The word cancer has become synonymous to breast cancer amongst Nigerians. The first thought that comes to the mind of an average Nigerian on the mention of cancer is breast cancer in women. The symbolic colour of breast cancer in women is pink. Little wonder then Nigerians have erroneously come to associate cancer in general with the colour “Pink”, rather than “Lavender Colour” which truly depicts cancer in general. Should it be assumed that we are all well- informed about breast cancer and don‟t need to talk about it? Well, October is an International Cancer Awareness Month (ICAM), with special emphasis on breast cancer, the commonest cancer among women globally. Breast cancer awareness month is an annual international health campaign observed every October to increase awareness of the disease, advocate for easily accessible breast cancer screenings and to raise funds for research into its cause, diagnosis, prevention and cure. Given the increasing incidence and deaths from breast cancer amongst Nigerians, the need to intensify awareness of the disease cannot be overemphasized.
We will start by examining what Breast Cancer is. Breast cancer is an uncontrolled growth of breast cells (building blocks). It occurs mainly in women, but contrary to general belief, men can get it, too. See www.facebook.com/cecpnigeria, for details on male breast cancer. Men need to be breast cancer aware, because apart from the fact that breast cancer can directly affect them, every woman with the disease is a man‟s beloved wife, mother, sister and daughter. Our women need our moral and financial support to overcome this medical monster.
Recent data by the International Agency for Research on Cancer (IARC) shows that one (1) woman is diagnosed of breast cancer every 20 minutes in Nigeria and about 40 Nigerian women die of breast cancer daily compared to 30 women daily in the 2010 report. Sadly, the incidence of breast cancer rose from 38.7% to 42.2% between 2008 and 2012 with about 35% increase in the number of deaths within the same period. Unfortunately, Nigeria is ill- prepared to tackle this epidemic. As a result, we have lost numerous precious women and mothers prematurely, to this disease including a serving Deputy Governor, a First lady, and highly talented professionals, among numerous others who are unknown and unsung. Is this situation acceptable? Nigerians, we can do better for our dear mothers and nation builders!
The good news is that most breast cancer deaths are preventable, given the current level of medical knowledge. Countless number of breast cancer survivors can testify to this fact. For instance, Queen Elizabeth, the Queen Mother, developed breast cancer at the age of 83 (after being cured of colon cancer at the age of 66). She again survived breast cancer and died cancer- free at the age of 101. Martina Navratilova had breast cancer which was picked up very early. She was treated without removing her breast and is cancer- free today.
To improve breast cancer survivorship, it is important to know its risk factors, the signs and symptoms as well as preventive measures. Breast cancer is always caused by a genetic abnormality (a “mistake or damage” in the DNA) called mutation. However, only 5%-10% of breast cancers are due to an inherited abnormality. The remaining 85%-90% of cases are due to genetic abnormalities that result from the “wear and tear” of life in general.
The risk factors of breast cancer could be classified as modifiable (can be controlled) and non-modifiable (cannot be controlled). The major non-modifiable risk factors include: gender, age, genetics, family or Personal history of breast cancer, race and menstrual history. Of these, the most significant are gender and age.
Gender: Simply being a woman is the main risk factor for developing breast cancer. Men can develop breast cancer, but it is about 100 times more common among women than men. This is probably because men have less of the female hormones (chemicals) estrogen and progesterone, which can promote breast cancer cell growth
Age: The risk of developing breast cancer increases with age. About 1 out of 8 invasive breast cancers in the United States are found in women younger than 45, while about 2 of 3 of these cases are found in women older than 54. However, breast cancer can occur in teenagers.
Genetics: About 5% to 10% of breast cancer cases result directly from gene defects (mutations) inherited from a parent. The most common cause of hereditary breast cancer is an inherited mutation in the BRCA1 and BRCA2 genes. In normal cells, these genes prevent cancer by making proteins that keep the cells from growing abnormally. If a mutated copy of either gene is inherited, it results in a high risk of developing breast cancer. Breast cancers linked to these mutations occur more often in younger women and often affect both breasts. Women with these inherited mutations also have an increased risk for developing other cancers, particularly ovarian cancer.
Family history of breast cancer: Breast cancer risk is higher among women whose close relatives have this disease. Having one first-degree relative (mother, sister, or daughter) with breast cancer doubles the risk whilst having two first-degree relatives triples the risk. However, most (over 85%) women who get breast cancer do not have a family history of this disease.
Personal history of breast cancer: A woman with cancer in one breast has a 3- to 4-fold increased risk of developing a new cancer in the other breast or in another part of the same breast. This is different from a return of the first cancer.
Race and ethnicity: Breast cancer occurs at an earlier age and is more aggressive in Africans. Overall, white women are slightly more likely to develop breast cancer than are African women, but African women are more likely to die of this cancer. However, in women under 45 years of age, breast cancer is more common in African women.
Modifiable risk factors of breast cancer are as follows: Previous chest radiation, Lifestyle-related factors such as Diet, Obesity (gross overweight), Smoking, excessive alcohol intake, and not breastfeeding.
There is no evidence that controversial factors such as antiperspirants, bras, induced abortion and breast implants, increase breast cancer risk, contrary to rumours often being spread by chain emails.
Please note that many people with one or more risk factors never get breast cancer, while others with few or no known risk factors may get the disease. Therefore, everyone should be aware of its symptoms as well as preventive measures.
Initially, breast cancer may not cause any symptoms. However, the usual first sign of breast cancer is a new lump in the breast. A lump that is painless, hard, and has uneven edges is more likely to be cancer. But sometimes cancers can be tender (painful to touch), soft, and rounded. So it’s important to have anything unusual checked by a doctor.
