BREAST CANCER IN NIGERIA: WHAT YOU NEED TO KNOW AND DO
( Highlight title & click to view photos)
By
Betty Anyanwu-Akeredolu
Founder/President
Breast Cancer Association of Nigeria (BRECAN)
Breast cancer is increasingly becoming the leading cause of death of Nigerian women. Whereas the deaths of prominent Nigerians make news headlines, countless unknown Nigerian women in their small corners are dying needlessly from this disease that the advances in medical research is proving survivable even curable.
Fig.1: Advanced breast cancer
Fig.2: Advanced breast cancer
Fig.3: Advanced breast cancer spreads Fig.4. Advanced breast cancer
to the head.
Late presentation due to ignorance is our main headache in the fight against breast cancer in Nigeria. Most often, breast cancer sign is a painless lump. A woman finds this painless lump and breast cancer does not cross her mind because “it is not her portion”. She carries on with her life until she begins to feel pain which is a sign of advanced breast cancer. The most annoying, so pervasive and deeply entrenched perception is the belief that breast cancer is caused by juju or spiritual attack which is largely responsible for the huge patronage to prayer houses.If you care to know, this false belief that you can pray away lump is sending many Nigerian women at the peak of their productive lives to the graves at an alarming rate. How else can one put it across for Nigerians to pay attention and reason? May be in capitals – YOU CANNOT PRAY AWAY BREAST CANCER! Not a single week passes by without a death due to this disease. It is frustrating to hear that even educated and high income women when diagnosed with breast cancer expect miracle healing when they ought to know better. I can understand an illiterate low income woman patronising the church after all miracle healing operates on “cure now and pay later with thanksgiving”. Tell me, how many have survived through that route? Nobody can tell as there are no population-based figures on incidence, mortality and survival rates of breast cancer in Nigeria because of our failure to recognize the importance of data in national planning. But what I know for sure is that the miracle way of dealing with breast cancer is a gamble that ends with a sad note. All end up in the hospital with 4th stage advanced breast cancer when little can be done. As a matter of fact, there is a thin lining separating faith and foolishness, and hopefully I am communicating! Until government, at all levels, deploys resources to raise awareness and create access to affordable treatment and care, Nigerian women will continue to die untimely from breast cancer due to ignorance.
Awareness is the entry point in the fight against breast cancer. It is important that you know what you are up against, that is, understanding the disease before you can make informed decision. For example, breast cancer is a disease that has a woman’s face, meaning, it predominantly affects women though men do have breast cancer but in relatively low percentage.
Fig 4: Locally advanced breast cancer Fig 5: A 60year old Nigerian Man with
in a 31 year old lady advanced right breast cancer
Several studies on breast cancer prevalence in Nigeria show that the age range of highest incidence is 26 to 45. The disease progresses with time, from stage 0 when only mammography machine can detect to stage 1 or early stage when your fingers can feel changes in your breasts then moves on to stages 2, 3 and culminating to stage 4 or advanced stage – the dreaded metastatic stage no woman should experience. It is this lack of understanding of the nature of the disease that is largely responsible for late presentation (at stages 3 and 4) with the resultant poor outcomes reported in hospitals nationwide.
WHAT IS BREAST CANCER?
Breast cancer occurs when a cell in the breast starts to divide without stopping but you are not aware. You are only aware of any changes when you feel a lump, hardening or thickening, discolouration of skin or see discharge from the nipples. These are signs that something has gone wrong inside your body and for a very long time. It is important to note that by the time a lump is large enough to feel, it may have been growing for as long as 10 years! I will equally add that not all breast changes are cancerous or life threatening like in the case of benign lump. But it is advisable to check out such changes with your doctor to ascertain the nature of the lump. However, all lumps are recommended removed!
BREAST CANCER DIAGNOSIS AND TREATMENT
Recent studies have shown that breast cancer is not one disease. Treatment is no longer one cap fits all. One person’s breast cancer diagnosis may be quite different form another’s. Because of the differences between breast cancers and between people, treatment can vary from person to person. Treatment/management of breast cancer more often than not takes this pathway: diagnosis including several tests, surgery (total removal of breast or mastectomy/ removal of lump or lumpectomy), chemotherapy, radiotherapy, adjuvant therapy or treatment to check recurrence and psycho-social support.
As a breast cancer survivor of 18 years and still counting, HOSPITAL is the place I will strongly recommend for breast cancer diagnosis and treatment, NOT PRAYER HOUSES, NOT HERBAL HOMES. As you begin to understand breast cancer and that the stage progresses with time, you will appreciate that any delay in going to a doctor is dangerous. As you move from one prayer house to another so is the upward mobility of your cancer cells from one stage to another. It follows that early presentation as soon you notice any unusual changes in your breasts does a lot of good as you may likely detect the disease at its early stage when chances of survival are highest. I must also emphasis that NOT all doctors can handle breast cancer, only the specialists can. So it follows that you do not go to hospital to see any doctor, YOU MUST SEE A BREAST DOCTOR OR AN ONCOLOGIST- a doctor that deals with cancer.
WHAT AFFECTS YOUR CHANCES OF GETTING BREAST CANCER?
