its mortality is approximately twice as attributed to overdiagnosis through
much as in White men [4]. There are extensive PSA testing and the use of
scant data available regarding native more extensive prostatic biopsy protocols
African men. [4]. 15

MORTALITY

The mortality rate of prostate cancer rises with age, and almost 55% of all deaths
occur after 65 years of age [2]. Its distribution varies widely worldwide. African-
American men have the highest prostate cancer incidence and mortality rates. This
suggests not only that African-American men may possess some specific genes that
are more susceptible to mutations in prostate cancer, but mainly that these
mutations are associated with a more aggressive type of cancer[5].

16

SURVIVAL   
Although prostate cancer incidence rates are high, most prostate cancer cases are
detected when the cancer is confined to within the prostate in the USA and Europe.
The 5-year survival rate in the USA for men diagnosed with prostate cancer is around
98% [6]. In Europe, the 5-year survival rate is 83% [7]. This is in contradistinction to
what obtains in many parts of Africa, because of weak healthcare structures and
facilities. In this instance, many cases are locally advanced or metastatic.
AETIOLOGY AND RISK FACTORS
The aetiology remains unknown. The well-established prostate cancer risk factors are
advanced age, ethnicity, genetic factors, and family history [8-10]. Other factors
positively associated with prostate cancer include diet (increased consumption of
saturated animal fat and red meat, lower intake of fruits, vegetables, vitamins, and
coffee), obesity and physical inactivity, hyperglycaemia, infections, and
environmental exposure to chemicals or ionizing radiation [9, 11-15].
Age is an important risk factor for the development of histological prostate cancer,
the disease being rare below 40 and becoming increasingly common with
advancing age, according to post-mortem studies [16].   
Geographic variation: The disease is rare in Asia and the Far East, but US migrants
from Asia and Japan have a 20-fold increased risk. This suggests an environmental
aetiology, such as the western diet, may be important.   

17

Ethnicity: Black men are at greatest risk, Over the years, there has been growing
than Caucasians, Asians and Oriental evidence of a link between rate of ejaculation
races. The world’s highest incidence is and lower chances of prostate cancer. The
among African Americans. balance of data and opinion still conflicts at
present.
Family history: 5% of PC is believed to be
inherited [17, 18]. Hereditary PC tends to Possible dietary inhibitors of PC growth
occur in younger (<60y) men who have a include vitamin D, the antioxidants lycopene
family history. The risk of a man (present in cooked or processed tomatoes)
developing PC is doubled if there is one and polyphenols (pomegranate, blueberry,
affected first-degree relative and is 4-fold green tea, red wine), isothiocyanates in
if there are two. Men without sons are at cruciferous vegetables (sprouts, broccoli), and
greater risk than those that have fathered omega-3 unsaturated fatty acids present, for
sons. example, in mackerel and other oily fish.
Conversely, arachidonic and linolenic acids
Exercise appears to confer protection and omega-6 polyunsaturated fatty acids
against PC. It is known to reduce serum (present in high-fat red meat) promote PC
IGF-1, insulin, leptin, and testosterone cell growth in vivo and increases risk of
while stimulating antioxidant protection advanced PC in prospective cohort studies.   
pathways and immune function, thereby
reducing harmful reactive oxygen Obesity does not confer increased risk of PC
species. diagnosis, but appears to be associated with
more aggressive disease.

18

CLINICAL PRESENTATIONS GROUPED BY Metastatic disease (N+, M+)
DISEASE STAGE
1. Swelling of lower limb(s) due to lymphatic
Localized prostate cancer (Stage T1–T2) obstruction.
2. Anorexia.
1. Asymptomatic; detected in association 3. Weight loss.
with elevated or rising serum - PSA or 4. Bone pain.
incidental abnormal DRE.    5. Pathological fracture.   
2. Lower urinary tract syndrome (LUTS), in 6. Neurological symptoms/signs in lower
most cases due to coexisting benign limbs (spinal cord compression).
hyperplasia causing bladder outlet 7. Anaemia.
obstruction. 8. Dyspnoea.
3. Haematospermia.   

4. Haematuria (probably in most cases due to 9. Jaundice.
coexisting benign - hyperplasia). 10. Bleeding tendency (coagulopathy).
5. Perineal or voiding discomfort (probably
due to coexisting prostatitis). DIGITAL RECTAL EXAMINATION (DRE)

Locally advanced cancer, non-metastatic Digital rectal examination is the most
(Stage T3–4 N0, M0)   
important examination in making a clinical
The above symptoms can be present, with
the following: diagnosis of prostate cancer. An abnormal

