African Researchers Magazine Interview with Dr. Kenneth ATOE. Speaking on his recently published research work titled “Assessing the utility of a Cytokine in the diagnosis of Cervical Intraepithelial Neoplasm (CIN) among women in Benin City, Nigeria”.
It’s my pleasure to be with you guys this afternoon. I am Dr. Atoe Kenneth. I am a Consultant, Chemical Pathologist and a Metabolic Physician. A fellow of the National Post Graduate Medical College of Nigeria, and am also a member of the West Africa College of Physicians. Currently I am a Senior Lecturer and Head of Chemical Pathology Department, Edo university Iyamho, in the Faculty of Clinical Sciences, College of Medicine and, I am also an Honorary Consultant to Edo Specialist Hospital, where I run the Metabolic Clinic and, most of the patients, I see here are diabetic patients, and a few patients that have thyroid disorders and adrenaline insufficiencies. I am not just a Chemical Pathologist, I have some Biochemistry background, because I started my career as a Biochemist. I had my first degree in Biochemistry with a second-class upper division. Thereafter, I did a Master’s Degree in Biochemistry from the University of Benin. During my fellowship training as a resident in University of Benin Teaching Hospital, I did my post graduate thesis in Preeclampsia and I got so much interested in Preeclampsia, so I had to replicated the models in animals. I am currently at the terminal phase of the completion of the project work for a PhD degree in Phytomedicine.
Thank you, sir you are welcome to Africa Researcher Magazine, we are here because you recently published a work titled, “Assessing the utility of cytokine in the diagnosis of Cervical Intraepithelial Neoplasm among women in Benin City Nigeria”, in the Africa journal of Health safety and Environment. Can you throw more light on that research?
Yes, I told you that I am a Chemical Pathologist, and as a chemical pathologist, one of my area of interest is in Hormones and Enzymes. And we know that some hormones and enzymes, have roles that they play as “Early Markers” in marking diagnosis of some disease condition. It will interest us to know that it is better-off to pick a disease condition in its early onset, than when the disease is fully established, because it will make management and control of the disease process easier and for better prognosis. So, as a metabolic physician and chemical pathologist, I’m interested in the use of “Biochemical Markers” or we can also call them “Tumor Markers”, are anilides that we can use in identifying the early onset of the presence of a tumor a disease condition, a malignant disease condition properly referred to as Cancers. And for us; we are doing our best to see how we can identify tumor markers, that will help is in the diagnosis and thereafter, help us in better assessing and managing our patients promptly and adequately. And so, I just thought about it and felt that cervical intraepithelial neoplasm is really not a full-blown cancer, it’s a premalignant state. Before women have the full-blown cancer of the cervix, there’s a pre-cancerous state, and if we are able to catch the women in this pre-cancerous state, the prognosis or management is better than someone with a full-blown cervical cancer, is a bit more difficult and challenging managing such malignance. So, it is better-off if we should catch them in the premalignant state, as for cervical cancer, the premalignant state is the CIN popularly known as the “Cervical Intraepithelial Neoplasm” and I was just thinking that apart from the traditional routine way of checking the women by using “Pap smear” to look at the cells and characterize it if the women actually have CIN or not, that we can look for tumor markers that can do the job better off for us. So, I started thinking about it, and after a while I just felt that; let me see if we can identify any of these cytokines that will be able to help us diagnose the presence of Cervical Intraepithelial Neoplasm among women that are at risk early enough even better off than the traditional routine Pap smear, so that was what brought the concept of the entire research.
Thank you very much and that is a very elucidative explanation you gave there. In your work that you published, while citing Pesani et. al., you mentioned that cervical cancer is most common in women in the sub-Saharan Africa, why is that?
Yes, it’s very common here maybe because, (probably because,) of the lifestyle, because our lifestyle most times places us at risk. The commonest risk factor for cervical cancer is the Human papillomavirus (HP) virus, and the virus most times is transmitted sexually. It’s an STI; sexually transmitted infection. And because of our lifestyle here, multiple sexual partners, it will also propagate the spread of the virus among sexually active women within the reproductive age. So, that’s basically what places them at risk, other risk factors will include OCPs, smoking which is a non-specific risk factor, I used the word non-specific, because smoking generally is a risk factor for all kinds of malignancies not just for cervical cancer alone, smoking is specific for virtually almost all cancer because of the Carcinogen in the cigarette itself, so basically I think that’s what place us more at risk of this of this Cervical Intraepithelial Neoplasm which is a premalignant state for the cancer of the cervix.
