. Awareness is dogged by procrastination, fear and denial –Prof Okoye
. ‘Developing countries have limited healthcare resources to diagnose breast cancer’

Breast cancer is the most common type of cancer in women. It is the leading cause of death of women from cancer in Nigeria, and all women are said to be at risk of having it. Isioma Madike, who has been following this trend, reports

For Ngozi, fear was the worst part of cancer. Her mother had breast cancer and a mastectomy. Her sister also had breast cancer but decided against chemotherapy or radiation. She was the third in the roll.

Her mother was diagnosed with breast cancer at the age of 64. When she first noticed a lump in her breast, she was assured it was “just a fatty lump” and that she had nothing to worry about. But that was not the case.

The lump quickly escalated to Stage 1 breast cancer. At the time it was found in her lymph nodes, it had graduated to Stage 2. After her surgery, it was found out that her cancer was more advanced than initially thought, and that’s when she was actually diagnosed with Stage 3. That was the day her life changed forever.

Unfortunately, she didn’t survive it. She died after struggling with the condition for about two years. Ngozi, who spoke with this reporter, refused to give the name of her mother and her elder sister. Her decision was understandable; both died of breast cancer. But, unlike her mother and sister, she survived it.

She said: “It was a harrowing experience I’d never forget in my life. I lost my mum to breast cancer when I was young; I was only 15 when she died. Because I was so young, I have some memories of her but not a lot.

“The most vivid are the ones when she wasn’t well. I remember visiting her in the hospital and she just seemed sad. She obviously knew she wasn’t going to be here much longer, but I was ignorant of her circumstances.

“Now I realise she was being strong for us. I can’t imagine having to leave your children behind, looking in their eyes knowing they’ll have to deal with the loss. A mother’s instinct is to protect their children, so to think of my mum being in that position, breaks my heart.

“I was sad and angry for a long time. At that time, I didn’t know much about cancer, just that it made her very sick. I was angry at the nurses and doctors for years because I didn’t understand how she could be given the all-clear then and be told it had come back again.

“I genuinely thought they had missed something, but I guess I was looking for someone to blame and direct my anger at. It wasn’t until I started reading about breast cancer that I realised it wasn’t their fault, it just happened.

“Years later, I found myself in a similar situation, but, I thank God I survived it. We were encouraged to be going for a routine check in the hospital after her death. It was one of such visits that the doctor told me there was a lump in my breast. The first thing I said to the doctor was, ‘that’s what killed my mum.’

“In that instant I believed I was going to die just like she had. I cried loudly for a while, while the doctor sat patiently waiting for me to digest what I had just been told. I then looked at my father, who had tears in his eyes and my heart broke for him.

“I had surgery to remove the tumour. Almost immediately, I began a course of six chemotherapy sessions, which meant my hair started to fall off. My father shaved it for me as it was too upsetting watching it come away while taking a shower. I had my mastectomy and reconstruction. By this time, I was tired and was at my lowest, but the end was in sight.

“During treatment, I mainly read books. I also spent a lot of my time researching everything as I wanted to know all the facts and understand fully what was going on. I would visit my work from time to time as I didn’t want to lose contact with everyone, and figured it would help me when I came back if I stayed in contact.”

She added: “I went into fight mode for many months until after my double mastectomy when they told me all of the cancer had been removed. I cried with relief. I finally had hope after months of surgeries, chemo, losing my hair and daily radiation.

“I started hormone therapy and began to rebuild my life as I moved further away from my diagnosis. It was a struggle to get back into the rhythm of things because so much had changed after treatment. It felt like life came to a crashing halt when I was diagnosed, and the trauma of the journey took its toll on aspects of my life like my work and my marriage.

“Today, I savour every moment, cherish the things that money can’t buy, and I love my friends and family that much harder. I feel blessed to have experienced the generosity of strangers, the kindness of friends and loved ones, and the passion of others to want to help in times of crisis.

“Cancer changes you forever. Most times I find myself grateful that I can see the life lessons that facing down cancer have taught me. It has made my heart bigger, more open to receiving and accepting love from others.”

This narration breaks hearts even though many are still going through it. Some are ignorant of the disease until it advances to a stage it can no longer be managed. Little wonder many dread it as it remains the leading cause of cancer deaths in women in Nigeria and globally.

It has become, over the years, a major health problem in the country, according to medical experts. All women, they say, are at risk of getting breast cancer.

It is also a global phenomenon as women die from the disease every 68 seconds around the world, according to available data. Statistics quoted by experts equally suggest that the chances of a woman getting breast cancer in her lifetime is about 1 in 7 (globally) and 1 in 29 in Nigeria. This picture makes cancer most dreadful to women around the world.

A professor of Radiology and Director, University of Nigeria Centre for Clinical Trials, College of Medicine (UNTH), Ifeoma Okoye, quoting statistics, told this reporter that about 350,000 – 500,000 women are diagnosed with breast cancer in Nigeria annually, and that 83-87 per cent of them come in at “late stages”, increasing death by 70 per cent.

Quoting Dr Blaylock, Newsmax medical editor of The Blaylock Wellness Report, the cancer specialist also said, “All these deaths should not have happened, if women are given more information.”

Breast cancer, she however noted, can be treated successfully, but the chances for successful treatment, she added, are highest when the cancer is found early.

Okoye said: “The awareness level of Nigerian women to breast cancer ‘best practices’ is very low, even this is dogged by procrastination, fear, denial (‘It is not my portion syndrome’), socio-economic, and superstitious/cultural restraints.