1. Symptoms of renal failure/anuria due to DRE is defined by the finding of asymmetry,
ureteric obstruction.
2. Malignant priapism (rare). a nodule, or multiple nodules or a fixed
3. Rectal obstruction (rare).
craggy mass. A normal DRE however does

not preclude the presence of prostate cancer;

the chances however increase with an

abnormal DRE by about 30%. This

underscores its importance. 19

Prostate-specific antigen (PSA) Gleason score of 7 may be called moderately-
differentiated or intermediate-grade.
PSA has revolutionized the diagnosis and Gleason scores of 8 to 10 may be called poorly
management of PC, although its use in differentiated or high-grade.
screening remains controversial. PSA is The scoring system helps to prognosticate.
prostate-specific, but not prostate cancer-
specific. A normal PSA level is considered to If the results of a PSA blood test, DRE,
be 4.0ng/mL of blood. For men in their 50s or or other tests are suggestive of
younger, a PSA level should be below 2.5 in prostate cancer, a prostate biopsy is
most cases. Other causes of elevated PSA indicated.
include BPH, urinary tract infection,
prostatitis, prostate biopsy etc.    In addition to
its use as a serum marker for the diagnosis of
PC, PSA elevations may help in staging,
counselling, and monitoring PC patients. PSA
is used, along with clinical (DRE) T stage and
Gleason score, to predict pathological tumour
staging and outcome after radical
treatments.

Transrectal ultrasound

The most common diagnostic modality for
PC is transrectal ultrasonography (TRUS) with
guided biopsies.    The peripheral/transition
zones, cysts, and calcifications within the
prostate can be seen. It also helps to estimate
prostate volume.

Prostate biopsy   

If the results of a PSA blood test, DRE, or
other tests are suggestive of prostate cancer,
a prostate biopsy is indicated. Based on the
Gleason score, prostate cancers are often
divided into 3 groups:   

Gleason score of 6 or less may be called well-
differentiated or low-grade.

20

TREATMENT PREVENTION

Modalities of treatment of PC, when Epidemiological data indicate a dominant
indicated include the following: role for lifestyle factors in prostate cancer
development. Considering that prostatic
1. Watchful waiting carcinogenesis takes many decades, lifestyle
2. Active surveillance modification may represent a feasible and
3. Radical prostatectomy cost-effective approach to retard prostate
4. Radiotherapy    cancer development.
5. Minimally invasive therapy
6. Androgen deprivation therapy Although the available data about the roles of
7. Chemotherapy    lifestyle factors are conflicting, most of the
studies clearly show that a diet rich in fruits,
vegetables and anti-oxidant micronutrients,
and poor in saturated fats, may significantly
reduce risks of prostate cancer development,
as well as the risk of diseases typical of the
industrialized world.

Several nutrients and pharmaceutical agents
have been studied as potential
chemoprevention candidates. Vitamin E and
selenium showed promise [20, 21]

FUTURE DIRECTION   

1.    The identification of novel genetic
biomarkers will undoubtedly improve cancer
diagnosis, subtype identification and risk
stratification.

2. Chemo-preventive strategies will require a
large trial for translation into clinically useful
strategies.

21

3. Conducting more studies that will give
more understanding of how social and
genetic variants interact and contribute to
the development of aggressive prostate
cancer especially in Blacks. One was recently
done by the “Research on Prostate Cancer in
Men of African Ancestry: Defining the Roles
of Genetics, Tumor Markers, and Social
Stress” (RESPOND) study.

CONCLUSION

Prostate cancer incidence and mortality rates
are strongly related to the age with the
highest incidence being seen in elderly men
(> 65 years of age). African-American men
have the highest incidence rates and more
aggressive type of prostate cancer compared
to White men. There is no evidence yet on
how to prevent prostate cancer; however, it is
possible to lower the risk by limiting high-fat
foods, increasing the intake of vegetables and
fruits and performing more exercise.
Screening is highly recommended at age 45
for Blacks with family history.

22

REFERENCES

1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and
mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394424.

2. Ferlay J EM, Lam F, Colombet M, Mery L, Pineros M, Znaor A, Soerjomataram I, et al. Global cancer observatory: cancer today. Lyon, France:
International Agency for Research on Cancer. Available from: https://gco.iarc. fr/today, Accessed 02 February 2019. [Internet].   

3. Ogunbiyi JO, Shittu OB. Increased incidence of prostate cancer in Nigerians. J Natl Med Assoc. 1999;91(3):159-164

4.    Panigrahi GK, Praharaj PP, Kittaka H, Mridha AR, Black OM, Singh R, Mercer R, et al. Exosome proteomic analyses identify inflammatory
phenotype and novel biomarkers in African American prostate cancer patients. Cancer Med. 2019

5. Kheirandish P, Chinegwundoh F. Ethnic differences in prostate cancer. Br J Cancer. 2011;105(4):481-485

6. Quinn M, Babb P. Patterns and trends in prostate cancer incidence, survival, prevalence and mortality. Part I: international comparisons.
BJU Int. 2002;90(2):162-173.   

