•140,000 people affected annually in Nigeria, with only 100 oncologists
By Ngozi Nwoke
Breast cancer is on rampage in Nigeria and even globally. It gives more concern to people in Nigeria due to the low chances of surviving the disease as a result of poor medical facilities. The high rate of mortality caused by breast cancer is attributed to late-stage presentation, cost, fear of stigmatisation, misdiagnosis, belief in spiritual healing and the patronage of traditional medicine, among others.
It is not only disturbing that the disease is on the rise but also disturbing that, despite awareness campaigns, sensitisation programmes and free breast screening by some organisations, including voluntary and religious groups to ensure that young ladies and women are well informed early enough, it still has not yielded the desired result. According to the World Health Organisation (WHO), breast cancer, especially in a low and middle-income countries (LMIC), including Nigeria, is the second leading cause of death in women, and the chance that women in their mid-30s to mid-40s are more likely to die of breast cancer is high.
The most terrifying side of the disease is that medical experts say there have been cases of breast cancer among female adolescents and young ladies between 16 and 24. Concerned Nigerians have called on medical doctors, social welfare organisations, caregivers and government agencies involved in healthcare services to take proactive measures to save the situation and stop this life-threatening disease from decimating young girls and women.
Speaking on the surge of this non-communicable disease, an oncologist, Great Ihemjika of Zion Specialist Hospital, Owerri, Imo State, said women develop breast cancer more often than men because their breast cells are constantly exposed to the female hormones estrogen and progesterone, which promote cell growth. He noted that breast cancer mainly affects women within the age bracket of 50, adding that people should make conscious efforts to note some of the changes taking place in their bodies or be aware of their family health history.
He said: “Breast cancer is the most common tumor in the world. Breast cancer mainly affects post-menopausal women over the age of 50, but it doesn’t spare men entirely, who represent around 1% of all cases of breast cancer.
“Despite years of research and major scientific progress, unfortunately, the disease can still be incurable at diagnosis, especially when detected late. The result of an excessive proliferation of cells caused by a series of genetic mutations, this type of cancer can develop in any breast tissue.
“Depending on its ability to spread inside the organism and attack organs and tissue far away from the point of origin, breast cancer can be: non-invasive (or in-situ) if it stays localized to the area of the breast where it originates, without spreading through the surrounding breast tissue.
“Invasive is when the neoplasm is able to migrate through the lymphatic system and blood and gradually compromise vital functions. The most common primary types are: lobules: milk-producing breast glands. Lactiferous ducts: the ducts that transport the milk from the lobule to the nipple.
“Depending on how advanced the disease is, breast cancer can be diagnosed at early stage, which is when the tumor remains localized in the breast or axillary lymph nodes, locally advanced stage, which is when the disease has spread to the nearby tissue and lymph nodes and metastatic stage, which is when the primary tumor has colonized other parts of the body organism, leading to secondary tumors locations.
“While the disease is much rarer among men than it is among women, men can nonetheless have it. The low number of diagnoses of this cancer among men statistically corresponds to a higher degree of aggressiveness among male patients.
“The growth of breast cancer tumors is influenced by hormones. Specifically, in many cases, estrogen and progesterone encourage the cancer to spread. We classify the disease according to the receptors on the tumor cells so we can understand how hormones affect individual cancer patients.
“If there are numerous receptors, the tumor may be treated with an endocrine therapy, which blocks the action of the hormones. Besides estrogen and progesterone receptors (ER and PR), human epidermal growth factor receptor 2 (HER2) also causes diseased cells to multiply in breast cancers.
“For example, locally advanced or metastatic breast cancer occurs in three subtypes are: HR+ HER2- (HR includes ER+ and PR+/-) Estrogen receptor-positive and human epidermal growth factor receptor 2-negative cancer. HER2+ (includes HR+ and HR-) Human epidermal growth factor receptor 2-positive cancer. Triple Negative(ER-, PR- and HER2-) Negative for all receptors.”
