Ignorance of breast cancer rife among Batswana

| Friday October 22, 2010 00:00

FRANCISTOWN: As the Breast Cancer Awareness Month comes to an end, Mmegi took to the streets of Francistown to find out how much people understand about this illness.

The majority of people interviewed expressed ignorance of the disease - its causes and treatment.

Forty-eight year old Selina Jackalas of Somerset East says she does not know much about breast cancer, though she sometimes hears about it on radio.

'I have never taken the illness seriously. I just thought it was something for whites only. I think we need to be given more information so that we know what to look out for in order to prevent it if we can,' she says.

Tebelelo Matlhomane (59), who resides at Ntshe location, also expresses ignorance about the disease, noting that he has never come across anyone who suffers from it.

'No such information has ever reached me. It just means that those who are responsible for disseminating information are not doing enough,' he charges.

For a Botswana Accountancy College (BAC) student, Lorato Afrikaner (21), the little information that she has about breast cancer is that one has to always check for lumps or changes in the breasts and that if one notices anything unusual, one must consult a doctor.

But still, she says it is often difficult for a layperson to figure out if there are any unusual changes in the breasts.Other people like Lesedi Ntuluki of Bank of Baroda in Francistown seem to be fully aware of breast cancer.

She says she always examines her breasts for any unusual lumps and knows that it should be detected early so that treatment becomes easy.

'I understand that breast cancer may lead to the person affected losing their breast. So I check my breasts regularly because I wouldn't want that to happen to me,' says Ntuluki.

She expresses concern at the insufficient dissemination of information on breast cancer by the Ministry of Health, saying most people in the rural areas do not have access to information, which puts them at risk of being affected by the disease.

A man who identifies himself only as Moses believes that the government has not done enough to sensitise people about breast cancer as it does with HIV/Aids.

'Cancer is equally deadly and should be taken seriously. The same should be done about other deadly diseases like hypertension, diabetes and so on,' he says.

In the meantime, Ministry of Health staff today come to work wearing pink as a sign of showing solidarity with those affected by breast cancer.

According to a statement issued by the ministry, from 1998 to 2008, 11,363 cancer cases were registeredAccording to Dr Lulseged Alemu of Nyangabgwe Referral Hospital, the government has done enough to address breast cancer issues.

He says there is a great effort to improve early detection of breast cancer and that the hospitals are equipped with modern mammography machines to help detect breast cancer when it is still at a curable (early) stage.

'Government puts a lot of effort in providing care with available resources, but we do understand that more is still to be done,' he says.

Dr Alemu explains that the first national symposium on breast disease was conducted in early 2008 and that it helped to disseminate information to different health facilities and through community leaders to different villages.

He adds that Nyangabgwe Hospital staff go out to communities on outreach services and distribute brochures.  'We also have a breast clinic twice a week. The clinic gives health education about self breast examination and provides professional help, which includes screening,' says Dr Alemu.

As a result, they are seeing more and more early breast cancer patients. Although he cannot give figures, Dr Alemu says a good proportion of the community hears about the breast disease and knows what to do. He notes, however, that they need to increase their efforts and perhaps include breast cancer in the primary school curriculum.

He explains that breast cancer is a malignant tumour originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk.

'While the disease occurs almost entirely in women, men can get it too,' he says. The first noticeable symptom of breast cancer, according to Dr Alemu, is a lump that feels different from the rest of the breast tissue. He adds that other clinical presentations include changes in breast size or shape, skin dimpling, nipple inversion while some may present with a nipple discharge.

'Occasionally, breast cancer presents as metastasis, that is cancer that has spread beyond the original organ.Common sites of metastasis include bone, liver, lung and brain,' says Dr Alemu.

Unexplained weight loss, he explains, can occasionally herald an occult breast cancer that is often not symptomatic and whose symptoms are not specific to cancer, hence most are detected during routine breast screening.

Dr Alemu says the commonest breast lump is non cancerous. 'Our preliminary statistics from Nyangabgwe breast clinic show that seven percent to eight percent of all who attended for breast problems were found to have breast cancer. If not detected and treated early, it is fatal,' he says.

Like any operation, Alemu warns, breast surgery carries its own risks, though insignificant. But they have not seen any mortality in the past three years that is due to surgery. 'The mortalities we have seen occurred because of an underlying disease because the majority of patients come when the disease reaches an incurable stage,' he points out.

He says according to the national cancer registry, breast cancer is the third commonest solid malignancy in women in Botswana, after Kaposi sarcoma and cervical cancer.

'In Western countries, it usually occurs above the age of 50. However, in Botswana, our observation is that breast cancer occurs between 35 and 45.'

The doctor says it is difficult to establish a cause-effect type relationship. He however notes that there are certain risk factors that contribute to the development of breast cancer, which include gender, ageing, genetic risk factors, family history of breast cancer, personal history of breast cancer, race and ethnicity, certain benign breast conditions, menstrual periods, previous chest radiation, having children, combined hormone therapy, alcohol, being overweight or obese and lack of physical activity.

'Breast cancer is 100 times more common among women than men. Risk of developing breast cancer increases as one gets older,' Dr Alemu says. He indicates that about five to 10 percent of breast cancer cases are thought to be hereditary, resulting directly from gene defects inherited from a parent.

He adds that breast cancer risk is higher among women whose close blood relatives have the disease. A woman with cancer in one breast, he says, has a three to four times risk of developing a new cancer in the other breast or in another part of the same breast. Dr Alemu further notes that white women are slightly more likely to develop breast cancer than blacks. He says women diagnosed with certain benign breast conditions may have an increased risk of breast cancer, noting that in such situation, breast mammography and/or biopsy is taken, and if necessary, the lump is removed.

'Women who have had more menstrual cycles because they started menstruating at an early age (before 12) and/or went through menopause at a later age (after 55) have a slightly higher risk of breast cancer,' he points out, adding that women who as children or young adults had radiation therapy to the chest are at a significantly increased risk for breast cancer.

Furthermore, Alemu says, women who have had no children or who had their first child after age 30 have a slightly higher breast cancer risk and that having many pregnancies and becoming pregnant at a young age reduces breast cancer risk.

Physical activity in the form of exercise is said to be effective in reducing breast cancer risk. According to Dr Alemu, breast cancer can be treated by surgery, which means that part or all of the affected breast may need to be removed, depending on the size of the breast and the extent of the cancer. Other forms of treatment could involve the use of drugs, hormonal therapy and chemotherapy and radiation.

Asked whether breast cancer has any relation to HIV/AIDS, Alemu responds: 'Studies so far have confirmed that breast cancer is not increased among HIV-infected individuals. However, since women with HIV are living longer as a result of HAART (Highly Active AntiRetroviral Treatment) and better supportive care, it is unknown whether the incidence of breast cancer will increase.'

However, he says, breast cancer seems to be more aggressive among HIV-positive individuals.