7. SEER Cancer Statistics Review, 1975-2013 [Internet]. National Cancer Institute, Bethesda, MD. 2016. Available from:
https://seer.cancer.gov/csr/1975_2015/. Accessed 04 February 2019. [Internet]. SEER, 2018.

8.    Epidemiology of prostate cancer in Europe [Internet]. European Commission, 2015. Available from: https://
ec.europa.eu/jrc/en/publication/epidemiology-prostatecancer-europe.

9. Bostwick DG, Burke HB, Djakiew D, Euling S, Ho SM, Landolph J, Morrison H, et al. Human prostate cancer risk factors. Cancer. 2004;101(10
Suppl):2371-2490.

10. Dagnelie PC, Schuurman AG, Goldbohm RA, Van den Brandt PA. Diet, anthropometric measures and prostate cancer risk: a review of
prospective cohort and intervention studies. BJU Int. 2004;93(8):1139-1150.   

11. Pienta KJ, Esper PS. Risk factors for prostate cancer. Ann Intern Med. 1993;118(10):793-803.

12. Kolonel LN, Altshuler D, Henderson BE. The multiethnic cohort study: exploring genes, lifestyle and cancer risk. Nat Rev Cancer.
2004;4(7):519-527.

13. Kolonel LN. Fat, meat, and prostate cancer. Epidemiol Rev. 2001;23(1):72-81.

14. Wolk A. Diet, lifestyle and risk of prostate cancer. Acta Oncol. 2005;44(3):277-281.   

15. Wilson KM, Giovannucci EL, Mucci LA. Lifestyle and dietary factors in the prevention of lethal prostate cancer. Asian J Androl.
2012;14(3):365-374.   

16. Scardino PT. Early detection of prostate cancer. Urol Clin North Am. 1989;16(4):635-655.

17. Ferris-i-Tortajada J, Garcia-i-Castell J, Berbel-Tornero O, Ortega-Garcia JA. [Constitutional risk factors in prostate cancer]. Actas Urol Esp.
2011;35(5):282-288.

18. Sridhar G, Masho SW, Adera T, Ramakrishnan V, Roberts JD. Association between family history of prostate cancer. JMH. 2010;7:45-54.

19. Markozannes G, Tzoulaki I, Karli D, Evangelou E, Ntzani E, Gunter MJ, Norat T, et al. Diet, body size, physical activity and risk of prostate
cancer: An umbrella review of the evidence. Eur J Cancer. 2016;69:61-69.

20. el Attar TM, Lin HS. Effect of vitamin C and vitamin E on prostaglandin synthesis by fibroblasts and squamous carcinoma cells.
Prostaglandins Leukot Essent Fatty Acids. 1992;47(4):253-257.

21. Helzlsouer KJ, Huang HY, Alberg AJ, Hoffman S, Burke A, Norkus EP, Morris JS, et al. Association between alphatocopherol, gamma-

tocopherol, selenium, and subsequent prostate cancer. J Natl Cancer Inst. 2000;92(24):20182023. 23

Cervical cancer- Adeyemi Okunowo is a Consultant Gynaecologist at
Not a death the Lagos University Teaching Hospital and a
sentence lecturer at the College of Medicine of the University
of Lagos, Nigeria.

Introduction

Cancer is one of the leading causes of death and sickness worldwide. It is a non-communicable disease that does not
spread from one person to the other by direct or close contact. Cancer is simply the abnormal growth of cells in the body
without control that has the potential to spread from its native site to adjacent or distant sites. The cervix, on the other
hand, is the hollow and cylindrical part of the female genital tract that connects the womb (uterus) to the vagina. It is
called the “mouth of the womb.”

Cervical cancer is the cancer that EPIDEMIOLOGY ETIOLOGY
occurs in the cervix. It is the abnormal
growth of cells in the mouth of the Cervical cancer is a very preventable Cervical cancer has a known cause and
womb. There are two common types of and easily detectable disease, yet it is several factors that can increase
cervical cancer. The more common type the most common cancer of the female women’s chance of developing the
is the squamous cell carcinoma that genital tract worldwide. There is a cancer.
originates from squamous cells from the significant disparity in the burden of the Human papillomavirus (HPV) has been
outer part of the cervix called disease between high income countries identified as the “necessary cause” of
ectocervix and the less common type and low- and middle-income countries cervical cancer. This means that without
called adenocarcinoma which originates (LMIC) with LMIC have the lion share this infection, cervical cancer is unlikely
from glandular cells within the inner of the disease. More than three quarter to occur. HPV is a sexually acquired and
part of the cervix called endocervix. of all new cases (77.6%) and new transmissible infection that is quite
deaths (80.9%) that occurred in 2020 common in young girls and women. All
24 occurred in LMIC especially in Africa women would have one time or the
and Asia. In Nigeria, cervical cancer is other acquired this infection in their
the commonest genital tract lifetime. Luckily, this virus is easily
malignancy, followed by ovarian cancer cleared by the body’s natural immunity
and endometrial cancer. It is the second without causing any disease. If this fails,
most common cancer in women after cancer and other diseases can occur.
breast cancer and a leading cause of There are two main types of HPV, which
cancer related sicknesses (morbidities) are high risk HPV (hrHPV) and low risk
and deaths (mortalities). HPV (lrHPV). The lrHPV do not cause
cancer but may cause genital warts
especially serotype 6 & 11. The hrHPV,
also called oncogenic HPV has increased
risk of causing cancer. Only persistent
hrHPV infection can result into cancer.
The common hrHPV serotypes
associated with cervical cancer are
serotypes 16, 18, 31, 35, 39, 45, 51, 52,
56, 58, 66 & 68. Amongst these
serotype 16 & 18 accounts for 70% of
all the cervical cancer cases.

