The Rising Threat Of Breast Cancer

THE thunderous echoes of wailing women and children fill the air. Men sit with arms cowardly hiding between closed laps as tears choke the vulnerable ones. A loved one has passed on to the world beyond. Yes, death has visited a family, and who dares stand up against it. Lying in state in a glamorously stitched and fitted white gown with perfectly matching make-up, 58-year-old Florence Amantanah, who was abandoned by her family, has finally given up the ghost after struggling with breast cancer for less than five years. This month, countries around the world are marking Breast Cancer Awareness Month. Globally, the number one cause of death in women is breast cancer. In Ghana, like most non-communicable diseases, it has received limited attention. Though it has killed and deformed many women, especially in developing countries, stigmatization makes it difficult for many to go for early treatment. An educationist in her part of the world, Africa, Amantanah, like thousands of women, associate breast cancer with death. Many women diagnosed with the disease either die or end up losing their breasts through surgery. Breast Cancer Breast cancer is a malignant tumor that starts in the cells of the breast, but is most of the time painless, says Dr. Verne Vanderpuije, a clinical oncologist at the Korle-Bu Teaching Hospital. “It is a malignant tumor with a group of cancer cells that can grow into or invade surrounding tissues of the breast, or spread to distant areas of the body,” she says. “It occurs almost entirely in women, but men can get it, too.” She says there are many other diseases of the breast which people mistakenly think are cancerous, adding that, “You don’t just assume every defect in the breast is cancerous. “We know it is the number one cancer among women, which was considered to be a disease of old people, but now younger women and even girls in their teens have been diagnosed with the disease.” Awareness Many have and still live in darkness when it comes to breast cancer, lacking knowledge of its existence. Unlike Amantanah, Mary Mingle, a 25-year breast cancer survivor, tells Daily Guide, “I first thought the lumps under my armpit were boils because I wasn’t feeling pains. I decided to treat it with an ointment, but after applying it for some days, I started having pains. “It was after a doctor told me I had breast cancer that it dawned on me that I was really facing death because by then I knew nothing about the disease. I never in my life heard about a disease called breast cancer.” As an educationist, Florence had once said, “I felt as an educationist, that better knowledge of the cancer could have spared me this agony. But no, I was one hell of an illiterate who could not even educate myself more or less my own community. “Later I became angry with myself for failing to detect the early signs of the disease. And to add more insults to my pain, my friends and relatives started shunning me. It was a taboo for any of my relations to even eat with me whenever I return home from visiting the hospital.” In agreement with survivors, Dr. Kofi Nyarko, head of Cancer Control Programme at the Ghana Health Services (GHS), says, “We are aware that awareness of the disease is very low, even amongst social elite.” The world, according to him, until recently had not placed much emphasis on the disease and in view of this, the GHS was working hard on it. “The right thing needs to be done,” he said, but “we do not have the resources.” He confirmed that breast cancer is becoming more prevalent in the country, though exactly how prevalent is yet to be determined due to lack of statistics. Stigmatization In spite of their educational level, most women suffering from the disease find it very difficult to talk about it for fear of rejection, states Dr. Vanderpuije. “Also, it’s culturally unacceptable, because if you have cancer you are thought to be dying soon,” she adds. “It has caused a lot of problems with young couples. It’s not just social and psychological, but economical too.” She says some people lose their jobs because when victims tend to keep asking for money from their employees, they are often laid off for fear of draining funds. They also lose their spouses because of the huge finances they have to part with. She adds that there is also the fact that one can lose her breast, which she stressed can be very frustrating because “we live in a polygamous society where patients suffering from breast cancer are not considered whole women, whether we like it or not”. Mary confirms that even though she has enjoyed a 25-year support from her loving husband, sister, and children, she is still afraid to tell her church and even other family members about the disease. “I am scared they will insult me with the disease and even spread it to the whole community,” she says. “Many people have died due to the stigma attached to the disease and I don’t want to be a victim.” Like many women, she prefers to die in silence than to live with the stigma attached to breast cancer. “I prefer to keep it secret from others till I die,” she says. “I can’t stand the stigma. Society will insult and mock me.” Cultural Overtones Though we are in the 21th century, cultural overtones have pushed many people, including the ‘cream of the crop’, to live in darkness when it comes to breast cancer, Dr. Vanderpuije says. Many still believe people suffer from breast cancer because they have offended the gods or their lives are some how crocked. It is widely believed to be a devilish disease that needs not be mentioned among people. To the African society, a ‘full’ woman is the one who can boast with both meaty and succulent breasts, and also feed a baby with her