Breast cancer: Who’s next?

Breast cancer: Who’s next?

Cancer-machine-1IS Mrs. Abi Adaranijo now a victim of the disease that frightens her most? When Abi, as she is fondly called by family members and friends, discovered a tiny lump in her left breast, she deliberately did not link it as a symptom of cancer.

She initially did not pay much attention to what she considered a ‘mere’ pimple that would soon vanish.  But, two weeks after, what she took for tiny bean-shaped acne, began to give her ‘uncontrollable’ pain.

She could neither sit, nor stand. Doing her routine chores became problematic. Even her work as a school teacher was also suffering. All these became a source of concern to her and the people around her.

The consequences of the development on her were anything but pleasant. At work, she barked at colleagues for no reason. The pain was taking a debilitating toll on her.

Her two-year-old son, Tolu, was not spared. The little boy got knocks for minor mistakes. Her spouse of five years, Femi, could not understand what the problem was. Her incessant hissing and shouting were too much for him to bear.

Abi had visited a private clinic at Ikotun, a Lagos suburb, where she complained to a doctor two weeks after the pain started. The doctor assured her that she would soon get better after treatment.

She wasted no time before buying the drugs that were prescribed at a store within the neighbourhood. Though, she ‘religiously’ followed the doctor’s prescription, the pains persisted.

The 32-year-old school teacher changed her countenance when she returned to the clinic for a check-up. “The pain is unbearable”, she told the doctor. “What else can you prescribe for me? I feel like dying. Oh my God!”, she exclaimed.

Abi has become more agitated about her health than ever. She is enveloped with the fear of the worst as the prescription could not help her condition.

Her dream of attaining the zenith of her career and becoming  a permanent Secretary in the Lagos State Ministry of Education may not be achieved unless something was done fast.

The amiable, young and hardworking woman is in a dire strait and she appears to be losing the will to carry on. The weight of the problem has relegated her athletic built and carriage, which complemented her intelligence quotient (IQ).

Abi, who has heard of women dying of breast cancer, never thought she could be victim until last September.

“It all started like a joke. I only felt a small pimple,” she explained to a friend, “but I never thought it would become something problematic like this,” Abi said.

The mother of two has become a recluse of her old self. She at the cross-roads over what steps to take next, since the doctor’s prescription failed her.

Scared of doctors telling her that she may have her breasts removed, Abi started to seek alternative treatment. She would have allowed an unorthodox doctor to make incisions on her breast but for the timely intervention of relatives who persuaded her to visit the hospital.

Some of her friends advised her to see an oncologist, the real cancer doctors in orthodox medical practice. She was always lost in thought for fear of having a lumpectomy.

Not a few women die from breast cancer for not seeking medical help early enough.

While delaying, she discovered that her breast has shrunken and two tests confirmed her fears. The immediate solution was radical mastectomy, which is the total removal of her two breasts.

She said: “But, the irony of it is when I had the first test at the Lagos University Hospital (LUTH), it came out negative. That made me lose a lot of time because I was told it was not cancer.

“When the pain became persistent I went back there but I was told the cancer machine had broken down. So, I decided that I must seek a second opinion.

“I travelled down to the University College Hospital (UCH), Ibadan in Oyo State where the bombshell was released to me that I have cancer.

“The doctor said I have cancer and it is at stage three. He said only very little can be done at that stage to save my life. I have been living in misery since he told me that.

“I cried all night, but family and friends reassured me it would be alright.

“But, the thought of losing my breast keeps coming into my consciousness. I just could not pretend it is not there. Now, I am ready to lose my breasts but would not I lose my life. This is because the doctor kept saying I presented late,” she said.

Cancer patients across the country are at their low ebb. They could not access any functional cancer machine for investigation and treatment.

While Abi struggles to get over her breast cancer, 62 year-old Itoro Etim, a native of Akwa Ibom, was not that lucky. She did not live to tell her story.

When Ms Etim saw a tiny spot on her breast, she applied some ointment on it.

But, rather than get better, her case worsened. Consequently, she visited a Primary Health Care (PHC) centre, from where she was referred to the University of Calabar Teaching Hospital (UCTH). She was asked to take some tests but she could not afford the bill.

So, she discharged herself from the hospital. A month later, she discovered that the lump had grown bigger and affected the second breast. It was then that she decided to seek financial assistant from her elder sister in Lagos.

On hearing what had happened, her sister, Mrs Julie Ita, sent some money and she returned to the hospital. But, doctors were emphatic in their response.

“Your cancer has progressed. Where did you go all these while”, a doctor asked. She was told that  the only way to save her life was to remove her breast and place her on radiotherapy. But, she would not have any of that. So, she left the hospital again and returned to Lagos.

In Lagos, she was having uncontrollable pain. This made her sister to take her to LUTH where she was admitted at the Oncology Unit,

She was asked to pay for her treatment but it was difficult raising the money.

Her sister, being a retiree, could not do much. However, her daughter helped with the payment for drugs, oxygen and accommodation.

Ms Etim became unconscious for weeks and was on the bed until she finally died.

A radiation oncologist at the Lagos University Teaching Hospital (LUTH), Prof Remi Ajekigbe said: “Cancer is not a death sentence. This is because people can live through it. This is a reassurance somebody needs to have as she battles breast cancer.

“But, many people have died from the disease because they presented themselves for treatment at stage three and four. At any of these stages, not very much can be done to help the patients than manage it until they die. And many more may yet die unless something drastic is done about it because cancer is an expensive disease to treat,” he said.

Ajekigbe also assured that the cancer machine in the hospital was undergoing being repair.

