Awo (not her real name) was a 65 year old woman I met during my surgical rotation as a house officer at the La General Hospital. She had been on admission at the ward for over a month at the time we met and had been brought there only because the stench from her ulcerated breast cancer could no longer be tolerated at home.
She had had a breast mass for 3 years, and only became concerned about it when she noticed a wound at the site of the mass. She resorted to herbal concoctions, spiritualists and prayer camps, in that order.
She was brought to the hospital only when all had failed. But after a confident diagnosis of breast cancer was made, all that could be offered was palliation.
Every day, when we stand over her moribund body to change the blood-soaked dressings on her breast wound, trying without success to avoid cringing at the noxious smell, her eyes would fill with tears, more due to the regret of presenting late, than to the unbearable pain. She would eventually die; a slow, painful, needless death.
A death that could have been prevented had she presented earlier.
Awo’s story, as sad as it is, is more the rule than the exception. It is all too common.
Every year, there are over 1000 deaths from breast cancer in Ghana, many of which play out just like Awo’s.
October is celebrated as breast cancer awareness month and the need for increased awareness of the disease could not be overemphasized.
The knowledge that breast cancer exists, the knowledge of its manifestations and effects on the body and the knowledge of the possibility of a cure should be known by every woman (by everyone, really).
If we understood it to be a disease which can be cured, people would not think of it as a curse and seek help from spiritual healers, rather than the hospital.
That said, it must be noted that the probability of cure is highest when the cancer is detected early.
This is why every woman, from the age of 40 years (or earlier if there is a family history of early onset breast cancer), must have a breast screen at least every other year. This comes in the form of breast ultrasonography or mammography.
Unfortunately, in our resource poor country, only a small fraction of the population have access to and can afford these diagnostic procedures. All is not lost though: breast self-examination is a no-cost way of detecting breast cancers early.
The Johns Hopkins Medical Centre states that “Forty percent of diagnosed breast cancers are detected by women who feel a lump, so establishing a regular breast self-exam is very important.”
Breast self-exams are not as sensitive as ultrasounds and mammograms in picking up breast lumps and masses, but they make you familiar with the characteristics of your breasts so that any changes may be picked up early and expert advice sought quickly.
It is advised that every woman, whether she has access to mammograms and ultrasound sans or not, should perform a breast self-examination once each month. It is simple, easy to learn and can save lives.
The pictogram below shows how to perform a breast self-examination properly.
Managing the risks
The risk factors for breast cancer include increasing age, early onset of menstruation, late onset of menopause, never giving birth or being older at the birth of the first child, using hormone replacement therapy, being overweight or obese, a personal or family history of breast cancer, consumption of excessive amounts of alcohol and exposure to radiation or cancer causing agents.
Most of these risks are non-modifiable. However, there are still ways to lower the risks for breast cancer.
The US Centers for Disease Control and Prevention (CDC) proposes the following:
Keep a healthy weight.
Exercise regularly (at least four hours a week).
Get enough sleep.
Don’t drink alcohol, or limit alcoholic drinks to no more than one per day.
Avoid exposure to chemicals that can cause cancer (carcinogens).
Try to reduce your exposure to radiation during medical tests like mammograms, X-rays, CT scans, and PET scans (they should be limited to only prescribed ones).
If you are taking, or have been told to take, hormone replacement therapy or oral contraceptives (birth control pills), ask your doctor about the risks and find out if it is right for you.
Breastfeed your babies, if possible.
As many more women realize that they wield some power to prevent breast cancer or have it managed early, we will have many more survivors of the disease.
Cases like Awo’s will soon become an extreme exception, and not the rule.
Breast cancer is curable.
The conversation continues this Wednesday on the Citi Health Chat at 1pm on the Citi 973 Facebook page.
By: K.T. Nimako (MB ChB)
Dr. Kojo Nimako is a private medical practitioner with an interest in public health and Citi FM’s Chief Medical Correspondent.
He is also the Executive Director of Helping Hand Medical Outreach, an NGO focused on health education.