According to the World Health Organization (WHO, 2018), breast cancer is the most common cancer among women, impacting 2.1 million women each year. It also causes the highest number of cancer-related deaths among women. By 2018, an estimated 627,000 women died of breast cancer – roughly 15% of all cancer deaths among women.
Most deaths from breast cancer in low-income settings occur a lot because these cancers are detected in late stages where medical intervention is very limited.
Once considered a disease in the developed world, the incidence of breast cancer is gradually increasing in developing countries. Almost 50% of breast cancer cases and 58% of deaths occur in developing countries, and this should worsen over time. In addition, breast cancer is increasingly being detected in the younger population and this is worse in developing countries (on average, the diagnosis is 10 years younger than in developed countries).
This is partly due to the increase in the elderly population, urbanization and changes associated with their lifestyle. This, coupled with increasing public awareness and the availability of screening and diagnostic tools for breast cancer, has led to the detection of more cancers in our populations.
According to WHO country cancer profiles (Rwanda 2014), breast cancer affected 576 Rwandans and accounted for about 8.5% of all cancer deaths.
A study in Rwanda on possible causes of delays in breast cancer patients (performed at Butaro and Rwinkwavu hospitals in 2015) indicated that 76% of patients were not bothered by symptoms, while 63% of patients thought that There was no need to seek medical advice and they believed the symptoms would go on their own.
Breast cancer usually presents at an older age (over 50 years), although in some cases it may manifest as early as 35 years in some women.
Any appearance of breast lump, changes in shape or size of breast or nipple, armpit swelling or breast pain should warrant medical consultation. Up to about 90% of breast cancers start as painless breast lumps, usually after 35 years of age.
It is important to know that although the appearance of a breast lump or any of these symptoms at a much younger age is usually not associated with cancer, medical consultation should still be sought for proper evaluation and guidance.
In addition to female and older age, other known risk factors for breast cancer include; family history of breast cancer (most significant family history is; first-degree relative with breast cancer under 40 years old, family member with breast cancer of both breasts, male breast cancer in the family), alcohol consumption (increases risk up to 30 percent and risk depends on amount and duration), obesity especially postmenopausal obesity. Other risk factors include the use of long-term hormone replacement therapies and, to a lesser extent, smoking. Breastfeeding is known to decrease the risk of developing breast cancer.
Treatment options for breast cancer depend on many considerations, but especially on the stage of cancer at diagnosis, the availability of additional treatment options such as radiotherapy, as well as the choice of the patient, etc.
After proper diagnosis and staging of breast cancer; For early stage breast cancers, surgery can be done to remove only the cancerous breast lump and any suspicious breast tissues and then radiotherapy to the other breast tissues. This allows breast cancer to be cured without the need to remove a woman's entire breast and is also termed breast conservation surgery.
In countries or centers without radiotherapy, most breast cancers are treated with surgery to remove all affected breasts, usually followed by chemotherapy to improve the overall treatment outcome.
Today in Rwanda, we have a fully equipped high-level radiotherapy center, located at the Rwanda Military Hospital, where women can undergo radiotherapy after these breast cancer surgery. This allowed women to be cured of breast cancer without losing all of the affected breast and thus the associated health, physical and psychological benefits.
However, it is important to understand that this radiotherapy breast conservation surgery can only be performed for early stage cancers for the best outcome. Thus, the emphasis on early medical consultations for breast symptoms, as well as routine screening, through personal and medical evaluations, even without symptoms, especially when approaching forty and older.
Dr. Ian Shyaka,
Resident in Plastic Surgery, Rwanda Military Hospital