Stressing that breast cancer can be prevented, he said: “On its prevention, a healthy lifestyle reduces the likelihood of developing the disease. To ensure that the disease is diagnosed at an early stage, an annual breast examination by a specialist is highly recommended for all women over the age of 20. Women over 50 should also have a mammogram every two years.
“If anything unusual is found during the examination, there are usually follow-up investigations (second mammogram, ultrasound, medical appointment, biopsy) to ascertain the patient’s health and rule out, or confirm, the presence of a tumor.
“Once the cancer reaches an advanced stage, the only option is treatment, which aims to prolong progression-free survival and improve quality of life. Consequently, regular screening and comprehensive prevention are the best allies in the fight against breast cancer.”
Ambrose Nweke, a gynaecologist at Women’s Health Specialist, Port Harcourt, Rivers State, said cancer was no longer a death sentence and advised women to undergo regular breast screening and self-examination.
He said: “Women and girls should visit the hospitals regularly whenever they notice any unusual thing such as a lump in their breast and not focus on religion alone as the solution. With what we do here, we are known for raising awareness that breast cancer can be defeated.
“Some young ladies and women say they prefe to be examined by their fellow women. They don’t like to open up to men who are not their brothers, husbands and lovers. This mentality has not only made many women to miss early detection, treatment and management of the disease, but also allowed their situations to degenerate before giving the ailment the attention needed which by then, is already at an untreatable stage.”
He admonished ladies who take alcohol to either reduce the quantity of consumption or avoid it entirely, as the consumption is a leading cause of breast cancer.
In addition, Tonia Goodluck, a chief medical consultant at Lilly Women’s Healthcare, Lagos, cautions ladies on menopausal hormone drugs or any birth control pills to always seek medical advice before taking them and not self-medicate, noting that some of the drugs could trigger breast cancer in a woman.
She equally advised nursing mothers against denying their babies their breasts to suck, saying babies sucking and massaging the breasts is healthy for breasts, as they help to free the boobs of lumps.
Calling on parents to take their daughters and young adults within the age bracket of 14 and 30 years for regular checkups and tests, Goodluck disclosed that some young people can inherit the disease from their parents or grandparents and early detection was a way out to help put it under control.
She said: “Although, the treatment of breast cancer is now personalised, depending on the patient, the stage and grade of disease, histological type, drug preference, immunohistochemistry, surgery and radiation impact, among others, it would be much better for a patient with a family history of breast cancer or inherited changes in breast cancer genes (BRCA1 and 2) to see her doctor and discuss how best to lower the risk of having a breast cancer.
“Knowing what to do to stay healthy, having the right information and knowing where to go to get the right help and early too, will lower the risk of developing breast cancer. And if at all it happens, this will boost the chances of surviving it and as well save many women from going to their graves early.
“It is also good to have a mammogram if you have not had one before and do not wear your bra beyond eight hours daily. Have a quality sleep, reduce pressure on the breast and loosen any tight bra, reduce intake of fried or canned food and live a stress free life.”
The chief medical director of MeCure Healthcare Limited, Dr. Adeniji Adeoluwa, raised the alarm that 23 per cent of Nigerian women suffer from breast cancer, saying 140,000 people are likely to have the disease annually.
Adeoluwa lamented that the mortality rate of breast cancer in West Africa has failed to reduce because victims seek preventive measures late and urged women to be consistent in examining their breasts and call the attention of an expert if anything unusual is detected.
Adeoluwa, who regretted the shortage of oncologists in the country, also urged the government to create a conducive environment for medical practitioners.
He said: “Generally, breast cancer is a disease that affects mostly women, but men also have breast cancer. For men, it is not as common as we have in women, and that is the reason nobody talks about breast cancer in men.