Thank you very much, at this point can you give us a little detail regarding the methodology on how the research was carried out.
Yes, it was very cumbersome, it took a period of time to be able to get enough patients to be able to it carry out, let me use the word participate, because we also have some control subjects that were negative for the cervical intraepithelial neoplasm. It took us about fifteen (15) to sixteen (16) months, of sample collection, the whole journey started around 2017, one of our senior resident doctors in Department of Osteitis and Gynecology, Dr. Simba Peter, she was very useful in identifying the subjects and collecting the sample for the Pap smear. And most of the patient we collected samples from, where from the University of Benin Teaching Hospital (UBTH), the gynecology coupled with the O&G clinic and a few patients came from the general practice clinic in UBTH and somewhere also referred from the CDC (Center for disease control) in University of Benin Teaching Hospital, probably a few referrals that came from private clinics in town that came to University of Benin, O&G department. So, we were able to collect our samples there and for the Pap smear, Dr. Dike Mekorma, was a senior registrar, Histopathology Department, University of Benin. He took he’s time to look at the Pap smear and he was able to help in characterizing the various histological stage of the Pap smears, so that was how we were able to identify the various stages of CIN stage 1 which is the low grade, stage 2 and stage 3 so, he did a wonderful job there. Blood samples were collected from these participants and as a chemical pathologist, I did the immunoassay myself and it was done in the Metabolic Research Unit, the Central Laboratory in Edo University, Iyamho. It was an Enzyme linked immuno-solvent assay, as a matter of fact, it was a heterogeneous immuno-solvent assay. So, I did the immunoassay myself and we were able to come out with the data. When we finished, coming out with the data, Professor Beckley IKHAJIAGBE, associate professor in University of Benin. He did the statistical analysis and we were tried to look at the possibility of, (…) because we did a diagnostic statistic on the data that were generated, we tried to look at specificity and sensitivity, because that is what will eventually help us to see if this cytokine has the capacity to be able to serve as a very good diagnostic tool for the identification or early identification of the patient that has this cervical intraepithelial neoplasm. So, we had a lot of help, it wasn’t a one man show, because of course there is no way one man will be able to do this kind of research, if one man has come up and said he did it all alone by himself, you know that there is element of fraud in it. So, we had a lot of support, a lot of help from different sources. Dr. Richard Emagbie in the Department of Anatomy, University of Benin, was very instrumental in helping to get the Elisa kit, the immunoassays kit he brought was very instrumental, of course those kits are not cheap they are quite expensive. But he went all the way out to be able to source for the kits and made them available for us to do the assays. I must also recognize the likes of Dr. Ayinowa Ekiye, Dr Sapka, they took their time to go through the manuscript and made significant inputs and corrections, that was how we were able to come out with the quality of paper like that. I will use the opportunity to advise young researchers and other researchers that, if you really want to do a good/quality work, it should not really be a one man show, I know the concern is that; they don’t want too many people involved in the name because, we want to get more points to ourselves, but everybody’s name may not necessarily be there you can recognize their contributions, but you need inputs from different people and with that, you’ll be able to come up with a very good research idea and manuscript at the end of the day.
Yes, thank you very much, we appreciate your time, at this point, can you tell us about the findings of this research in a lame man’s language?
Yes, like I said, our goal was to see if we can identify a tumor marker that will help us in early diagnosis of cervical intraepithelial neoplasm as against the traditional Pap smear that we’ve always done, but at the end of the day, when we finished the research work, we discovered that the specificity of the marker, the specificity of the cytokine was very OK, it was about over 95% to 97% specific. However, the sensitivity was just fairly on the average side, it is about fifty-something percent sensitive, so in concluding the work, we advise that we still cannot throw away the traditional way of screening for cervical cancer which is histological diagnosis. So, we still have to rely on the histological diagnosis, but however we can also use this one in collaboration, because the specificity is excellent, it will be able to exclude the true negative patients, so that is basically the summary of our findings.
Wow that’s very important and very interesting too. OK thank you so much. At this point, I’ll like to quote from your published work, where you stated that 30% of the participants with positive sign histological results where smokers compared to 13.2% in the control, and you went further to say this perhaps may point to smoking as being a risk factor for CIN although, there were significant number of smokers within those who were positive for CIN what does it mean can you throw more light on that.
