In the past few weeks there has been a lot of interest on the breast as different organizations advance various initiatives to help reduce risk of Breast Cancer in Ghana. These activities attracted a lot of attention and have been very successful in raising awareness about this disease.
With all that good publicity there is always the risk that some of the good messages run off the rails as they get transferred from one person to the other. As a physician and a man who is also very much in love with the breasts I would like to use this space to contribute my due diligence to this great campaign that my sisters in Ghana and the diaspora have been pushing with so much passion and grace.
Breast cancer risk is definitely increasing worldwide for various reasons. In countries like the United States and the UK it appears that people of African descent tend to develop breast cancer earlier and also have more advanced disease at the time of diagnosis. In Ghana a recent study done at the Komfo Anokye Teaching Hospital from 2009 – 2014 revealed that most women were diagnosed with advanced cancer, 51% of cases were stage 3 and 4 increasing their risk of dying even with treatment. Fortunately this was better than previous results from a study in Korle bu, Accra which revealed about 58% late stage disease in 2007. One other observation was that breast cancer among Ghanaian women appears to occur in women younger than what is seen in the US and other Western countries. Most studies suggest that in Ghana about 1 in 5 of all cases occur in women younger than 40 years the age at which most US women start routine screening suggesting that regular screening using US standards would miss close to 20% of all cases.
Currently Ghana’s Breast cancer screening focuses on Breast Self Examination (BSE) and Clinical Breast Examination (CBE) from age 35 years. Mammography has in recent times become widely available across the country mostly in urban areas but utilizations is low and inconsistent as such reducing its overall benefit. When used consistently mammography screening has been shown to reduce breast cancer mortality by about 20%. In Ghana though with early screening one must worry about a significant number of false positive tests with mammograms exposing many women to unnecessary anxiety and further medical procedures. One government paper suggested using mammography for diagnosis only which may be reasonable on that account, but one must consider including that in screening after age 45 and beyond.
In the United States CDC (Center for Disease Control and Prevention) has reported a similar trend of early onset of breast cancer among African American women and currently recommends earlier assessment of risk in that population. Whilst the risk in African American women in the US may mirror that in Ghana the outcomes on account of late stage of diagnosis in Ghana and resources for treatment differs significantly. Among Ghanaian women diagnosed with breast cancer only 48% are alive 5 years after their diagnosis. This compares to 78% 5-year survival rates among African African women in the US, a number that is still lower than that of white American women who have 91% chance of being alive 5 years after a breast cancer diagnosis.
The reasons for the poor survival rates among Ghanaian women may be difficult to accurately tease out however these are few that have been suggested;
- Stigma associated with diagnosis leading to late presentation
- Higher proportion of triple negative breast cancer which does not respond well to current available treatments
- Fear of mastectomy among women
- Denial of diagnosis and seeking treatments from other alternate medical providers such as spiritualist and herbalists.
How can women reduce their risk of breast cancer or ensure they benefit from treatment if affected?
- Maintain a healthy weight
- If you want kids have them early and more is better when it comes to breast cancer risk.
- Exercise daily, if you cannot make specific time for it weave it into your day
- Limit or avoid alcohol use
- Do not smoke cigarette or weed, I only suspect weed could be a problem I cannot support that with any research
- Eat a healthy diet that’s low in processed foods, sugar, and trans fats
You would need to start breast cancer screening with a combination of these methods, breast self examination (BSE), clinical breast exam (CBE) and mammography. I realize some women hate having their breast squeezed in the machine, but better have the machine squeeze your breast than to risk missing a early cancer.
If a close relative (parent, sibling or child) was diagnosed with breast or ovarian cancer at an age younger than 45 you need to start screening at age 30 yrs rather than 40 yrs. Other people who would need early screening are listed below;
- Anyone treated with radiation therapy to the breast or chest during childhood or early adulthood.
- Those who have changes in certain breast cancer genes (BRCA1 and BRCA2), or have close relatives with these changes.
The most important take home message for any woman is that breast cancer is a disease that can be managed successfully if seen early. Having your partner suck your nipples is not going to prevent breast cancer but most men and women enjoy that so do it if you can. If you have great breasts you might as well enjoy and allow others to enjoy them. Know your breast very well by making sure you play with them as much as you can. Please see a doctor right away if you feel anything different in your breast so it can be carefully looked at.
Go ye therefore and continue enjoying the life and resources that you have been so graciously given.
By Dr. Leonard Sowah, an internal medicine physician in Baltimore, Maryland