RISK FACTORS 25

These are factors that increase the
chances of exposure and repeated
exposures to HPV infection. These
include:

- Early sexual initiation (early
coitarche)
- Early marriage
- Early childbirth
- Having had 3 or more deliveries (high
parity)
- Having many children
- Having multiple sexual partners
- Having partners with multiple sexual
partners
- Polygamous family
- Promiscuity
- Presence of other sexual transmitted
infections such as chlamydia
trachomatis infection, herpes simplex 2

Cervical cancer is a
very preventable and
easily detectable disease

CO-FACTORS PREMALIGNANT DISEASE

These are factors that enhances the Cervical cancer has a long precancerous
persistence of HPV infection and its phase that can last between 10 – 15
oncogenic potential by impairing body’s years before invasive cancer develops.
immune response to fight the virus or This precancerous phase is called
promoting the process of cancer cervical intraepithelial neoplasia (CIN).
development (oncogenesis). These There are 3 different grades of CIN
include: which depends on the degree of
- Smoking involvement of the cervical epithelium.
- HIV/AIDS When only the basal one third of the
- Any form of immunosuppression cervical epithelial thickness is involved, it
- Prolong use of oral contraceptive pills is termed CIN I. If two third of the
(OCP) cervical epithelial thickness is involved, it
is termed CIN II. When more than two
third of the epithelium or the whole
epithelial thickness is involved without
invasion of the basal membrane, it is
termed CIN III. CIN I is regarded as
low-grade lesion while CIN II and III
are regarded as high-grade lesions.

26

CLINICAL FEATURES PREVENTION AND SCREENING

The common symptoms and signs of Primary prevention of cervical cancer is
cervical cancer include: by vaccination with HPV vaccine.
- Postcoital bleeding Vaccination is recommended for all girls
- Abnormal vaginal bleeding and young women between the ages of
- Foul smelling vaginal discharge 9 and 26 years before the initiation
- Vague lower abdominal pain sexual activity. Currently, there are 3
- Weight loss types of HPV vaccines available for use:
- Passage of urine or feces through - Cervarix, a bivalent vaccine which
the vagina protects against hrHPV 16 and 18 alone
- Difficulty in passing urine due to - Gardasil, a quadrivalent vaccine that
obstruction protect against two hrHPV serotypes
(16 and 18) and two lrHPV (6 and 11)
DIAGNOSIS - Gardasil 9, a nonavalent vaccine
protect against seven hrHPV serotype
Diagnosis of cervical cancer is based (16, 18, 31, 33, 45, 52, 58) and two lrHPV
on clinical suspicion followed by a serotypes (6 and 11)
thorough examination under Secondary prevention is by regular
anaesthesia, staging of the disease cervical cancer screening of sexually
and cervical biopsy for histological active women to detect and treat early
confirmation. precancerous lesions. The preferred
screening methods are:
TREATMENT - Primary HPV testing which is done
every 5 years from the age of 25years
Treatment of cervical cancer is based - Cervical cytology (Pap smear or liquid
on the stage of the disease. Treatment based cytology) is done every 3 years
can either be surgical or chemo- from the age of 21 years.
radiation. Surgical therapy involves the - Combination of HPV & cervical
removal of the uterus with or without cytology (co-testing) every 5 years
the ovaries and the removal of the Others are visual inspection with acetic
tissues around the uterus and cervix acid (VIA) and visual inspection with
including the lymph nodes draining the Lugol’s iodine (VILI). When these tests
cervix and uterus. This type of surgery are abnormal, colposcopy and directed
is called radical hysterectomy and pelvic cervical biopsy is done to rule out high
lymphadenectomy. Radiotherapy cervical lesions.
treatment involves the use of external
beam radiation and brachytherapy. REFERENCES:
Other forms of treatment are targeted 1. Sung H, Ferlay J, Siegel RL, Laversanne
therapy and immunotherapy. If the M, Soerjomataram I, Jemal A, Bray F.
disease is confined to the cervix, Global cancer statistics 2020:
surgery is preferred. But if the disease GLOBOCAN estimates of incidence and
has spread beyond the cervix, chemo- mortality worldwide for 36 cancers in
radiation is given. 185 countries. CA Cancer J Clin. 2021.
doi: 10.3322/caac.21660
2. Cohen PA, Jhingran A, Oaknin A,
Denny L. Cervical cancer. Lancet 2019;
393: 169–82
3. Momenimovahed Z, Salehiniya H.
Incidence, mortality, and risk factors of
cervical cancer in the world. Biomed
Res Ther 2017, 4(12): 1795-1811 doi:
10.15419/bmrat.v4i12.386

