Breast Cancer: How poor awareness, dearth of facilities, professionals, spike cases in Nigeria

Cancer, especially of the breast, has become a malady of great concern to many people in Nigeria and even globally. In Nigeria, where income is poor and medical facilities are in deplorable state, diagnosing any one of a breast cancer is like sending the person to the guillotines, as the rate of survival is abysmally low.

Some health workers have attributed this high mortality rate to late stage presentation, poor health seeking behaviour, misdiagnosis, belief in faith healing and the patronage of traditional medicine, among others.

Despite the awareness some organisations, including voluntary and religious groups, are making, efforts to ensure that young ladies and women go for cancer screening early enough have not yielded desired result. Many would still not go, for reasons ranging from cost to quality assurance, fear of chemotherapy and traditional belief and male chauvinism especially as screening centres are dominated by male handlers.

Some young ladies and women are very reluctant to have men who are not their husbands, lovers or brothers examine their breasts.
This belief has not only made many women to miss early detection, treatment and management of the disease, thereby, allowing their situations to degenerate before giving the ailment the required attention needed.

According to the World Health Organisation (WHO) breast cancer, especially in a Low-Middle-Income-Countries (LMIC), including Nigeria, is the second leading cause of cancer death in women.

The global health body added that the chance that one woman in every 39 will die of breast cancer is high. This seems to be the case as many advanced breast cancer patients in the country are women in their pre-menopausal stage; that is from mid-30s to mid-40s.These are women that are still in their productive age and part of the nation’s active workforce.

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 within the age bracket of 15 and 25.

This calls for organisations, caregivers and government agencies involved in healthcare services to take proactive measures and mitigate this non-communicable disease from decimating the nation’s strong women workforce.

In 2020, the International Agency Research on Cancer (IARC) recorded 28,380 new cases of breast cancer in the country. With this high figure and poor health facilities, The Frontiers in Oncology, Switzerland, described Nigeria as one of the countries with the highest breast cancer mortality rate in the world with an estimated 72,000 deaths occurring yearly and 102,000 new cases diagnosed from its population of over 200 million people.

Although, Western Europe has the highest incidence of breast cancer (90.7 incidence according to Age Standardisation Rate (ASR) of per 100,000 women), the West African region and Melanesia have the highest mortality rate of 22.3 per cent and 27.5 per cent ASR per 100,000 women respectively.

Speaking on the surge of this non-communicable disease, Dr. Ogbonnaya Orji of Ramat Specialist Hospital, Umuahia, Abia State, said though women have more breast cells than men, the main reason they develop breast cancer more often is because their breast cells are constantly exposed to the female hormones estrogen and progesterone, which promote cell growth.

This diagram of the breast shows the location of the lobules, lobe, duct, areola, nipple, and fat.

According to the oncologist, lack of access to a good medical care, obesity, family history, religious beliefs, sedentary and unhealthy lifestyles are a few of the causes, adding that people should make conscious efforts to note some of the changes taking place in their bodies or their family health history.

Stressing that breast cancer does not come overnight, he called on ladies that consume substances such as, alcoholic drinks to either minimise or avoid them entirely, as alcohol consumption is part of the risk factor of breast cancer.

In addition, Orji cautions ladies on menopausal hormone therapy or any birth control pills to always ask of the side effects before taking them and if there are any reactions that have brought any unpleasant changes in their bodies, they should immediately desist from taking them because some of the drugs could trigger breast cancer in a woman.

He equally called on nursing mothers to refrain from denying their babies of their breasts to suck, saying babies sucking and massaging the breasts is healthy for breasts, as these activities help to free the boobs of lumps.

“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 of 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,” he said.

Calling on parents to take their girls and young adults within the age bracket of 15 to 25 and sometimes, 30 years, for regular checkups and tests, Orji disclosed that some young people have genetic predispositions to specific cancer types and early detection will help put it under control.

He noted that aside from this, inherited gene mutations such as BRCA1 and BRCA2 for breast and ovarian cancer can also escalate the risk, stressing that healthy diet that includes vegetables, lean protein, whole grains, any fruit in season, among others, can mitigate the risk.

Corroborating Orji’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, adding that it would be better for susceptible ladies to work on the preventive measures, rather than allow it to blossom.