“In this part of the world, people prevent it very late. They come when the cancer is advanced. As a result, you will do your best, but you cannot cure the cancer. Cancer is curable when detected very early. It is the reason for having this campaign so that people can know that the whole essence is for them to go to the hospital, report the cases on time, detect them early and be cured.
“When it comes to breast cancer globally, we emphasize prevention, early detection, and early treatment. When we talk about prevention, we talk about creating awareness. For instance, letting people know what they can do to prevent cancer.”
On the number of oncologists in the country, he said: “Nigeria has less than 100 oncologists, but it is still better than what some African countries are going through presently. There are states in Nigeria that don’t have a single oncologist. The journey is still very far.
“To train an oncologist takes many years. When they are fully trained, most of the time they have made up their minds about leaving the country. It is so bad that senior professors are leaving. If we look at what is going on, it is so challenging. The policymakers will have to make the country attractive for professionals to stay. They also have to make up their minds to channel resources into the healthcare sector.”
Contrary to the views of others, the founder of Stepping Stones support group, Mrs. Sharon Smith, has expressed concern over the prevalence of breast cancer cases among women and men. According to her, breast cancer is not gender selective as it affects both males and females and has remained one of the top leading cause of deaths, especially among women.
Mrs. Smith, a breast cancer survivor, said effort should be made by support groups, social welfare organisations, healthcare centres and the government to sustain continuous sensitization of the ailment to the citizens, stressing that knowledge of it and its early detection are vital in surviving it.
She said: “Breast cancer awareness is already a solution to mitigate the lingering disease. By the time adequate awareness and enlightenment programmes are made to sensitise people about breast cancer, it will go a long way to curb the malady. We have been to schools and talking to little boys and girls on the danger of breast cancer.
“It is a problem on its own that most people are not aware that males usually have breast cancer. Yes, men also grow lumps in their breasts. Knowing about breast cancer is one thing but taking the right step to prevent it is another. Also, breast cancer may just be known to only adults in urban and metropolitan areas.
“That is why we at Stepping Stones support group have decided to take it down to the grassroots, particularly to our teenage boys and girls. The point now is that cancer hits everyone. Today, the breast cancer we are talking about is not only restricted to just females alone, males also suffer breast cancer. Whatever causes breast cancer can still happen in men and the treatment is the same.
“Since breast cancer can be prevented, then I wonder why people have to wait until they start experiencing it. We have stressed it repeatedly that early detection is always the first cure to breast cancer. Why do you wait to contract it and then begin to get treatment. So, it is about time we begin to pay adequate attention to our health and to our body. We have patients we have helped out of it and they survived. Quick intervention is the best treatment.”
Corroborating Smith’s views, the founder of So-Fine Medical Centre, Isheri-Oshun, Lagos, Dr. Joseph Omo-Emevor, revealed that exposure to environmental hazards including, chemicals and carcinogens in toilet soap and body cream can increase the risk of breast cancer.
He called susceptible women to maintain a healthy lifestyle, avoid tobacco and alcohol, protect themselves from sun exposure, use sunscreen and follow recommended measures from cancer screenings and check-ups.
He noted that the “treatment of breast cancer in the country does not come cheap. It would be better for susceptible ladies to work on the preventive measures, rather than allow it to blossom as the more advanced the sickness gets, the more difficult and expensive it would be to manage it because of the various treatment forms required.”
Recounting the excruciating pain her grandmother had from breast cancer before passing on, the president of Uzoaru Breast Cancer Awareness Enlightenment Foundation, Amb. Uloma Naomi James, said based on the research her organisation carried out on the non-communicable disease, anger, sadness and lack of love help to stimulate the growth of breast lumps and the spread in women, especially those undergoing treatment.
She also disclosed that a woman who had a child before, but stayed away for long without sex are at a higher risk of developing breast lumps, saying this equally goes for women who wear their brassieres for as long as 10 to 12 hours a day.
She called on women to be conscious of any change in their breast, in terms of shape, colour and size and also to know when to stay with or without bras for easy flow of blood into the boobs.
