Beating breast cancer: Early detection saves lives

BY ONWOSI IKECHUKWU

My first time knowing about breast cancer was about 20 years ago when my primary school teacher developed a fungating and ulcerated mass on her left breast. The mass was not responding to the several treatments my teacher was receiving, including herbal and pharmaceutical drugs. This made her visit a teaching hospital, where the diagnosis that she had breast cancer was made. Unfortunately, we lost her not long.

Since then till now that I have practised as a medical doctor for some years, I have seen and joined a team that managed patients with breast cancer, and that memory of my teacher is still green. It is more alarming to me as I am aware of several studies that project over 12,000 women to have died of breast cancer in 2018, with over 2 million being affected each year in Nigeria.

What is causing this rise in the number of people dying of breast cancer? Can it be prevented? What can men do to help their sisters, wives, mothers, or relatives, either to prevent it or reduce the risk? The above are some of the questions I will be attending to in this article.

What is breast cancer?

Breast cancer is a type of malignant change that affects mostly the breasts of women. These changes cause damage to the breast and also can move to other structures around it, including the second breast (metastasis). It is the leading cause of cancer-related deaths in Nigeria. The disease starts simple but gets advanced so fast.

The challenge here is that it is a disease that you need to tackle immediately after it starts; unfortunately, this is not usually the case as the resources and personnel to make the diagnosis are not readily available. Also, it needs an invasive procedure to confirm and start the treatment.

Breast cancer can start as simple as changes in the breast, including its looks, shape, colour, and unknown cause of releasing breast milk in one or two of the breasts. It is important to note that breast cancer easily advances in women who hardly engage in self-breast examination. This is because changes can be identified during breast examination, especially if it is routine.

The greatest impact of breast cancer comes from some women who will notice the changes and will still not take any steps to see their physician till it gets advanced.

How do we get this breast cancer?

The exact cause of breast cancer is not known. However, breast cancer runs in families, though it does not mean that everyone from a family that has had someone who suffered breast cancer will come down with breast cancer. It does not also mean that those from families that never suffered it cannot have someone suffering it for the first time. It starts in anyone with a genetic abnormality, but the chances of having this genetic change are higher in families where someone already has it.

Also, consuming fatty diets, alcohol, smoking cigarettes, lack of physical exercise, exposure to radiation, age, and other risk factors can raise the chances of anyone coming down with breast cancer.

Can breast cancer be prevented?

Since the exact cause is not known, it may not be easy to prevent breast cancer. However, reducing the risks of breast cancer can help. The best way to go about breast cancer is to notice earlier. If you do, you can take some measures that can add extra years to your life.

Is breast cancer a disease of the poor in Nigeria?

Breast cancer affects both the poor and the rich in Nigeria. However, the women from wealthy families are mostly well-educated and ready to flex the financial muscle that can result in good measures against it. On the other hand, folks from poor families may be lucky to identify it early but may not have the needed resources to lead the fight until it becomes advanced with only palliative options.

Why are more women dying of breast cancer?

Breast cancer is a progressive disease. It is not how you see it today that it will be tomorrow. It easily gets to a point of no return—when nothing can be done to give you more days. At that point, the only help from your doctors will be to improve the quality of your few days.

However, the story can be different if you start or continue your routine breast examination, which can help you notice changes in your breasts. It is highly helpful to visit your doctor with any change so that the right steps can be taken to confirm that it is not breast cancer rather than keeping to yourself and waiting for improvement.

Breast cancer needs an aggressive management plan, including doing the necessary investigations to confirm it and also following up on the next line of managing it. Unfortunately, some of the reasons why breast cancer sufferers are increasing are that not everyone likes to visit the hospital when they are sick, and other people don’t even have the money to seek hospital care. This usually results in late hospital visits.

Also, a wrong diagnosis can cause a delay in tackling the illness, and when the correct diagnosis is made, it may be too late to fight the monster. This is usually encountered among women living in rural areas where access to medical experts is slim. The available ones lack the requisite knowledge and experience in the steps for managing the cancer.

For those who can go to the hospital and do the needed investigation, their challenge can be retrieving the result late. For example, major steps in treating this cancer can only start when your histopathology result is out. In some hospitals, it takes between 6 weeks and 6 months for this result to be ready. In the western climes, you will get the result in less than 3 days and know the next thing to do. Unfortunately, in some Nigerian hospitals, the result will only come out when it is too late to take any of the medical options.

Another challenge that is making the disease continue to take a dominant posture in our country is the influence of wrong information and belief systems. While some patients easily attribute the illness to witchcraft, sorting for care in the hands of religious leaders instead of tackling it head-on. Some of the patients even mistake the investigation phase for definite treatment.

For example, some women who entered the theatre for an excision biopsy do believe that a curative step has been taken. Why is it not good to have this kind of belief? It is wrong because it will make you relax at home, thinking that there is no need for further hospital visits. When you miss your hospital appointments, you may even miss retrieving the result of the investigation, which costs you huge money to do.

Why is it important to retrieve the result of the investigation as fast as possible?

The best way to give care is to care for what is known with what is known to work. Another option will be to give care until the problem is known. In the case of breast cancer, you need histology results to confirm that it is cancer. It will also tell you the type of cancer, grade, and the best care to offer. The results will help your doctor know the type and stage of care to give you.

What could be your fate if the result confirms that it is cancer?

Treatment for the disease after it has been confirmed, depending on the stage when you visited the hospital, may include receiving chemotherapy, which will help you reduce the level of the abnormal cells in your breast. After that, depending on your response to the chemotherapy, you can be operated on. This operation may involve removing part of your breast that is affected or the whole particular breast and a few structures around the breast where the cancer has invaded.
The reason for removing the breast is because the cancer cells have invaded the whole breast and started growing uncontrollably, causing you pain and other symptoms. If you continue to leave it, it will continue to grow and spread to other parts of your body like the brain, bones, and even to your liver and lungs.

Is it only women who should be involved in breast cancer awareness and risk reduction?

No! This malignancy affects mostly women; however, they are our sisters, wives, mothers, and relatives. Therefore, we need to encourage them to do routine self-breast examinations. We also need to encourage them to visit the hospital as soon as they notice changes in their breast. It is not even about just visiting the hospital with the complaint—they should see an expert. Breast cancer is a disease that needs constant follow-up from the day of diagnosis till the day the patient will die.

In all, early hospital visits to see an expert can help much; however, following every step carefully and strictly can give the sufferer more years to live.

Is there still hope for anyone diagnosed with breast cancer in Nigeria?

Well, cancer is a terminal illness; however, its prognosis depends on the behaviour of the sufferer. Taking every stage of the care seriously can prolong the life of the sufferer by some more years, allowing more time to possibly achieve some set goals.

Recommendations

1 . Self-breast examination is very important
2. Women should take every change in their breasts seriously by visiting a general surgeon to assess them.
3. Follow-up care and your clinic visits, as breast cancer is a war that has no space for retreat.
4 . More awareness is needed down to the villages on the symptoms and signs of breast cancer.

Conclusion

Breast cancer is a monster that needs decisive and concerted family care. The sufferer needs emotional/psychological care as much as they need the best urgent care from their doctors. It is a death sentence that can be delayed.

Dr Onwosi Ikechukwu works at the surgery department of Alex Ekwueme Federal University Teaching Hospital, Abakaliki. He can be contacted via [email protected]