Ignorance, fear and taboo and religious beliefs are some of the problems, some oncologists believe, that may be partly responsible for late presentation of cancer to doctors in the hospital.

Lack of facilities is another problem patients grapple with. The dearth of facilities should be of concern to all and sundry. This also hampers experts’ effort to reduce the disease.

The facilities, which are located at the Lagos University Teaching Hospital (LUTH) Lagos, University College Hospital (UCH) Ibadan, Ahmadu Bello University Teaching Hospital (ABUTH) Kaduna, EKO Hospital Lagos, University of Nigeria Teaching Hospital (UNTH) Enugu, University of Benin Teaching Hospital (UBTH) Edo and Federal Medical Centre (FMC) Gombe, have broken down.

Only those at the National Hospital, Abuja (NHA) and Utman Dan-Fodio University Teaching Hospital (UDUTH) Sokoto, are functional.

The old and the young, rich and poor, have all died. The most vulnerable are women.

How many women are waiting to die from breast cancer, a seemingly manageable disease? Nobody knows.The disease, which has claimed many lives, is still on the prowl. Yet, radiotherapy machines have broken down.

There are indications that breast cancer has come to stay in Nigeria. In the United States (U.S.) kills 600,000 lives annually. But, there is no national cancer registry for proper record in Nigeria.

The United States Centre for Disease Control (CDC) has warned that about 40 per cent of the people are likely to suffer from one form of cancer or another in their lifetime.

If detected and treated early, early, some forms are curable. Others are simply manageable. But, a cancer patient can be better treated with early presentation to oncologists.

President, Cancer Education and Advocacy Foundation of Nigeria (CEFON), Prof Francis Durosinmi-Etti, described the dearth of functional mammograms for cancer treatment as national disgrace.

According to him, the Federal Government has not enough to reduce cancer in the country.

The professor of Radiotherapy said that the government can boast of only two functional radiotherapy (linear accelerators – LINAC) machines of the 10 available in the country.

His words: “We have that of the National Hospital, Abuja and that of Sokoto functional. The machine at LUTH has stopped work. The machines have been affected by irregular power supply. If power had been steady, may be the problem would have been averted. Irregular power has damaged some of the machines.

“Some experts came from South Africa to repair the machine at LUTH, but they didn’t get it right. There is nobody to pay for the full repair of the radiotherapy machines.

“We are going backward rather than moving forward,” he said.

“The truth of the matter”, the professor said, “is that there are no facilities to treat cancer in Nigeria. The facility in Abuja usually treats people up to 2am daily. The pressure on it is too much. And the patients are suffering at present.”

Durosinmi-Etti, who claimed to have helped to set up four radiotherapy centres in Ghana, called on the Federal Government to do something to stop deaths from breast cancer.

He condemned the inadequate equipment in the care and treatment of breast cancer.

Cancer deaths, he noted, remained a major contributor to deaths arising from non-communicable diseases (NCDs).

The CEAFON president called for a National Task Force on cancer to arrest the situation, as available facilities could not sufficiently serve the numerous number of patients from the six geo-political zones.

“No fewer than 105,000 cancer patients will require radiotherapy treatment yearly but the facilities are not there. That means we need at least 260 mega voltage machines to meet up with the figures.’’

He said a recent statistics by Globacon data identified 42.3 per cent of cancers in the as women, with breast cancer being responsible for 26.7 per cent to achieve optimal results in treatment.

Durosinmi-Etti said the country lacks the required infrastructure and manpower to deal with cancer.

“We do not even have a National Cancer Registry. Another problem is the lack of political will,” he said, urging the government to partner with private sectors, non-governmental organisations (NGOs) to fund cancer treatment/management.

He said: “There is no priority given to cancer care management at all levels. A lot of people lack cancer awareness. Where there is knowledge, poverty becomes an issue. Access to radiotherapy is crucial and we need to make sure it is safe and effective.

“There is also the need to check the present status of cancer treatment facilities in the country to ensure strategic plans were on to address the problem.

“About 50 per cent of cancer cases in the world occurred in Africa and among low income countries, which was expected to rise to about 70 per cent by the year 2030.”

The government, he said, should deploy necessary approach to assist cancer patients, especially those with breast cancer.

He recommended the inclusion of cancer care in the National Health Insurance Scheme (NHIS), adding that multinational companies should also be made to contribute to cancer management.

Besides, he recommended the implementation of National Health Act (NHA) and private-public partnership.

Burosimi-Etti said: “We need to enlarge the existing components of cancer treatment such as infrastructural and manpower as well as adding new centres and retrain health workers in cancer care.

“Nigeria needs a functional cancer registration to cover the states and funding of cancer treatment should be done the way HIV/AIDS was handled.”

An Associate professor at LUTH, Adetola Daramola, identified breast cancer as the second most common cancer behind lungs cancer.

According to her, cancer cases have been dropping in the United Kingdom (UK) because the government has been investing a lot of resources to its detection and treatment.

“According to hospital data at LUTH, 38 per cent of sample brought for examination are breast lesion,” Prof Daramola said.

Dr. Omolola Salako, an Oncologist at LUTH, said the causes of cancers are unknown but there are risk factors, such as sedentary lifestyle, smoking and consumption of alcohol, among others.

She urged women to always do regular breast self-examination. “Women above 35 years should do a mammogram once or twice a year,” she said.

Dr. Salako, who is the Chief Executive Officer of Sebeccly Cancer Centre, said breast cancer is hereditary.

“Women, who have history of breast cancer in their family, should be watchful. They should do regular tests. If a breast cancer has killed one’s sister or aunt, then that person should be very careful.”