Don’t Wait To Feel The Pain

Dr. Badu-Sarkodie

“Don't wait to feel pains in your breast before you go and see the doctor” is the advice breast cancer survivor, Sarah Mensa (pseudonym), is giving to Ghanaian women.

Sarah, now 56 years, has lived without breast cancer for the past 13 years. She, however, says she wouldn't have lost one of her breasts to the disease if she had sought treatment earlier.

“During one of my normal self-breast examinations, I detected that I had a lump in my breast. A friend took me to a herbal centre where they confirmed that I had breast cancer,” she tells DAILY GUIDE.

Sarah, however, decided to seek treatment at the centre for the next three years, where she was told her health condition was improving.

“I wasn't feeling any pain in my breast either, so I thought I was fine,” Sarah recounts. But a health outreach which she availed herself for again revealed the existence of an advanced cancerous lump in her breast.

“The specialists who diagnosed me the second time decided to start treatment immediately and I had to sell my properties to go through the process.

God being so good, I went through the various stages of treatment, including chemotherapy, surgery and radiotherapy, and I had one of my breasts removed,” she recalls.

Sarah is of the strong conviction that early diagnosis and proper treatment go a long way to help breast cancer victims have a higher chance of survival.

She points out that even though she sought treatment when she was at stage four of the disease, which is the worst stage, she survived through the various treatments, although it may not be the case for many women suffering from the disease.

President of Breast Care International (BCI), Dr. Beatrice Wiafe Addai, agrees with the call for early diagnosis, as she says over 700 women who were diagnosed of breast cancer survived the disease following early detection and prompt treatment at the Peace & Love Hospitals, which she founded.

Dr. Wiafe-Addai says the women who have survived the health conditions were detected during the free screening programmes carried out across the country by BCI.

The disease, Dr. Wiafe explains, is both “curable and survivable” on condition that patients report any breast abnormality to hospitals for treatment.

Breast cancer stages and treatments
According to the American Cancer Society, the stage (extent) of a breast cancer is an important factor in making decisions about its treatment options.

In general, the Society points out that the more the breast cancer has spread, the more treatment one will likely need.

But other factors such as if the cancer cells contain hormone receptors (that is, if the cancer is ER-positive or PR-positive), if the cancer cells have large amounts of the HER2 protein (that is, if the cancer is HER2-positive) how fast the cancer is growing (measured by grade or other measures), if you have gone through menopause or not and the overall health and personal preferences of the patient can also be important in determining treatment options.

Stage 0
Stage 0 cancer means that the cancer is limited to the inside of the milk duct and is a non-invasive cancer. The treatment approaches for these non-invasive breast tumours are often different from the treatment of invasive breast cancer. Stage 0 breast tumours include ductal carcinoma in situ (DCIS)

Lobular carcinoma in situ (LCIS) used to be categorised as Stage 0 but this has been changed because it is not cancer, but does indicate a higher risk of breast cancer. Look for more information about LCIS in non-cancerous breast conditions.

Stages I to III
Treatment for Stages I to III breast cancer usually includes surgery and radiation therapy, often along with chemo or other drug therapies either before or after surgery.

Stage I: These breast cancers are still relatively small and either have not spread to the lymph nodes or have only a tiny area of cancer spread in the sentinel lymph node (the first lymph node to which cancer is likely to spread).

Stage II: These breast cancers are larger than Stage I cancers and/or have spread to a few nearby lymph nodes.

Stage III: These tumours are larger or are growing into nearby tissues (the skin over the breast or the muscle underneath), or they have spread to many nearby lymph nodes.

Stage IV (metastatic breast cancer)
Stage IV cancers have spread beyond the breast and nearby lymph nodes to other parts of the body. Treatment for Stage IV breast cancer is usually a systemic (drug) therapy.

Inflammatory breast cancer
Inflammatory breast cancer (IBC) can be either stage III or stage IV, depending on whether it has spread to other parts of the body. Treatment for IBC can include chemo or other systemic therapies, local therapies such as radiation and surgery.

Recurrent breast cancer
Cancer is called recurrent when it comes back after treatment. Recurrence can be local (in the same breast or in the surgery scar), regional (in nearby lymph nodes), or in a distant area. Treatment for recurrent breast cancer depends on where the cancer recurs and what treatments you've had before.

Triple-negative breast cancer
Triple-negative breast cancer cells don't have oestrogen or progesterone receptors and also don't have too much of the protein called HER2. Triple-negative breast cancers grow and spread faster than most other types of breast cancer. Because the cancer cells don't have hormone receptors, hormone therapy is not helpful in treating these cancers. And because they don't have much HER2, drugs that target HER2 aren't helpful, either. Chemotherapy is usually the standard treatment.

Because there are not many current treatments for this type of breast cancer, if you are in otherwise good health, you might want to think about taking part in a clinical trial testing a newer treatment.

Late Diagnosis
About a month ago, the International Agency for Research on Cancer published the GLOBOCAN 2018 estimates of worldwide incidence and mortality of cancers.

They estimate that over 46,00 new cases of breast cancer will be diagnosed in Ghana this year and that more than 1,800 women will lose their lives to this cancer.

Dr. Florence Dedey, Head of the Breast Unit, Korle Bu Teaching Hospital (KBTH), indicates that the estimated cancers can be effectively treated if diagnosed early.

Unfortunately, she adds that more than half of the women who are treated for breast cancer in Ghana receive their treatment when the disease is very advanced.

“This negatively affects the outcomes that we see,” she explains.

This trend of missing out on diagnosing and treating breast cancer early when it is most amenable to cure, she discloses, can be attributed to many factors, including lack of knowledge about breast cancer, over-reliance on ineffective alternative therapies, inadequate facilities, trained personnel and lack of funds.

Dr. Wiafe further explains that breast cancer is not caused by supernatural forces, calling on every adult female to carry out their own breast self-examination periodically.

“We are saddened by the level of ignorance on the part of many despite our aggressive free screening programmes,” she opines.

Primary Breast Care Policy
The Ministry of Health (MoH), through the Ghana Health Service (GHS), is looking at incorporating breast cancer screening into the list of care given at the primary level health facilities.

Dr. Badu Sarkodie, Public Health Director at the Ghana Health Service (GHS), says government is currently working on a review of non-communicable diseases (NCDs) strategy, which is expected to include breast cancer care at the lowest level of healthcare.

“The strategy will be firmly rooted in the primary level of our health system, the community-based health planning and services (CHPS) and will extend to all levels of care in our health system, including district, regional and teaching hospitals,” he states.

He adds that the objective is to integrate screening service for breast and cervical cancer among other NCDs at the very primary level of health delivery in Ghana as part of routine care for early detection and more effective treatment.

Dr. Sarkodie observes that prevention pays and primary prevention is the best of options, thus, calling for a change in lifestyle changes, including working towards a healthy weight, limiting alcohol consumption to one drink per day or less, regular exercise and avoiding sedentary lifestyle.

Pink October
It is in line with raising awareness about the disease that the Surgical Breast Unit, multidisciplinary breast team of the Korle-Bu Teaching Hospital and the Breast Society of Ghana have decided to lead the awareness campaign for early breast cancer detection.

With affiliates spread across the country, the group has over the years embarked on a campaign through public education through the media, teaching self-breast examinations and raising funds to support care of needy patients.

Dr. Dedey says the month of October, dedicated to breast cancer awareness, is another opportunity for the group to further the successful campaign which now has over 25 health facilities offering free screening or discounted breast examinations for women within the month.

By Jamila Akweley Okertchiri