27

HEALT

Sci

TH

iences

Much ado about COVID

19 vaccines Olumide Elebute is a Consultant Paediatric
Surgeon at the Lagos University Teaching
Hospital and a lecturer at the College of
Medicine of the University of Lagos, Nigeria.

IntroductionǬ

Following the outbreak of the new corona virus, the entire world scene has been dragged into a
box of uncertainty. With the current statistics estimating deaths from the pandemic at over 3
million and with no immediate reprieve in sight many governments around the world have tried
to mitigate its spread with effort geared at ensuring a seamless and widespread vaccine rollout,
all in a desperate bid to change the tide [1] Nigeria as a nation started at a slow pace in its battle.
The government-imposed lockdown measures six weeks after the first confirmed case in the
nation. At the time this decision was announced the country had 111 reported cases and one
death[2]. With an estimated 2000 deaths so far, much lower than what had been projected, and
with recent figures revealing a drastic reduction in infection rates, it is natural for one to think
that despite its widely perceived botched response, things have worked in its favour. The call for
celebration may be further fueled by the fact that Nigeria appears to have fared well when
compared to other populous third world countries like India and Brazil. These two have been the
worst hit among the comity of developing nations by the pandemic. The current second wave
has resulted in four times more deaths in India than did the first. Brazil on the other hand has its
health sector on the verge of total collapse. Its health crisis will no doubt be further
compounded by fears of its economy slipping into a recession.

30

Morbidity and mortality   In addition, in sharp contrast to the initial
outbreak where certain categories were tagged
vulnerable, notably the old and those with
comorbid medical conditions, the mutant strains
of the virus appear to be 'no respecter of
persons. This has given rise to growing fears that
this pandemic may spiral out of control and that
by the time the battle ends several million lives
would have been lost in its wake[5]. The current
COVID 19 closely parallels the Spanish flu
outbreak of 1914-1918. Involved a few crowds of
people snowballed to a magnitude never
witnessed in the history of humanity. It has been
estimated that between 50-100 million people
died at the end of the outbreak. Although the
H1N1 virus, the causative agent of the flu does
not fall within the same family of coronaviruses,
they do have some semblance with respect to
their symptomatology and mode of spread.  

Experts have attributed the low mortality rate in In a bid to curtail the spread of the viral flu,
Nigeria to its young population, that accounts for several measures such as social distancing and
over half its entire size and the prevalent use of closure of schools were imposed by many
BCG vaccine which confers some form of governments at that time. Sadly, many of these
immunity against certain viral infections[3] measures were not stringently enforced or were
Economic at the economic front, the fallout of flouted. The popularity of the automobile added
COVID pandemic has been devastating. The another dimension to the narrative, with many
lockdown measures led to the shrinking of the cross-border movements taking place in an
country's economy with its attendant unprecedented fashion serving as viable
depreciation in the value of its currency. Many channels of dissemination. No doubt all this
businesses went bankrupt and countless contributed to the rapid and devastating spread
numbers of its citizenry were added to the of the H1N1 virus.  
unemployment pool. The agricultural sector was
worse hit. Production levels plummeted and the Any Panacea? Ĕ
supply chain was severally disrupted[4] Health in
Nigeria as with other parts of the world the health The vaccine rollout that has been initiated by
sector received its own fair share of the impact of many countries is gradually picking up.
the ongoing pandemic. Although, the fatalities Although, not at the pace necessary to rapidly
have not been on the scale witnessed in many tilt the balance into the world's favour. The
other countries, the emergence of new variants apparent failure of some pharmaceutical
of the virus is becoming a source of concern for industries to deliver vaccine in tranches agreed
health authorities. These variants are far more has constituted a major setback in the ongoing
virulent than the serotype initially identified at the war. Unarguably, it is a race against time, as
start of COVID 19 outbreak and are more many lives that would have been saved would
infectious, meaning that they spread faster be lost if the much-needed vaccines are not
among the populace.   received in time. Nigeria's effort appears to be
yielding some fruit, with statistics revealing a
gradual decline in infected cases and fatalities.
But looking away from the home front the battle
is far from over. If other nations are in the wood
Nigeria cannot be out of the woods.
Precautionary steps must be put in place to
prevent an escalation in numbers of affected
cases. As the focus by most government of the
world is on getting a sizeable number of their
population vaccinated, Nigeria must toe the
same path and revamp its vaccination campaign
and target more than half to achieve herd
immunity. The entire nation must not rest on its
oars until it is clear to all that the battle is over
and won. It would be rather foolhardy for the
government to heave a sigh of relief when there
is fire just next door.  