“This has given rise to the ‘crisis of this scourge in our environment’, more than 83-87% of the affected women present late, incurring unaffordable bills of N150,000 -N350,000 every three weeks on drug treatment.

“This is followed closely by rapid deterioration and death, with resultant high morbidity and mortality in young and middle age groups when they are most productive in contributing to the socio-economic development of our nation.

“Late presentation of breast/cervical and other cancers will continue to increase in Nigeria, unless we do something more proactive than we have been doing in the past.

“These are distressing statistics, given the fact that over one third of cancer deaths result from potentially preventable causes.

“Much of the suffering and death from cancer could be prevented by more systematic efforts to reduce viral infections, poor nutrition, physical inactivity, obesity, widespread tobacco use, expanding the use of vaccinations and screening tests.”

Dr Elima Jedy-Agba, an epidemiologist with a strong background in Cancer Epidemiology and Population Health, also noted that when breast cancer is detected and treated early, the chances of survival are very high.

She, however, said that women in many settings face complex barriers to early detection, including social, economic, geographic, and other interrelated factors, which can limit their access to timely, affordable, and effective breast health care services.

Developing countries, she also said, have limited healthcare resources and use different strategies to diagnose breast cancer. Most of the population, according to her, depends on the public healthcare system, which affects the diagnosis of the tumor.

Thus, the indicators observed in developed countries cannot be directly compared with those observed in developing countries because the healthcare infrastructure in developing countries is deficient.

The Breast Health Global Initiative (BHGI) had developed resource-stratified guidelines for the early detection and diagnosis of breast cancer.

In their consensus article from the sixth BHGI Global Summit held in October 2018, the authors described phases of early detection programme development, beginning with management strategies required for the diagnosis of clinically detectable disease.

Theirs was based on awareness education and technical training, history and physical examination, and accurate tissue diagnosis.

Breast cancer is a potentially dangerous or malignant tumor that develops from a cell of the breast. The disease occurs mostly in women, but men can get it as well.

Unfortunately in the early stages of pre-cancer and cancers, no symptoms are present; the individual would not feel that anything is wrong. It is at that point that screening becomes necessary.

Early detection

Professor Okoye noted that early detection of breast cancer starts when an individual, well, hale and hearty, takes the decision to diligently practice and participate in actions and tests that reveal something in her body that might be a sign that she may be harbouring breast cancer cells in her body.

“You will not see these signs ordinarily if you do not search for them. If you don’t know they are there, the breast cancer cells will grow and grow secretly in you, till one day, it will rear its ugly head through: ugly disfiguring disease of the breast, pain, bleeding and loss of weight.

“So, refusing to search for the early warning signs because of fear will not stop what is already in your body from growing and eventually becoming a threat to your life. So, lose your fear and take action today,” she advised.

Breast Self-examination (BSE)

. BSE is to be done every month by every female that has a breast (for breast cancer, although rare in children, have been found in 8, 14, and less than 25 years olds).

. A woman that is still having her periods (menstruation) should perform the BSE from days 8-12 after her period has stopped.

. If a woman is already menopausal (if she has stopped seeing her period because of age), should choose and perform the BSE on the same day every month.

NOTE: As most people don’t remember to do this monthly exercise, it is advised to pick a partner (your husband, friend, sister, and colleague) who will remind you to perform the examination monthly (This is called picking a Buddy or Buddy-Check 2).

Clinical Breast Exam (CBE)

A clinical breast exam (CBE) is an exam of the breast by a health care professional, such as a doctor, or nurse and should be performed once a year from age 20.

The CBE is a good time for women who don’t know how to examine their breasts to learn the proper technique from their healthcare professionals. They should ask their doctors or nurses to teach them and watch their techniques.

Risk that one can control

.Drinking alcohol

. Smoking and inhaling secondary smoke

. Leading sedentary lifestyle (physical inactivity)

.Being obese or overweight, especially belly fat

. 1st pregnancy ending in an abortion

. Old age at 1st birth or never having or giving birth at all

. First full time pregnancy after age 30

. Radiation before puberty

. Prolonged exposure to female reproductive hormones-oral contraceptive and hormone replacement therapy

. Wrong diet

. John Hopkins study found that cancer is also a disease of the mind, body and spirit and thus cancer cells can be fueled by emotional stress like anger, unforgiveness and bitterness

Risk that one cannot control

. Swelling of one arm (next to the breast)

. Weight loss

When to contact a medical professional

. When a woman has breast or armpit lump

. When a woman age 40 or over has not had a mammogram in the last year

. When a woman age 25, 30 or older and has a mother or sister with breast cancer, or has already had cancer of the breast, uterus, ovary, or colon

. When a woman does not know how or need learning on how to perform breast self-examination.

Mammogram

A mammogram is a low-dose X-ray of breast tissue. Healthcare providers use mammograms, or mammography, to look for early signs of breast cancer before symptoms develop. This is called a screening mammogram.

Source: Prof Ifeoma Okoye

Origin

The origin of the word cancer is credited to the Greek through physician Hippocrates (460-370 BC), who is considered the “Father of Medicine.”

Hippocrates used the term carcinos to describe non-ulcer forming and ulcer-forming tumors. In Greek, these words refer to a crab, most likely applied to the disease because the finger-like spreading projections from a cancer called to mind the shape of a crab.