Breast cancer treatment, early detection is key

Doctors contend that early detection of breast cancer enhances treatment and increases survival rate of patients. For this reason, participants at a three-day workshop in Accra raised concerns as to why the National Health Insurance Scheme (NHIS) covers breast cancer treatment but not screening for the disease.
The issue was brought to the fore by the Manager of the Non-Communicable Disease Control Programme of the Ghana Health Service (GHS), Dr William K. Bosu, who recommended to the government for inclusion of cancer screening under the NHIS.
The??? was at the end of a three-day workshop on Cost-Effectiveness Analysis of Breast Cancer Control and Policy Development in Ghana in Accra. The programme was organised by the Ghana Cancer Society with support from Ghana Health Service (GHS), the World Health Organisation (WHO) and the Susan G. Komen Foundation.
Participants were of the view that the survival rate of the disease could increase if the NHIS covers screening services for clients to enable those who have it present themselves for early treatment.
Breast cancer (malignant breast neoplasm) is a condition that originates from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk.
World-wide, breast cancer constitutes 10.4 per cent of all cancer incidence among women, making it the most common type of non-skin cancer in women and the fifth most common cause of cancer death.
The report adds that the number of cases is set to increase in the coming decade given our healthy lifestyles, rapid urbanisation and increased survival.
Breast cancer is about 100 times more common in women than in men, although males tend to have poorer outcomes due to delays in diagnosis.
Quoting from a WHO report, the Deputy Minister of Health, Mr Robert Joseph Mettle-Nunoo, said 17,000 new cancer cases and 13,000 cancer deaths occur each year.
In 1996, cancers were the third leading cause of deaths at the Korle Bu Teaching Hospital (KBTH). These accounted for 2.6 per cent of all admissions and 5.6 per cent of all the 2,502 deaths at the KBTH. Fifteen per cent of all patients with cancer died.
In all these, breast cancer was considered the sixth commonest cause of admission in women aged between 45 and 64 and the disease constituted 12.8 per cent of all cancer admission.
The term cancer typically evokes fear of pain and death among many members of society. There are misconception about causes, treatment and effects. In our part of the world, cancers are sometimes linked to witchcraft. In the case of breast cancer, there is the fear of one losing one’s breast under the surgeon’s knife.
Another point worth discussing is the fact that in Ghana there is little access to systematic screening to detect the potential incidence of breast, cervical and prostrate cancers.
These factors partly explains why the average duration of symptoms among patients seen at the Korle Bu Teaching Hospital within a three-year period is said to be about 10 months.
According to Mr Mettle-Nunoo, among these patients, the interval between when symptoms were first noticed to the time of presentation ranged from two weeks to five years.
The WHO revealed that the number of cancer cases was set to increase in the coming decade given our healthy lifestyles, rapid urbanisation and increased survival.
It also estimated that in low and middle income countries, alcohol use, over weight and obesity, and physical inactivity were the underlying factors in 18 per cent of breast cancers. The prevalence of several of these risk factors is said to be worsening.
For instance in Ghana, the proportion of women who were overweight or obese increased from 13 per cent in 1993 to 30 per cent in 2008.
Contrary to popular belief, breast cancer affects young women. The average age of cases from the KBTH was 41 years. The cases actually ranged from 24-75 years and a third of the cases were aged 40-49 years. Fourteen per cent of the cases were said to be unsuitable for breast surgery due to the advanced stage of the case and 26 per cent also ran away (absconded) from surgery or refused it.
In spite of these worrisome statistics, there is hope after all since according to the WHO, about one-third of all cancer cases are preventable through changes in lifestyle such as stopping smoking, consuming healthy food, immunising against infectious diseases such as hepatitis B, and human papilloma virus, treating certain infections linked to cancers and avoiding exposure to cancer causing elements (carcinogens).
It is also a welcoming news to know that one-third of cancer cases could be treated effectively if detected early.
The government has secured a loan of US$13.5 million to improve radiotherapy facilities at the KBTH and the Komfo Anokye Teaching hospitals, as well as to strengthen screening and prevention programmes. The Ghana College of Physicians and Surgeons has over the past few years, been training specialists to provide cancer care in the country.
With these in place and the efforts being made by some non-governmental organisations (NGOs) notably Reach for Recovery Ghana, Breast Care International, Mamocare, Palliative Care Society of Ghana and the Cancer Society of Ghana, we hope to see reduction in cancer cases in Ghana.