Yes, like I said, when in the introductory aspect, when I was talking about risk factor of cervical intraepithelial neoplasm. I said; the major risk factor is the human papillomavirus however, I did mention about smoking as a risk factor, smoking is a non-specific risk factor because it is not always specific for cervical cancer. It’s a risk factor for all cancers, smoking has a carcinogen. And even the people that makes this cigarette, they always say in their adverts, that smokers are liable to death, so if you’re smoking, you’re smoking at your own discretion, but it doesn’t mean that everybody that smoke must have a cancer, there are quite a significant number of people that smoke and they smoked till death and they never came down with cancer, however smoking on its own is a risk factor for cancer. From the study population, we discovered that a more significant amount of smokers had cancer, compared to those that aren’t smoking in control, if we compare the control with those that have the disease condition, they were more smokers that had the disease condition than those that control that do not smoke. That still point to the fact that smoking as we have always said is a risk factor for any cancer. However, like we said; smoking is not the only risk factor, when somebody smokes, it doesn’t, like we said, is not the only risk factor for somebody to come down with a malignancy. There must be some other risk factors, there must be more than one risk factors. The person may be a smoker, may be a family history, the person may have risk of multiple sexual intercourse which also predisposes the patient to risk of being exposed to the human papillomavirus, so from our clinical experience, we have realized that people that have malignancies, or cancers, that have more than one risk factor.
Thank you, sir. Ok, how long did it take you to write the manuscript?
In the writing of the manuscript, we finished the bench work in 2019, within 6months, we put the manuscript together. Ok the manuscript took about 6months to write.
Was there any source of funding outside one of your colleagues funding the kits, were there funding from the Federal or State government?
No. The money came from our pocket, we didn’t get any help or support from anywhere.
Ok, as a follow-up questions to that, let’s assume there was funding, how could funding have helped this type of research?
Ok, if there was funding, I would have suggested that we also try other cytokines, because of course granulocyte, monocyte stimulating growth factor is not the only cytokine that would we have worked with, we would have tried many other cytokines, there are a lot of cytokines, many, so many cytokines, we have tumor necrotic factors, we have interleukins, different interleukins, there are so many cytokines. We would have decided to try a lot of these cytokines, and maybe in the course of trying these other cytokines, we may have identified a cytokine with very high specificity and also high sensitivity that would have just been a perfect ideal tumor marker for the diagnosis of cervical intraepithelial neoplasm, but because of the lack of funds, we didn’t want to take the risk of starting what we cannot finish, but if findings are available why not we can source for other cytokines and we begin to try until we able to identify a cytokine with high sensitivity and also high specificity.
That’s interesting, besides funding, what other challenges did you face while carrying out the research, were there other challenges
Beside funding, other challenges, well some patients were be a bit reluctant when you tell them that we want to take your blood sample for research purpose, they want to shy out. Some patients did not also give consent like that, that was why sample collection took us about almost sixteen (16) months, because some patients declined and you cannot really force them, because it’s their right to either agree to fill the questionnaire or not. Because before you, you cannot just carry a questionnaire and give to a patient, and say: “begin to fill”. You must explain to the patient and say what you want to do. At the end of the day, we’ll collect your blood sample, and say this is what we intend to do, and it will be at no cost, it’s not all patient that gives their consent, so sampling now took a little longer time than it would have been, so that was another challenge we were actually having, but at the end of the day, we were able to find our way out.
Lastly, thank you for your time, lastly what advise would you give to a young researcher who wants to do similar research, what are the key hallmarks that you can give out as an advice?
The quality of a research work is always better where there’s collaboration. I will always advice people to be good team player, you can’t do it alone, where you have your strength and your weaknesses may be another person’s strength, so you try to identify people, that will be able to complement you in research, once you’re able to do that, you’ll come together and work together, at the end of the day, you’ll be amazed at the quality of research publications that you’ll start turning out, you can’t do it alone, that’s just the truth. I’ve been doing publications for quite a number of times now, but I really don’t think that I have any paper that I’ve authored alone as a single author. I’ve always been enjoying collaboration from other colleagues. Although, in most of my papers, I can tell you that close to like 60-70% of my papers, I’m always the first author, because most of the research ideas I developed it, then I try to look for people that will buy in to it and we’ll work together as a team, but even at that, I have hardly worked alone, and when there is collaboration, I think the quality of research work will come out better.
Thank you for your time, and for sharing your experience with us it has been very insightful and very educative and informative, at this point, we want to thank you for being on Africa Researcher Magazine and we look forward to having you some other time when you come for with a new research or a new discovery.
Thank you so much, it’s my pleasure
Thank you, sir.
God bless you, I appreciate.
Thank you, sir.