Lives Lost to Lags Early Diagnosis Key to Combatting Ethiopia’s Breast Cancer Scourge

Breast cancer, a global menace, stands as the fifth leading cause of cancer-related deaths worldwide. Its devastating grip extends across the borders of both developed and developing countries, leaving no nation untouched. Ethiopia, a land of vibrant culture and resilience, grapples with the weight of this affliction. Within its borders, breast cancer silently preys upon countless women, casting a shadow over their lives. Yet, a veil of ignorance shrouds the populace, obscuring the urgency of the matter. The lack of awareness engenders a troubling trend: a multitude of sufferers, aware of breast-related issues, choose to endure their plight in silence, avoiding the doors of hospitals. EBR’s Dr. Brook Genene delves into the current state of this battle, unearthing the challenges that lie ahead.

In 2019, Meron Kebede, a woman who diligently pursued regular medical checkups and embraced a healthy lifestyle, received a devastating blow: a stage 3 breast cancer diagnosis. The news landed upon her like a thunderclap, instantly shattering her world. The shock overwhelmed her, leaving her at a loss for how to navigate the treacherous path ahead. However, with unwavering determination and enduring strength, Meron embarked on a rigorous course of treatment, defying the odds and emerging triumphant in her battle against the insidious illness that had threatened to consume her.

Meron, a resilient breast cancer survivor, has not only conquered her battle but also forged a path of hope for others. As the founder of Pink Lotus Ethiopia, a dynamic support group, she has woven a tapestry of unity among those touched by breast cancer. Members gather to share their burdens within its compassionate embrace, weaving a safety net of understanding and camaraderie. Over the past three and a half years, Pink Lotus Ethiopia has become a powerful catalyst, igniting awareness and kindling a flame of knowledge about this formidable condition.

Pink Lotus Ethiopia has fervently championed the importance of early intervention. Their tireless campaigns have illuminated the path to early treatment, offering free screenings and enlightening awareness sessions. With unwavering dedication, they implore individuals to seek medical assistance swiftly, ensuring brighter prospects in their battle against breast cancer. Collaborating with esteemed medical practitioners, mental health experts, and renowned artists like Zeritu Kebede, their collective efforts resonate with a harmonious symphony of healing and support.

According to a study conducted by Memirie et al., breast cancer reigns as the predominant malignancy in Ethiopia. Astonishingly, it accounts for a staggering 33 Pct of cancers among women and 23 Pct of all cancers nationwide. However, amidst this alarming prevalence, a veil of ignorance shrouds the populace, casting a shadow over the urgency of the matter. Tragically, this lack of awareness leads to significant delays in seeking crucial medical assistance, perpetuating a cycle of missed opportunities for timely intervention.

Startling studies have shown a disheartening reality: women in Ethiopia often dismiss the early warning signs of breast cancer. A lump, which could be a potential red flag, is erroneously attributed to ‘sunstroke’ or the local term ‘mitch’. Tragically, even as pain and swelling persist, many choose to seek solace in religious institutions or traditional healers, unknowingly prolonging the crucial window for timely treatment. Burdened by financial constraints and the weight of other responsibilities, these brave women find themselves trapped in a web of obstacles, impeding their journey to seek vital medical care.

“Even when women muster the courage to seek assistance, a distressing delay of approximately 8 months ensues before they find the right physician,” reveals Dr. Yishak Suga, a distinguished Endocrine Surgeon from St. Paul Hospital Millennium Medical College. During this agonizing wait, the insidious disease stealthily progresses, intensifying the challenges of treatment. “Stages one to three offer treatment possibilities,” he explains, “but once breast cancer reaches stage 4, the focus shifts to palliative care and enhancing the patient’s quality of life.” Startling studies underscore the criticality of early detection, with a remarkable 89 Pct decrease in mortality odds for patients diagnosed in stages 1 and 2 compared to those diagnosed in stages 3 and 4. This poignant revelation underscores the urgent need for heightened awareness and prompt intervention to overcome this formidable adversary.

“A woman in her 30s bears immense responsibilities, shouldering the weight of her entire family,” laments Dr. Yishak. “Losing her to breast cancer is nothing short of devastating.”