own breast milk. Not to talk about the man whose greatest fun in life is to fondle the female breast. An Advocate’s Perspective Advocacy is very expensive and difficult, says Gladys Boateng, a breast cancer survivor and founder of Reach for Recovery Ghana. NGOs are striving to educate women on the early reporting of breast problems to health facilities, but most women put more faith in what their pastors say. They end up trusting the so-called men of God instead of their doctors. “Though we find it difficult to access resources such as vehicles, because there is the need for us to go to the hinterlands to educate and bring more women under our umbrella, it has been quite encouraging and emotionally moving, nursing our pains together,” says Gladys. As survivors, they have been organizing monthly meetings since 2003 to educate themselves. The guiding principle is that every woman who survives must help another. “Along the line, doctors saw the importance of our work and decided to offer screenings services to new people we identify,” says Gladys. “Over the past eight years, the advocacy group had been able to be in touch with 3,000 women at the early stages who have declined to report to health facilities.” Gladys also says market woman pollute food with colouring and other toxins, all in the name of preservation. “These practices are not healthy because they end up introducing toxins into the food which eventually make consumers get breast cancer,” she says. Treatment It’s best to get it before it starts. Primary preventative measures, according to Dr. Vanderpuije, include losing weight by exercising, eating more fruits and vegetables, and taking in less fat. “Helping your children as early as possible to know the conditions of their breast is also a key factor to preventing breast cancer,” she adds. “I think people are still scared of the C word. They don’t want people to know they are coming to the treatment. It’s kind of like jinxing. Someone in your family has jinxed you because of evil that you’ve done.” She contends that someone with an untreated case, when allowed to move beyond the breast, has an average lifespan of one and half to two years. “It will move from the breast, to the lymph, to the lungs, to the liver, to the bones, and to the brain.” Accessibility of Treatment Dr. Vanderpuije states explicitly that there are only two full service cancer centres in Ghana, one in Kumasi and the other in Accra, where about 3,000 cases are recorded annually. In Accra, she says, chemotherapy is not covered by National Health Insurance, though it is in Kumasi. On the low end, total treatment can cost GH¢420. On the high end, it can cost GH¢3,000. Dr Vanderpuije says it all depends on the type of breast cancer, and how far along the case has become. Sometimes, people will start treatment, and then abruptly stop. “Some of them are just going to a funeral,” she says. “My sister died, or my mother died. I have to go. Some also say it’s because of the cost.” She says Accra is now collecting statistics and waiting for follow-ups so that it can build a database. They’ve been doing this for one year. It will be hospital-based. As other jurisdictions follow suit – Kumasi started ten years ago – a population-based database can be constructed. Lack of Resources Over the years, the whole world has not paid the needed attention to addressing non-communicable diseases in developing countries, including breast cancer, because donor partners and NGOs have been heavily focused on communicable diseases like malaria and HIV/AIDS, states Dr Kofi Nyarko of Cancer Control Programme at GHS. The world’s choice of priorities in addressing health problems across board has made it difficult to access the needed funds and resources to help create awareness. Against this backdrop, Ghana started thinking about non-communicable diseases a long time ago. As indicated by Dr. Nyarko, in 2008, the GHS set up a National Cancer Steering Committee, which will soon bring out a national cancer strategy, probably by the end of the year. He says the strategy will make Ghana the only country in Africa that prepared, and other nations are waiting to follow. He makes it explicitly clear that on breast cancer, Ghana is working with World Health Organization to devise cost-effective treatment, saying the most cost effective method in Ghana is clinical examinations. “We are working on a five-year plan to roll this out,” he says. “Mammograms and ultrasounds will only be done as follow-ups to the clinical examinations. The plan will include an emphasis on primary prevention (exercise, fruits and vegetables, etc).” Dr. Nyarko, who is in control of all policies and activities on cancer control, says there are probably 10 mammogram machines in Ghana, and six of them are private. “You need certain equipment in place,” he says. “You need all these things and money for training. The fact that you are a doctor or you are a nurse does not mean you can examine someone and say, ‘You are free.’ You need to be trained.” He says that there will also be more screening centres, adding that a full service cancer centre could be on the cards for Tamale. “With the Geneva-based Union of International Cancer Control, we are rolling out posters that raise awareness about cancer,” he says. “They also do radio appearances and leaflets.” The GHS believes resources are a major factor in targeting the awareness materials for breast cancer, adding that currently, the disease is no longer an affliction of the old: Girls as young as 15 have been diagnosed with cancer. “It’s just now that there’s an emphasis on communicable diseases,” he says. “You know the right thing to do. You know the right thing to say. But you do not have the resources.”