31

References
1.https://en.m.wikipedia.org/wiki/Template:COVI
D-19_pandemic_data
2.https://www.aljazeera.com/economy/2020/3/
30/nigeria-announces-lockdown-of-major-
cities-to-curb-coronavirus
3.https://www.ncbi.nlm.nih.gov/pmc/articles/PM
C7608767/#
4.https://www.ncbi.nlm.nih.gov/pmc/articles/PM
C7550085/#
5.https://www.scientificamerican.com/article/ho
w-the-covid-19-pandemic-could-end1/

32

e Sage's

CORNER

CONTINUING Ope Adesanya is a Consultant
Paediatric Surgeon at the Federal
Medical Centre, Abeokuta, Ogun State.
Nigeria. He is a Fellow of the National
Postgraduate Medical College.

MEDICAL EDUCATION

A MUST FOR EVERY DOCTOR

Learning continues from the cradle to the grave, so
goes a popular aphorism amongst veterans in the
medical profession. This understanding is the basis on
which Continuing Medical Education (CME) was
established. The concept of CME, however, has
undergone enormous changes in recent years in terms
of its theoretical base, the methodologies used, and the
expectations of what it should deliver[1]. It has
become an increasingly important concern for
governments and health practice regulators, and by
extension of immense importance to practitioners as
well as the end users-the patients.
According to Wikipedia, continuing medical
education (CME) refers to a specific form of
professional training that helps practitioners in
the medical field maintain competence and learn about
new and developing areas of their field [2]. These
activities may take place as live events, written
publications, online programs, audio, video, or other
electronic media. Content for these programs is
developed, reviewed, and delivered by faculty who are
experts in their clinical areas. Contemporary workers
like Davis have defined continuing medical education
more simply as “any and all the ways by which doctors
learn after the formal completion of their training”[1].
While the terms “Continuing Medical Education” (CME)
and “Continuing Professional Development” (CPD) are
often used interchangeably in the literature, medical
education researchers see different emphasis in the
two terms with a general preference for the latter over
the former[1]. Continuing Medical Education is seen as
representing a more teacher-based, didactic style
whereas continuing professional development implies a
more learner-centred and self-directed approach to
learning. In this article, we will refer to all postgraduate
educational events as continuing medical education.

34

Continuing medical education has existed from the "Learning continues
beginning of institutionalized medical instruction in from the cradle to
medical colleges and teaching hospitals. Grand rounds, the grave..."
case discussions, and journal review meetings are
examples of such initiatives that sought to inculcate a
culture of continual learning among medical
professionals. In the 1950s through to the 1980s, CME
became more organized with increasing funding by the
pharmaceutical industry[2.] This however led to
concerns being raised about informational bias (both
intentional and unintentional) in the content of these
sponsored CMEs. Certifying agencies such as the
Society for Academic Continuing Medical Education, an
umbrella organization representing medical associations
and bodies of academic medicine from the United
States, Canada, Great Britain, and Europe were
subsequently set up to serve as watchdogs in the
rapidly developing sector. continuing medical
education.

Continuing Medical Education has existed from the
beginning of institutionalized medical instruction in
medical colleges and teaching hospitals. Grand rounds,
case discussions, and journal review meetings are
examples of such initiatives that sought to inculcate a
culture of continual learning among medical
professionals. From the 1950s through to the 1980s,
CME became more organized with increasing funding
by the pharmaceutical industry [2]. This however led to
concerns being raised about informational bias (both
intentional and unintentional) in the content of these
sponsored CMEs. Certifying agencies such as the
Society for Academic Continuing Medical Education, an
umbrella organization representing medical associations
and bodies of academic medicine from the United
States, Canada, Great Britain, and Europe were
subsequently set up to serve as watchdogs in the
rapidly developing sector.

Global perspective

There is a global consensus among international
medical associations on the need for continuing
medical education among health professionals. In the
United States, individual states mandate completion of
periodic CME for medical professionals to maintain their
licenses [2].
In Europe, participation in CME programmes is
voluntary, but both the European Union of Medical
Specialists and the Standing Committee of European
Doctors have adopted charters that state that doctors
have an ethical obligation or duty to undertake further
education [3]. The European Union of General
Practitioners, “recognising that moral responsibility
alone is insufficient,” has suggested that doctors should
be given incentives to participate in CME activities4.