He stressed that 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 agony her grandmother that had breast cancer passed through 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 the research revealed 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, 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,” she said.

For Abani Egwu, whose wife just died of the dreaded disease, government should establish breast screening centres at the rural areas, saying he had to travel from his state, Ebonyi, to Lagos State, to do the screening and mammogram of his late wife.

Saying the insufficiency of diagnostic centres in some cities, especially the rural and semi-urban areas make some families to patronise spiritual or traditional healing homes for their loved ones to be healed, Egwu added that workers in these homes have little or no knowledge of what breast cancer is all about and end up worsening the case.

He noted that most times they depend on spiritism and administer herbal concoctions and when the case gets beyond their power, they will request you to come and take away the patient if you are fortunate the person is still alive.

Lamenting the plight of breast cancer patients, Egwu observed that many of them die because of lack of fund to treat and maintain themselves, especially after mastectomy, where they are to do stress free work and rest for long, but the reverse is often the case as a good number of them go back to their work to earn money for their upkeep.

“Because of poverty and no social welfare packages, breast cancer patients do return to their work to sustain themselves and this does not only impact their health, but also lead to other complications that could make recovery difficult. I wish our healthcare services can create a policy where every girl in her late teens and every youth and young adult will yearly be screened of breast cancer. I also wish to see a situation where the treatment given to polio, tuberculosis and other malignant diseases would be given to breast cancer and other forms of cancer. This will go a long way to help safe life,” he said.

Following the United Nations World Population Prospect of 2019, which puts the demographics of Nigeria at 211.40 million with female population being 104.25 million, that is 49.31 per cent, it behooves on the government to make adequate provisions for women coming down with ailments of this nature, and where funding stands as an obstacle, it should partner private organisations to save lives, especially in areas of availability and affordability of the drugs.

Although the National Health Insurance Authority (NHIA) Act was enacted in 1999 and amended in 2022 to cater for the healthcare expenditures of Nigerians, including medical, surgical, prescription drugs, dental and other expenses incurred by the insured, the body would have been much more valued had greater number of Nigerians been captured by in its net.

According the National Centre for Biotechnology Information, the scheme has only captured about five million Nigerians out of the over 211.40 million.

This number, it noted, represents about three per cent of the population. The record further revealed that those captured are mostly workers in the formal sector, especially the federal civil service. This gives room for more grounds to be covered.

Recently, the NHIA Director General, Prof. Mohammed Sambo, at a workshop organised for desk officers of Ministries, Departments and Agencies (MDAs) in Abuja, said the NHIA has introduced a reform, which would ensure that about 80 per cent of the cost for cancer treatment would be taken away from cancer patients through a cost-sharing system whereby Roche pays 50 per cent of the cost of treatment, while the NHIA pays 30 per cent and the patient pays 20 per cent.

However, analysts believe the agency needs to do more, as rural and semi-urban women who operate at the informal sector do not have access to how to be part of the scheme.

To give breast cancer patients a ray of hope, the National President of Breast Cancer Association of Nigeria (BRECAN), Tolu Taiwo, disclosed that things were improving, as there are now seven comprehensive cancer treatment centres in the country as against one over two decades ago.

She further disclosed that private entities have also come into the system to fulfill critical needs of breast cancer patients, saying despite this, there was still much work ahead.

Speaking on some of the challenges breast cancer patients still face, the BRECAN president said: “Despite the availability of these comprehensive cancer treatment centres, the japa syndrome within the healthcare sector remains a formidable challenge with grave implications in the years to come. Our best healthcare professionals are understandably leaving the country in droves for better remuneration, career advancement and quality standard of living. The government has a lot of work to do to address this growing trend.”

Checking For Lumps In The Breast

President, Uzoaru Breast Cancer Awareness Enlightenment Foundation, James, who earlier spoke on how to care for breast cancer patients, lists four steps to check for lumps in one’s breasts.

  • How often?
    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.
  • Use a mirror
    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.
  • Get into position
    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.
  • Lump pattern check
    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 is a lump. If you notice any change, do not panic, rather reach out to your medical doctor or reach out to physicians at the Uzoaru Breast Cancer Awareness Enlightenment Foundation, Idimu, Lagos.