Detecting breast cancer changes through self-awareness

When 49-year-old Dorcas Moreen Wangulu discovered that she had a lump in her right breast, she thought it would just go away on its own.

It was as tiny as a pimple. But as days went by, she still felt the lump, so she decided to visit a doctor to rule out any danger.

She went to a hospital in Nakuru County where a scan was done and the results showed that it was a cyst, which her doctor said would have no negative impact on her health. “However, after one year, I noticed the lump continue to grow and protruding to the surface of the skin. This made me uncomfortable and I decided to go for a second scan,” says Dorcas, a mother of four.

“I requested the doctor who attended to me to recommend a minor surgery to remove the lump,” she recounts.

Life-changing news

I was booked for surgery the same day and the lump was successfully removed,and I was told to return after two weeks to get the results from the biopsy test that would be done on the extracted lump at the Lancet Laboratories in Nairobi.

 Meanwhile, I continued visiting the doctor for dressing of the wound.”

When Dorcas went to collect the results, he recalls the doctor opening the envelope and suddenly going quiet, what followed was news that changed her life forever. Dorcas, who was 43 years then, in 2016 was diagnosed with breast cancer, which was at its third stage.“The doctor advised me to go for a chest and abdomen C-T scan and a mammogram. I delivered the results and he recommended a masectomy (removal of the breast) immediately, because the cancer had started spreading to the local lymph nodes,” she narrates.

The procedure was successfully done in two weeks time and the wound healed three weeks later. I was also referred to Dr Kennedy Gogo, a certified oncologist and physician, who recommended eight cycle sessions of chemotherapy, which I began immediately in April at War Memorial Hospital in Nakuru County,” she explains.

Dorcas went through the sessions successfully, amid trauma and stigma from the society, an experience, she says, she cannot describe in words. “I lost my hair, my skin colour changed and my life seemed upside down. Every session cost Sh53,000 excluding other miscellaneous costs. Family members had to chip in for the monthly fees to counter two cycles of chemotherapy per month,” she narrates adding that they had to organise a fundraiser to raise Sh500,000 to cater for her radiotherapy treatment, unsuccessfully, but eventually got the help of a doctor at  Kenyatta National Hospital. She, however, says that her condition left her jobless and weak after the surgery, especially on the right hand side. Her diet also had to change to eating vegetables and fruits, and cutting off red meat, sugar and processed foods.

The healing process, she says, has been progressive. Unfortunately, she is not sure whether she is completely free from the cancer,” she shares.

Emily Muga, the Head of Programmes for Global Fund Grants at Kenya Red Cross Society discovered she had  breast cancer in July, 2019, when she was 44 years old.

“I was doing a self-examination when I discovered a lump on my left breast. I was also experiencing itchiness on my nipples, so she sought the advise of a doctor. After a few tests, they found that the growth was cancerous. I was utterly shocked by the news,” she narrates.

“After the diagnosis, my husband and I did a lot of consultations with various doctors to understand what needed to happen next. I became aware that my life was at risk and I needed to do everything to evade it for the sake of my children,” she adds.

From August 2019 to November 2020, she underwent four cycles of chemotherapy that were three weeks apart followed by radical mastectomy then weekly chemotherapy sessions for 16 cycles which were followed by radiation for 25 days. After that, she had 16 rounds of targeted therapy, which were three weeks apart until November 2020. “It was quite a difficult journey to navigate. It took a toll on the family both emotionally and financially.  Currently, I am in remission. You never recover from cancer, anyway,” she says.

Just like Dorcas, Emily also had to adjust her lifestyle, which included a change in diet and exercising and avoiding stress.

From their experience, Dorcas and Emily agree that breast self-awareness, which is knowing what your breasts normally look and feel like, then you’re more alert to any changes that might need to be checked by your health care provider.

In response to the growing breast cancer burden in Kenya, emphasis has been put on the need for early detection in the management of the disease.

