The breast cancer burden: men are needed in the fight too

Monday November 15 2021
Breast pic

A lot has been said and published on breast cancer over the years.

The hows and whys and whos and I can competently reveal that for every clinic that I run, there is one or two breast cancer patients or even more.

That’s how common this particular cancer has become among women.

Given that this cancer is common among women, it has necessitated accumulation of research surrounding the disease. Despite all of this, the problem is far from over.

Worldwide, breast cancer still ranks number one among cancers affecting women but drops behind lung cancer as cause of death.

In Tanzania, it affects around 3000 women and more than 1900 of these ladies succumb to the disease.

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This is more than a half. Unacceptable!

The hurdles leading to these high figures of breast cancer in Tanzania have remained more or less the same despite growing improvements in the health care sector.

One of the biggest challenges remains in the knowledge gap. The ordinary mwananchi still does not know enough about breast cancer.

More than two months ago, I joined a group of experts and researchers to discuss a recent report on cancer in Tanzania and it was evident from the report that we still have a long way to go.

Renowned Professor, Twalib Ngoma of oncology in the country lamented on the slow progress we have made so far as a society.

The patients still present themselves to medical facilities late and this could be accrued to a number of reasons.

As a doctor, this is, for practitioners, the biggest setback that can be avoided and ultimately save lots of lives.

One study that was conducted at Muhimbili National Hospital and Tumaini Hospital in Dar es Salaam of about 348 women, found out that 83.7 percent and 16.3 percent were found with stage III and II of breast cancer respectively.

This is a statistic right in the centre of the urban area.

This means that in the rural areas, the situation is more alarming due to the fact that the infrastructure or support system there is in limit.

There are less health facilities, less experts, poorer social economic status and many more.


Breast cancer awareness

October is a special month in the oncology world as it was been set aside as the breast cancer awareness month. It is a time to reflect on the disease and the hope we have of saving more lives in the years to come.

It is a time to engage all relevant stakeholders with the objective of finding ways to put an end to the burden.

These commemorations were initiated as early as 1985 in USA by a family of physicians in the name of American Cancer Society with the help of one pharmaceutical society.

The main objective is to be able to prevent the disease but also detect and treat early. It’s also agreed that the month is used to raise funds for different aspects of the fight, from procuring drugs for treatment to research that can be used to foster new breast cancer frontiers.

In Tanzania, fundraising and lobbying for cancer care is very much unheard of, which is not a good thing.

We have left cancer to the government, a trend which has led to failure to save more lives that succumb to cancer.

The health system is already over stretched. Fundraising from the private sector and involvement of all other able Tanzanians to supplement the government’s efforts can be a huge game changer.

Breast cancer care isn’t entirely free and the costs are huge for individual cancers. Globally, over USD1.16 trillion is lost due to cancer annually. This is tsunamic by all means.

We don’t have data to estimate the economic impact of cancer in Tanzania but I would dare predict it has reached unacceptable figures. There is loss of productivity that may be exceed due to the loss of life and disability caused by cancer.


Where are the men?

Although it is rare, men can get breast cancer too. Breast cancer in men is very similar to the one in women and therefore, it is important that we include the men in the discussion.

Why haven’t we done this before? We can’t leave our mothers, daughters, wives, sisters and friends to battle this alone.

The breast is both a sexual organ and reproductive organ. It is for this sexual component of the breast, in my opinion, that makes a man a very important player in the attempt to detect the disease much earlier.

I am usually dumbfounded when an affluent married lady walks into my clinic with late presentation of breast cancer.

Men can do more before the diagnosis and after the diagnosis and hence all breast cancer awareness talks should include men in the audience.

With men on board, I am hopeful that we will see more cases of the disease earlier, that we may stand a higher chance for more recoveries.

Oncology should borrow from their colleagues in obstetrics, where there was a change of name from Maternal Child Health to Reproductive and Child Heath in order to include more men in these clinics.

The inclusion has led to more compliance as men realised how important a figure they are in the wellbeing of a woman. The support is immeasurable.


The loud and silent wounds of breast cancer

Breast cancer treatment, unlike other cancers, causes a major physical change associated with feminism. Surgery is a major part of the treatment of breast cancer.

In most cases, it includes removal of the breast with the cancer. This is very traumatic to women. They lose one of the very thing that makes them who they are.

Loss of a breast causes loss of a sense of feminism and many are affected in their sexual life. This is something that is rarely discussed with the doctor. The reasons for this are a myriad. The most obvious and prominent being, for all the parties involved, the belief there is more at stake here, which is death.

These wounds, whether seen or not, have increasingly shown the need for psychological help for breast cancer. This type of therapy should be initiated at the very beginning. We can’t wait for our Tanzanian ladies to air these out.

How do they even start? The culture did prepare them for that. So the counselling will help them with a mind-set shift as they battle cancer and the trauma associated with the treatment.

I must admit the barrier to this approach is the attitude we have as a society towards counselling. We assume that once you see one then you have this mental ailment called “ukichaa”.

This type of stigma has led to the health care givers feeling hesitant to refer their patients to counselling sessions. Of course in this if the patient is lucky enough to be spotted to need this type of therapy.

Many go through unnoticed and they bear the pain alone and in ways we will never know. This type of pain has contributed to earlier deaths for some these patients.


Preventable?

My biggest cry this year would not be on the treatment of breast cancer because we have gained a lot on this front. The treatment modalities are very much available, though not covering every part of the country but all centres providing cancer services are equipped enough to treat adequately.

This is a milestone. However we still have high number of new breast cancer cases. This is unacceptable because breast cancer is among the cancer types that can actually be prevented.

We should not lose more women due to breast cancer. Early investigations have shown to catch the disease in its very early stage and in some cases, in its precancerous state.

Mammography is an advanced x-ray that can detect a breast cancer tumour at the size of a grain. Let’s roll out more of these wonder machines all over the country and catch this disease.

The campaigns done so far that mainly asked women to come forward for a clinical breast examination have done a lot but more lives will be saved if symptom free women are allowed to stand in front of a mammography for that very small lump to be picked out and removed before it becomes lethal.


Funding

Let’s first agree that we need a lot of money poured in the breast cancer care for us to have tangible results. This money can be used for research, diagnostics, prevention campaigns and buying modern drugs that have shown to work on some forms of very aggressive breast cancer.

I encourage my fellow countrymen to be involved in this rather than wait for those from outside to assist. I was recently impressed by a local who gave a Sh100 million in donation for Covid-19 research. This is commendable.

The fight against breast cancer should be championed by us and nobody else. Since it is among the cancers that are preventable, we stand a chance of making things better and saving more lives.

Let’s do more by talking more about the disease and hence increase awareness. Then let’s strengthen our infrastructure to diagnose early and treat promptly.


Written by Dr Kheri Tungaraza

Oncologist, Muhimbili National Hospital