Primary prevention, screening and appropriate follow-up, treatment and provision of palliative care reduce the burden of breast cancer. Ethiopia is also focusing on these preventive methods to reduce the fatal effects of the disease.
However, poor awareness, inadequate cancer-treatment infrastructure and cancer-management options are challenging the country of estimated 104 million from effectively addressing the issue. EBR’s Hiwot Selalew explored the interventions.
In recent years, the spread of non-communicable diseases such as breast cancer are growing dramatically in developing countries like Ethiopia that focused their policy direction in controlling communicable diseases. Though comparatively easy to be detected at an early stage, a number of factors including life style change are contributing for the increase in the probability of getting breast cancer in Ethiopia.
In Ethiopia, a country with a higher level of illiteracy rate, lower level of awareness level, poverty, conservative cultural and religious heritages, women often discover breast cancer at much developed stage of the disease.
Abesha Mamaru, 40, was diagnosed with breast cancer two years ago. After hearing the bad news, she panicked and felt extremely anxious. “I imagined that all the worst things are happening to my body and expected even the pain of the treatment to be excruciating.”
A strange feeling inside one of her breasts bothered Abesha for a few weeks before she could not shake the thought of it and decided to take some pain killers. When she figured out this did not work, she went to a hospital where doctors there confirmed she has breast cancer.
Abesha’s story resonates with a lot of Ethiopian women who have very little, if any, awareness about breast cancer. Often, many women in Ethiopia are diagnosed with the disease at a later stage drastically reducing their chances of recovery. In a country where 13,000 new cases of breast cancer are registered every year and more than 7,000 deaths are caused by the disease, women’s awareness level and understanding of the disease is shockingly disturbing.
According to the American Cancer Society, breast cancer starts when cells in the breast begin to grow out of control and form a tumor that can often be seen on an x-ray or felt as a lump. Breast cancer occurs almost entirely in women, but men can get breast cancer, too although the chance is relatively low. If detected at early stage, there are many steps to be taken to heal. In this regard, early detection and treatment of cancer is known to be an effective way of reducing the burden of cancer and improve outcomes. On the other hand, diagnosis and timely treatment of cancer helps to cure or prolong the life of cancer patients as well as ensure the best possible quality of life for cancer survivors.
However, a significant number of women in Ethiopia visit medical institutions late for treatment, which results in lower survival rate. According to the National Cancer Control Plan document prepared by the Ministry of Health in 2015 about 80Pct of reported cases of cancer are diagnosed at Tikur Anbesa Specialized Hospital, which is the only oncology centre in the country, were at advanced stages, when very little can be done. This is largely due to the lower level of awareness signs and symptoms of cancer, inadequate screening and early detection as well as treatment services.
In Ethiopia, cancer constitutes for about 5.8Pct of total national death rate, according to the document. Although data that shows the national trend is unavailable except for Addis Ababa, it is estimated that the annual incidence of cancer is around 60,960 cases while the annual mortality caused by cancer stood at 44,000 in 2014. The most prevalent cancer type in Ethiopia in the adult population is breast cancer with 30.2Pct of prevalence rate. Cervical cancer and colorectal cancer have the prevalence rate of 13.4Pct and 5.7Pct respectively.
Hayat Abdu, 31, a housewife and mother of two, says she has very minimal knowledge about breast cancer. “I heard on the radio that we can check our breasts by touching, but that’s just everything I know about the disease.” she told EBR.
In addition to the unimaginable agony during the treatment, failing to conduct early tests costs Abesha both her breasts. Doctors at Tikur Anbesa Specialized Referral Hospital performed double mastectomy on Abesha to prevent the spread of the cancer to the rest of her body.
Aynalem Abreha (MD) is a breast cancer specialist and has been working at Tikur Anbesa for the past 13 years. Over the years, he has observed the steady rise of cancer cases in Ethiopia. “The number of registered general cancer patients at the hospital in 2005 was 450. The number grew to 8,500 in 2017.” he told EBR. “Precaution, prevention and consequent treatments are crucial in the battle against cancer.”
Observable effort in expanding institutional infrastructure began in 2006 with the establishment of a department for cancer treatment at Tikur Anbesa. In 2011, a center dedicated to treat breast cancer was also set up there, where a project for registering cancer cases in the country kicked off. Staffed with three oncologists, three resident doctors, a general practitioner, four radio therapists, 18 nurses and several more support staffers and clerks, the center is providing treatment for cancer patients on a daily basis.