Campaigns on women checking for lumps on their breast have been leaning more lately on self-awareness, other than a Breast Self-Exam (BSE). Studies have found that BSE as part of routine breast cancer screening, has not been effective.

Self-awareness for early detection

“Medics no longer encourage monthly breast self-exams for women at average risk of breast cancer. Instead, they teach this new, more mindful method for self-detection of breast self-awareness,” says Janet Jared, a clinician.

Dr Kodjo Soroh, Medical Director East and Anglo West Africa at Pfizer at a recent presser said that the country must step up efforts to drive regular medical check-ups to facilitate early detection since advantages of early detection of cancer cannot be overemphasised. “Our current focus remains on innovating and improving oncology therapies to potentially cure non-communicable diseases, such as cancer.”

According to the World Health Organisation’s (WHO) International Agency for Research on Cancer, Global Cancer Observatory (GLOBOCAN), breast cancer is the leading type of cancer incidence in Kenya accounting for 16.1 per cent of all cancers and is the second leading cause of deaths in the country.

Soroh said early detection, timely diagnosis and effective treatment of early-stage tumours are the cornerstone of breast cancer control to improve survival rates. However, data from the Kenya National Cancer Registry 2014-2019 shows that seven out of 10 cancers are diagnosed at advanced stages.

“Unless urgent action is taken to improve breast cancer screening and early diagnosis, breast cancer will compound Kenya’s disease burden, increase poverty and gender inequalities as well as reverse current gains against maternal mortality,” said Dr Angela McLigeyo, a Medical Oncologist.

In this regard, the Government of Kenya has established a breast cancer screening and early diagnosis action plan 2021-2025 aimed at ensuring that women with breast cancer are diagnosed in early stages.

The action plan will be achieved through putting in specific mechanisms to improve uptake of mammography screening in the eligible populations, ensuring that at least 90 per cent of symptomatic women are linked to timely further evaluation and management within 60 days from their first encounter with a healthcare worker.

High costs prevents care completion

“In breast cancer diagnosis, timeliness of the service to avoid excessive delay, availability of diagnostic imaging studies of the breast and axilla, staging studies to detect metastatic disease and tissue sampling methods are important,” Dr Njoki Njiraini, a clinical radiation oncologist said.

Prof Miriam Mutebi, a consultant breast surgeon and Chair of Kenya Society of Hematology and Oncology(KESHO), there have been considerable strides made in as far as diagnosis and treatment for breast cancer is concerned.

However, the reality is that the majority of patients are still diagnosed with advanced cancers and do not complete their care due to the high cost of treatment. “We have seen a considerable improvement across the entire continuum. There has been an increase in the number of centres that are now providing care for patients and an increase in the number of regional centres that are providing comprehensive cancer services, including radiotherapy,” says Mutebi.

The expert also notes that the number of workforce has increased and currently there are training programmes involved in the various levels of care, which are all designed to improve the workforce.

She offers: “For the last 10 years, more efforts have been made to support cancer patients get treatment. NHIF is now able to cater for chemotherapy, radiotherapy and surgery. It’s not 100 per cent since it may not cover all the cycles, but at least it is helping to ease some of the burdens the patients are facing. Having more patients completing their treatment journey is promising.”

Christine Mugo-Sitati, Executive Director at the Kenyan Network of Cancer Organisations (KENCO) says cancer treatment in Kenya is expensive. “NHIF caters for some treatment costs, but it is not comprehensive. Thus the patient will definitely incur out of pocket expenditure in accessing treatment. There are also other indirect costs, such as transport, accommodation, food, caregiver costs, supportive treatment, such as blood transfusions, palliative care and rehabilitative commodities, such as breast prosthesis, mastectomy bras and stoma bags.

She says cancer education has improved compared to former years, but there is still a lot that needs to be done to curb myths and misconceptions plus stigma in the community. “We encourage early screening for timely diagnosis and treatment, which improves outcomes,” Christine says.