35

Nigerian Perspective

In Nigeria, The Medical and Dental Council of Nigeria
(MDCN) regulates CME for medical and dental
practitioners. CME attendance has been made one of
the major requirements for the renewal of the annual
practising licence5. This directive is in the exercise of
MDCN’s powers as the regulatory body for the practice
of Medicine, Dentistry and Alternative Medicine in
Nigeria, as established by an Act of Parliament in 1963,
now Cap M8, Laws of the Federation of Nigeria, 2004.
In July 2007, MDCN approved the Continuing
Professional Development (CPD) Programme, to
improve, renew and update the skills and ability of all
doctors to ensure that appropriate and high-quality
health services are being rendered to patients. A
curriculum for the CPD programme was also drawn up
at the inception of the program. It covers Basic Medical
and Dental Sciences as well as Clinical Sciences,
Management and Administration, Cost and Management
Accounting, Ethics and Law, Information Technology,
E-Learning and Telemedicine.
CPD activities in Nigeria are centrally regulated by the
Education Committee of the MDCN. They set standards
of CPD programmes for all stakeholders and accredit
the Providers/programmes. Since its inception, several
institutions and organizations have been authorized to
organize Continuing Professional Development
programmes. They include Medical and Dental Training
Institutions, Teaching and Specialist Hospitals, State
General Hospitals., Private Hospitals, postgraduate
medical colleges, medical unions/associations as well
as accredited Overseas Professional Societies and
Institutions.
Each practitioner is expected to obtain a minimum of
20 units annually and a total of 40 units for biannual
license renewal. A credit unit is equivalent to one (1)
contact hour on any subject under-qualified, approved
tutelage. The provider of such a service is expected to
plan and deliver maximally useable knowledge or
information on the subject matter within one hour of
engagement. This may be in the form of a didactic
lecture, tutorial, grand/ward round, clinical meeting,
seminar, skills acquisition, practical sessions, and
workshops. For a practical class or hands-on skills
training, it is recommended that a 2-hour engagement
should constitute one credit unit. In all, the program or
subject matter should be appealing, oriented and
delivered in a friendly atmosphere to encourage
users/recipient's participation.

36

The MDCN has the overall and oversight responsibility
of ensuring high-quality CPD programmes. It ensures
adherence to the regulations governing the CPD
programme by CPD Providers. MDCN has set up zonal
CPD accrediting units for this purpose. The accredited
CPD Providers are expected to install internal
mechanisms to monitor and evaluate their activities to
ensure sustained quality, acceptability, relevance, and
continued improvement of their
programs. Consideration is also made for physicians
who may have attended international conferences and
seminars. These are assessed by MDCN and
appropriate credit units awarded. Doctors and dentists
who are 70 years and above are exempted from the
mandatory credit unit accumulation. Those afflicted by
debilitating ill-health for up to six months are also
exempted from accumulating CPD credit unit if they
show evidence of ill-health during that period. Resident
doctors in formal professional training were also
excluded from this requirement.

BENEFITS OF CONTINUING MEDICAL
EDUCATION

British researchers- Cantillon and Jones, in a systematic
review of the medical education literature found that
continuing medical education improves clinical
performance and patient outcomes [1]. According to
their findings, the most effective methods of continued
medical education include learning linked to clinical
practice, interactive educational meetings, outreach
events, and strategies that involve multiple educational
interventions (for example, outreach plus reminders).
They also found that the least effective methods are
also the most used in general practice continuing
medical education—namely, lecture format teaching and
unsolicited printed material (including clinical
guidelines). These findings are like findings from a
Cochrane review on the effects of CME meetings and
workshops on professional practice and health care
outcomes [6].
Locally, Adewole et al [7] in an analysis of self-
reported training needs of physicians at a tertiary
institution in Ibadan found that concerning training
needs and capacity development, research/audit skills
had the highest need (0.83). Furthermore, training that
enhances managerial/supervisory skills had a rating of
0.68. Clinical tasks and administration tasks have the
same rating (0.63), whereas communication/teamwork
had the lowest rating. Consultants expressed higher
training needs compared with resident doctors across
all task domains. They recommended that future CPD
training should reflect the critical needs for
performance improvement, of the end-users – the
physicians.

37

In conclusion, CME is a moral and ethical obligation for
health professionals especially physicians as leaders of
the health team. Health organizations and institutions
should provide incentives, adequate funding, and
protected time for CME activities. Professional and
regulatory bodies should enforce participation and
where necessary impose sanctions so that the goal of
ensuring that physicians are always up to date and
ready for the next professional responsibility is attained.