Harping on the need to key into the preventive measures, as they are cheaper and easier to observe than witness the real full bloom cancer, Miss. James noted that no level of cancer treatment come cheap, especially in Nigeria where the nature of healthcare services calls for concern.
According to her, breast cancer patients often feel gloomy, because they have lost their former lives, saying people around them should discourage this, because their dispiritedness could escalate their condition.
She disclosed that having a stable mind is vital for recovery. “Unhealthy socio-psychological environment may make some breast cancer patients to pass on early. While undergoing treatment, they should be made happy, play for them the type of music they enjoy listening and dancing to. This will raise their spirit and boost healing. Also, make them laugh to get out of their gloomy state. Most times, people do not know that music and laughter are therapeutic in nature.”
Further narrating steps to look out for the sickness, James listed four steps to check for lumps in one’s breasts. She said: “It is advisable for a start that you check your breasts bi-monthly. Each must be before your period and again the week after your period. But if you are worried that something has gone wrong, then check it monthly. This is because there might be changes on the breasts as a lady goes through her menstrual cycle.
“Stand in front of a mirror and take a look at your breast. Inspect your breasts for any change in the nipple inversion, skin changes, redness, flaking nipples, dimpling skin, nipple brown or red discharge or asymmetry. If there is anything unusual, do not hesitate to see your doctor.
“While seated or lying down, raise your left arm and later, your right arm, just as you raised your arm. This displaces your muscle and makes you feel the breast tissue better. Run your hand through your breast for any sign that has not been there before then.
“Maintain a pattern for your check. You can start by running your hand on your nipple and later shift to running it around the nipple in a spiral or up and down or left to right movement. Following a pattern like this will enable you dictate any changes, lumps or abnormalities in the breast. It is also worthy of note that not all changes are lumps. If you notice any change, do not panic, rather reach out to your medical doctor.”
For 48-year-old Daniel Ogbonna, whose wife just died of the dreaded disease, appealled to government for the establishment of more breast screening centres at the rural areas, saying he had to travel from his state, Imo, to Lagos State, to do the screening and mammogram of his late wife.
He tearfully revealed that it was the non-availability of a standard health center on his community that lingered the treatment of the disease until it got to an untreatable stage.
Attributed the high patronage of traditional and spiritual remedy to the insufficiency of diagnostic centres in some cities, especially the rural and semi-urban areas, Ogbonna added that most times the people in the rural areas depend on herbalists that administer concoctions due to the unaffordable cost of diagnoses and treatment.
Lamenting the plight of breast cancer patients, Ogbonna observed that all communities in his local government area, Aboh Mbaise, do not have specialist healthcare centres for cancer screening and treatment.
He said: “Because of poverty and no healthcare centres in my community, women with breast cancer die. Before my late wife was diagnosed with breast cancer, her cousin died when it was discovered that she had it. We all thought it was a spiritual attack, until the female pastor who was praying for her healing for months saw her breasts and advised us to seek medical intervention.
“When they told us it was stage four cancer, it was late. About one year later, this was in the year 2020, my wife noticed a boil on her left breast. She thought it was an ordinary boil, she burst it and that was it as she thought. Weeks after, the spot developed mucus. She continued to press out the mucus whenever it formed, until it started forming mucus mixed with blood.”
“Just like that, it continued. We started receiving advice from different people. Some advised we apply palm oil on the spot, some advised we apply olive oil, others advised we apply palm kennel oil. By this time, the spot had turned sour and open. We continued to apply all ointments recommended. Now it’s late because we lost her recently.
“I wish our government can provide standard hospitals that specialise in cancer treatments in all rural communities. My wife may still be alive if we had the right healthcare service.
“I also wish we can have affordable treatment for breast cancer in rural communities. Even when you have these standard facilities, it still costs huge amount of money which those of us at the rural areas do not have.
“Most importantly, I wish my late wife was still alive.”