Any of the following unusual changes in the breast can be a symptom of breast cancer: swelling of all or part of the breast; change in size or shape of breast, irritation or dimpling; nipple pain or the nipple turning inward; redness, peeling, or thickening of the nipple or breast skin; a nipple discharge other than breast milk, especially bloody nipple discharge; a lump in the armpit, and persistent pain. These changes can also be signs of less serious conditions that are not cancerous, such as an infection or a cyst. It‟s important to get any breast changes checked out promptly by a doctor.
The risk of breast cancer can be lowered by changing those risk factors that can be modified. Everyone should adopt steps to help the body stay as healthy as possible. These include: eating a balanced diet with lots of fruits & vegetables, maintaining a healthy weight, not smoking, limiting alcohol, and exercising regularly. While these may have some impact on the risk of getting breast cancer, they cannot eliminate the risk. Therefore, developing breast cancer is not your (anyone’s) fault. Feeling guilty that breast cancer happened because of something you or anyone else did, is not productive. Rather, be proactive, get diagnosed early and don‟t delay treatment after diagnosis.
Early detection and prevention of death from breast cancer is as simple as „ABCD‟, where „A‟ stands for Annual Mammogram. ‟B‟ stands for Breast- Self Examination (BSE), „C‟ stands for Clinical Breast Examination (CBE) and „D‟ stands for Don‟t Delay! Don‟t Deny!! Don‟t Dilly Dally!!! Because breast cancer is an emergency.
Annual Mammogram: A mammogram is a special x-ray of the breast that can detect cancer years before the lump can be felt. Women aged 40 and older should have a screening mammogram every year and should continue to do so for as long as they are in good health. Women who are breastfeeding can still get mammograms, but these are probably not quite as accurate because the breast tissue tends to be dense.
Modern mammogram equipment is safe and uses the lowest dose of radiation possible. The level of radiation does not significantly increase the risk for breast cancer. To put dose into perspective, if a woman with breast cancer is treated with radiation, she will receive around 5,000 rads. If she had yearly mammograms beginning at age 40 and continuing until she was 90, she will have received 20 to 40 rads (0.8% of the amount of radiation from radiotherapy).
It is important to note that a mammogram cannot prove that an abnormal area is cancer. To confirm that cancer is present, a small amount of tissue MUST be removed and looked at under a microscope. This procedure is called a biopsy and histopathology. Screening mammograms are done to find breast cancers that cannot be felt. If you have a breast lump, you should have it checked by a doctor and consider having it biopsied even if your mammogram result is normal. It is unethical to have a breast lump removed without carrying out histopathological evaluation!
Breast- Self Examination (BSE): The aim of regular BSE is to enable women to know how their breasts normally look and feel and to notice any changes. It should be done once a month and any breast changes reported immediately.
Clinical Breast Examination (CBE): Women should have a yearly CBE by a health professional as part of their periodic (regular) health examination. Breast- Self Examination and CBE complement mammograms.
Women at high risk for breast cancer should get a combination of Magnetic Resonance Imaging (MRI) and mammogram every year, from age 30. Unfortunately, these are expensive and out of the reach of most Nigerians.
There is an urgent need to make breast cancer screening widely available and accessible to all Nigerians. An excellent way of achieving this would be through the deployment of Mobile Health Centres which would take holistic health promotion to the grassroots. The campaign to actualize this, (“the BIG WAR against Cancer in Nigeria”), is the present focus of the Committee Encouraging Corporate Philanthropy (CECP-Nigeria).
A Mobile Health Centre is NOT the same as a Mobile Mammogram. Rather, it is a clinic on wheels, in which screening, follow-up and treatment (including surgeries), can take place. It includes facilities for mammography, sonology, colonoscopy, colposcopy and cryotherapy, as well as a surgical theatre. It is also equipped with laboratory facilities for screening against certain cancers like prostate, colon and bladder cancer and other common diseases which are risk factors of cancer. These include malaria, diabetes, hepatitis, kidney disease, hypertension and HIV/AIDS. Thus it would tackle the double burden of disease i.e. Communicable & Non-Communicable.
All hands needs to be on deck in order to stem the cancer menace in our dear nation. Anyone may contribute towards the Mobile Clinic project by giving via ATM or online at www.quickteller.com using the code „777526‟ (see donation page of www.cecpng.org or contact [email protected]). Individuals, families or organizations who donate a mobile unit, could have them branded in their name.
In line with the objective of the Breast Cancer Awareness Month, there shall be FREE BREAST and CERVICAL CANCER SCREENING as well as screening for breast cancer risk factors such as DIABETES MELLITUS and OBESITY.
BENEFICIARIES: Women aged 18 years and above
VENUE: National Cancer Prevention Programme (NCPP), 30 Ishaga Road, Surulere, Lagos.
DATE: Saturday October 18th (National Pink Day) and November 15th, 2014 (National Philanthropy Day)
TIME: From 9am
The NCPP is a non-governmental initiative and the technical partner of the CECP-Nigeria.
Interested participants should register by sending their full name, email address and preferred date of attendance as sms to the short code: 44777 from any of the major mobile networks. Then download and print the screening forms from www.facebook.com/cecpnigeria. Completed forms should be returned on the day of screening.
To learn more about cancer, tune in to 99.3 Nigeria Info FM every Friday at 8 am as we demystify cancer.
Dr. Abia Nzelu
Dr. Abia Nzelu is the Executive Secretary of the Committee Encouraging Corporate Philanthropy (CECP-Nigeria).