CME is a moral and
ethical obligation for
health professionals

38

REFERENCES

Cantillon P, Jones R. Does continuing medical education in general practice
make a difference?. BMJ. 1999;318(7193):1276-1279.
doi:10.1136/bmj.318.7193.1276
Wikipedia contributors. Continuing medical education. Wikipedia, The Free
Encyclopedia. December 8, 2020, 15:25 UTC. Available
at: https://en.wikipedia.org/w/index.php?
title=Continuing_medical_education&oldid=993053277. Accessed April 15,
2021.
Holm HA. Quality issues in continuing medical education. BMJ.
1998;316(7131):621-624. doi:10.1136/bmj.316.7131.621
European Union of General Practitioners (UEMO). Declaration on Continuing
Medical Education. In: European Union of General Practitioners reference
book 1995/96. London: Kensington Publications, 1996.
How to be accredited MDCN CPD provider https://www.mdcn.gov.ng/sub-
page/education/how-to-be-mdcn-accredited-cpd-provider. Accessed
April 15, 2021.
Forsetlund L, Bjørndal A, Rashidian A, et al. Continuing education meetings
and workshops: effects on professional practice and health care
outcomes. Cochrane Database Syst Rev. 2009;2009(2):CD003030. Published
2009 Apr 15. doi:10.1002/14651858.CD003030.pub2
Adewola DA, Adeniji FI, Makanjuola AV. Self-reported training needs among
physicians ina tertiary institution, Southwest, Nigeria: An application of
hennessy-hicks training needs assessment tool. Niger J Med 2020;29:396-
400

39

Youn
Shal
Grow



Tips on passing

Surgery Primaries Nzemeke J. Chukwuemeke is a
Exam PGY 3 Surgical Resident at the
Lagos University Teaching
Hospital, Lagos, Nigeria

1. Have at least

Haven written and passed several medical a Mentor:
school exams, in April 2016, I applied for the
West African College of Surgeons primaries Having a mentor gives a great
exams. For the first time, I drank from the cup motivating mental boost. The
of failure. I failed my first attempt at the drive to achieve what your mentor
primary's exams. It felt terrible, but I had to has achieved, keeps you going,
learn my lessons which were especially useful even when circumstances aren’t
in the next exams. encouraging.

Six months later, I re-sat the exam, and A mentor has experienced the
finally, I passed. Although, I would attribute current challenges you are having
my passing to the ‘God Factor’ but ‘wisdom and can be guide to the easiest
was profitable to direct.’ ways to handle those challenges.
Remember the saying-
I will share in his article some of the “experience is the best teacher”?
mistakes I made in the first exam, and But you must also know that the
workable solutions that were useful in the experience must not always be
second exam. These mistakes may also your personal experience, your
handle many failing same exams. mentors’ experiences, can also be
of great learning value.

42

"Having a mentor gives a great
motivational mental boost."

2. Have complete 3. Try to
knowledge of understand that
what to expect:    the exam will be
testing:
Knowledge of the pattern of the exams,
timing/ duration of exams, number of Is the exam testing mental recall?
questions and if possible, familiar challenges
noticed during most exams by people who Is it testing the application of principles
have passed earlier exams. learnt (clinical essay)?

It’s important for this information to be Is it testing speed?
recent. You could find out these from those
who wrote the last 2 exams prior. Also, note You need to know all these and prepare
that some of the challenges may be venue accordingly before the exam.
specific.
4. Read the
Let me share my experience on this. In my recommended
first exam, I have gotten information from a books from those
senior, which wrote his primaries exams 11 who have passed
years prior. He described that the exam the exams:
was in 2 sections- paper 1 (anatomy), paper
2 (physiology, pathology, surgery principles Although there is usually an inexhaustible list
all put together in small ratios). of recommended books by the exam board,
it may not be possible to read all of them
When I got to the exams, the first paper before the exams.
was truly anatomy as he had said, but as I
was going in for the second paper, I was This is where you need the guidance of 43
told by a colleague it was physiology; and those who just passed the exams lately on
the last paper was pathology. I was shocked the best and fewest materials to read.
by this news and coming this late.

I later got to find out the pattern of the
exam had been changed long ago. Aside
from not being prepared for what was to
come, the late news was mentality crippling.

"Write down questions you can
remember and within the first
72hrs post-exam..."

5. Do a post exam Conclusively, I cannot exhaust all I did to
mental recall: pass my second WACS exam, but during
my second attempt at the exams, it
Write down questions you can seemed I had seen most of the questions
remember, and within the first 72hrs previously.   
post-exam, check every question you Well, Thank God! I Passed!! You are next!!!
remember, to store answers into your
long-term memory.

I have always followed this principle, not
really because I see myself rewriting the
exam, but because it is expected I have
known most of the answers to the
questions at that level and future
examinations will build on precepts in
earlier exams. If I am not confident of
answers to today’s questions, I may be
embarrassed if asked these same
questions later and fail to get them.

44

45

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