The hospital’s diagnostic cancer therapy center also works with focal persons spread across 20 governmental and private health facilities. These focal persons send medical information on a weekly basis for general registry for updating the data and analyzing the trend.
Yonatan Daniel, an oncology nurse, has been serving in this center for seven years. “Breast cancer has three stages. Most of the out-patients that visit our center are either on the first or second stages. The chemotherapy at these stages requires a half an hour and one up to four hours of treatment.” he described.
“There is a shortage of trained chemotherapists at the center.” Yonatan said. With just five nurses and 15 cots, patients sometimes wait for as long as six months before they are admitted for treatment. “Lack of medical instruments and space are also among the major factors hindering our service delivery.”
As part of the move to address some of the problems faced by the centre, a biological safety cabinet was delivered to the center. But Yonatan emphasizes more needs to be done to raise people’s awareness for early detection to increase the chance of full recovery.
There are also other medical institutions providing services. The Ethiopian Cancer Association has a center active since 2014 to treat cancer patients. The Association provides clinical services for patients who come from different regions but cannot afford the hospital bills or access hospital cots. In 2015/16, the Association provided clinical services to 186 cancer patients. Mathiwos Wondu Ye-Ethiopia Cancer Society has also been providing awareness creation and support services for the past 14 years.
As the number of cancer patients has fast increased in Ethiopia while treatment centers remained intact, some well to do Addis Ababans have pursued their own ways for treatment. Patients with relatives in the western countries fly to the United States and Europe in search of cure, while several others travel to South Africa and neighboring Kenya.
However, in recent years, the trend has changed and many patients travel to Bumrungrad International Hospital in Bangkok, Thailand. The Horizon Regional Cancer Center at the Hospital provides comprehensive cancer care and treatment by a multidisciplinary team of cancer specialists, including prevention, diagnosis, treatment, assessment of treatment plan and management of possible complications, emotional support, nutritional care, pain management, and close monitoring of likely recurrence. The Center has a large set of physical infrastructure and highly advanced technologies for Chemo, Radiation, Hormonal, and Targeted Therapy.
More than 900 Ethiopians visited the Cancer Treatment Center in the hospital in 2016 alone. Though not yet compiled, more and more Ethiopian patients are being treated in this year. However, according to Suthida Suwanvecho (MD), a specialist on Hematology (Blood) Medicine and Oncology (Cancer), many Ethiopian cancer patients come here after the case has developed further and controlling the disease thereafter is very complicated.
In addition, as cancer needs consistent follow up and regular treatment, Ethiopian patients find it too difficult to sustain the financial burden. The fact that patients have to see doctors at least on monthly basis makes the treatment for Ethiopians a big challenge.
“Sometimes, many patients think they can get the cure for cancer at a single treatment, which isn’t the case. So when I tell them the regular treatment they need to receive, they opt not to start the medication,” Suthida told EBR with sadness taking her emotions high.
“The Ethiopian government should expand the cancer treatment centers in the country.” she told EBR. Suthida, is aware of the challenges cancer patients in Ethiopia face. While the illness needs frequent treatment, a patient may need to wait for more than half a year to see a cancer specialist at the only treatment center in Tikur Anbesa.
As cancer treatment services are poorly developed throughout the country, prevention is the best strategy to contain the spread of the deadly disease. This is especially true to women who bear 73Pct higher probability of developing breast cancer. “Harmful sunrays are one of the major causes of cancer; additionally, smoking, drinking, poor diet, and exposure to harmful substances cause also increase the risk of cancer.” says Aynalem.
Studies conducted on the issue also indicate that about 40Pct of cancer types are preventable through interventions such as tobacco control, promotion of healthy diets and physical activity, protection against exposure to environmental carcinogens and vaccination against specific infections. Primary prevention is thus considered the most cost-effective way of combating cancer.
This is why medical experts like Aynalem urge awareness creation activities are crucial to improve breast cancer treatments following early detection. In addition, expansion of the coverage of primary level care across the country and access to basic information and referral for cancer patients, particularly for breast cancer patients should improve to ease the burden.
6th Year . December 2017 . No.56