Risk factors: A risk factor is anything that predisposes you to getting a disease. There are many risk factors linked to breast cancer. The two most common, being a woman ( therefore, every woman is at risk) and getting older, are beyond our control. But some things, like exercising, maintaining a healthy weight and limiting your alcohol intake, are within your power. However, as efforts in finding a cure and how not to get cancer in the first place continue, we have been made to understand, quoting @drdonsdizon, that “the steps we take today can lower our chances of getting cancer not prevent it”. My understanding is that, though, we may not be able wipe out breast cancer or cancer in general from the surface of the earth, it should not be beyond our control. People will get breast cancer but the enabling capacity brought about by the advances in medical research will prevent increasing number of patients from dying untimely.
Fig.7: a) Reduce your risk of breast cancer b)How to do BSE
SCREENING AND EARLY DETECTION
Regular screening tests (along with follow-up tests and treatment if diagnosed) reduce your chance of dying from breast cancer. After all, screening tests can find breast cancer early, when the chances of survival are highest. That’s why our organization Breast Cancer Association of Nigeria (BRECAN) strongly demands government to fund local programmes that provide screening tests (e.g mammography screening) in communities. So more people can have access to these valuable and important tools. But there are also things you can do to help improve your chances of early detection like Breast Self Examination (BSE).
Breast Self Examination (BSE): When other parts of your body look or feel different than they normally do, you notice. For example, if you see an unusual rash on your arm, or a boil or have a toothache, you’re likely to visit your doctor to check it out. The same should apply to any changes in your breasts.
WHAT CHANGES ARE YOU LOOKING/FEELING FOR?
- Lump, hard knot, thickening inside the breast or underarm area
- Swelling, warmth, redness or darkening of the breast
- Change in the size or shape of the breast
- Dimpling or puckering of skin
- Itchy, scaly sore or rash on the nipple
- Pulling in of your nipple or other parts of the breast
- Nipple discharge that starts suddenly
- New pain in one spot that does not go away
Knowledge and practice of Breast Self Examination (BSE) is very critical in an individual’s effort in fighting this disease. It is therefore imperative that every woman knows how to do BSE.
HOW TO DO BSE: Two steps- Looking in the mirror to be familiar with how your breasts look like including the shape of your nipples and Feeling with your three middle fingers to check for any lump.
WHEN TO DO BSE:
- Immediately after menstruation when breast swelling and pain are minimal
- Postmenopausal women: A day you can remember e.g. First day/Sunday of the month
OTHER TESTS TO DETECT BREAST CHANGES:
- Clinical Breast Examination: Done by a doctor or nurse
- Ultrasound: to examine lumps that women have already noticed, and quickly identify those who most urgently need treatment. Ultrasound works better than mammography in younger women below 40 years, and can help to distinguish cysts and other benign growths from lumps that need biopsies.
- Mammography: X-ray of the breast which can detect breast cancers before they are felt. Recommended for women from 40 years and above.
ROLES OF INDIVIDUAL/GROUPS IN THE FIGHT AGAINST BREAST CANCER.
- Join a breast cancer organisation or support group to raise the profile of the disease and advocate for changes in healthcare system. Eg: Lack of government funded awareness and screening programmes in communities, Inadequate infrastructure for cancer treatment, Cancer is not covered under NHIS etc
Fig .8:BRECAN delegates at the NBCC Annual Fig 9: 2012 Pink Oct (Jog for Life in Lagos)
Advocate Summit, Washington D.C, 2012
Fig.10: 2012 Pink Oct (Jog for Life in Ibadan) Fig.11: 2014 Pink Oct (Jog for Life in Ibadan)
Fig12: 2013 Pink Oct (BRECAN Choir) Fig.13: 2015 World Cancer Day in colab with
All Saints’ College, Ibadan
Fig.14: 2015World Cancer Day @ Maryland Fig.15: Participants @ 2015 World Cancer
Comp. Sec. School (MCSS) Lagos Day @ MCSS Lagos
ROLE OF GOVERNMENT:
- Urgent need to make breast cancer a national health priority and create access for treatment and care through policy.
- Adequate funding for sustained public education and provision of breast health care facilities- mammography and radiotherapy machines, subsidy on cancer drugs, training of cancer specialists etc
- Include cancer coverage under NHIS
- Cancer research policy
ROLE OF CORPORATE BODIES:
- Sponsoring of public enlightenment and screening programmes
Fig.16: Shoprite 1ry sponsor of Jog for Life Fig.17: Screening at Jog for Life
- Donation of equipment to hospitals
- Funding of research in tertiary institutions
SUMMARY/TAKE HOME MESSAGES:
- Every woman is at risk of breast cancer
- Breast cancer does not discriminate, it affects the rich and the poor
- Breast cancer is not infectious
- Breast cancer is not caused by juju or spiritual attack
- You cannot pray away breast cancer
- Becoming familiar with how your breasts look and feel like by doing BSE will enable you detect any unusual changes
- If you notice any unusual changes, go to hospital without delay and see a breast doctor or oncologist
- Awareness is the entry point in the fight against breast cancer
- Awareness saves lives
- Awareness needs money
- Identify your role
- Join in the fight
- Individual/Groups: Be part of various advocacy efforts in galvanising action against the disease in Nigeria
- Government: Make breast cancer a national health priority through policy formulation to fund research and create access to treatment and care
- Corporate: Identify with the fight against breast cancer through sponsorship of sustained public education and funding of research