While commendable initiatives like Pink Lotus Ethiopia tirelessly educate the public, a disheartening gap persists as many women remain untouched by health professionals through media platforms. Particularly, those residing in rural areas need more crucial information than their urban counterparts receive. Dr. Yishak emphasizes the urgency of bridging this divide, recognizing the importance of reaching out to these underserved populations.

Studies have revealed compelling factors that facilitate early breast cancer diagnosis: the persuasive influence of family and friends, higher educational attainment, and the impactful experiences of neighbouring women. These catalysts empower individuals to recognize the urgency of seeking timely medical assistance, fostering a culture of proactive care.

Certain risk factors, such as early onset of menstruation, delayed age of first childbirth, nulliparity, and late onset of menopause, are associated with cancer. Alongside these, a range of lesser-known factors have emerged: family history of breast cancer, alcohol consumption, exposure to ionizing radiation, hormone therapy, recent use of oral contraceptives, physical inactivity, early-life leanness, and later-life obesity.

Patients typically exhibit a range of symptoms when presenting with breast concerns, including the presence of a breast lump, nipple changes, alterations in the skin of the breast, breast enlargement or asymmetry, the discovery of an axillary mass, or even musculoskeletal discomfort. Pathologic discharge, on the other hand, manifests as spontaneous, persistent, and unilateral discharge confined to a single duct (uniductal). This discharge may appear serous (clear or straw-coloured), sanguineous (bloody), or serosanguineous (blood-tinged). Remarkably, over half of pathologic discharge cases are attributed to intraductal papilloma, while 5 to 10 Pct can be traced back to underlying malignancy. Intriguingly, breast pain, though not a definitive indicator, leads to a breast cancer diagnosis in 1.2 to 6.7 Pct of cases, underscoring the complexities of this enigmatic disease.

A range of investigative modalities exists to diagnose breast cancer, each serving a unique purpose. Mammography, a versatile tool, is employed for screening and diagnostic purposes, boasting an impressive 90 Pct actual positive rate. When mammographic results aren’t conclusive, ultrasound steps in, aiding in identifying cystic masses and providing guidance for fine needle aspiration or core needle biopsy. In high-risk women, MRI emerges as a valuable resource. Finally, breast biopsy plays a pivotal role in determining the specific type of cancer, ensuring accurate diagnosis and subsequent treatment decisions.

Upon identifying breast cancer, various treatment options are available, tailored to the specific stage of the disease. Surgical interventions encompass breast-conserving surgery or mastectomy, the complete removal of the breast. Traditional practice favours modified radical mastectomy for early-stage invasive breast cancers. Another approach is chemotherapy, which poses a significant challenge due to its exorbitant cost. Dr. Yishak emphasizes the financial burden: “The amount spent on chemotherapy drugs alone could establish healthcare facilities in rural regions.”

October, a globally celebrated Breast Cancer Awareness Month, is an opportune time in Ethiopia for diverse stakeholders to educate the public. Dedicated health professionals effectively reach out to women through engaging online campaigns and enlightening webinars, disseminating crucial knowledge about the disease. This concerted effort to raise awareness not only empowers individuals with life-saving information but also fosters a sense of unity in the fight against breast cancer.

Dr. Bethel Samson, a medical doctor and visionary health tech entrepreneur, has emerged as a critical stakeholder in the battle against breast cancer. Her groundbreaking contribution comes from Etege, a mobile app that provides a comprehensive guide to self-breast examination in Amharic. It is a vital tool for women to assess their need for medical assistance. This innovative solution bridges the gap by offering accessible and user-friendly resources, empowering women to take charge of their health.

To combat the devastating impact of breast cancer, collaboration between government officials, health professionals, and media organizations is paramount. Compelling testimonies from individuals affected by the disease serve as powerful catalysts in encouraging women to prioritize their health and seek necessary medical care. By working together and leveraging their respective platforms, these stakeholders can effectively educate the masses, raising awareness and empowering individuals to take proactive steps in the battle against breast cancer. Through collective efforts, lives can be saved, and a significant impact can be made in the fight against this formidable disease. EBR

12th Year • January 16 2024 – February 15 2024 • No. 125


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