By Marjory Haruwandwi Bayayi: Bachelor Of Science In Nursing Science Student at University Of Zimbabwe
Breast cancer is the uncontrolled proliferation (increase) of cells and it comes in various forms. This is determined by the location of cancer in the breast. A breast is made of three main parts namely the lobules, ducts, and connective tissue. The lobules are linked to the ducts. The ducts are thin tubes where milk flows from the lobules leading to the nipple. The breast has no muscle. Most cancers develop in the ducts or the lobules of the breast. In some cases, breast cancer can move to other parts of the body via the lymph vessels or the bloodstream and it is said to have metastasized. Breast cancer is the most common form of cancer in women worldwide and is curable in 70-80% of cases when detected early and non-metastatic (Harbeck et al2019).
There are many types of breast cancer but the most common are invasive ductal carcinoma where cancer starts in the ducts and invasive lobular carcinoma where cancer starts in the lobules of the breast. These may be benign(not harmful) or malignant.
The symptoms may include but are not limited to:
- Pain in part of the breast
- Unusual nipple discharge
- Lumps on the breast or armpit
- Dimpling of the breast
- Inflammation of the breast
However, these symptoms may point to other medical conditions and so one needs to be screened for breast cancer to be sure.
Who is at the greatest risk of developing breast cancer? Various studies have shown that breast cancer arises from a combination of different factors. These include and are not limited to:
- Older people above 50 have a higher risk of developing breast cancer than most people
- Genetic mutations meaning there are changes in one’s DNA sequence that may occur during mitosis(cell division).
- Reproductive history meaning women who start their menstrual period before the age of 12 and undergo menopause after the age of 55 have been shown to have a higher chance of developing breast cancer.
- Having dense breasts as the connective tissue makes it more difficult for the mammogram to spot cancer putting them at a greater risk of developing breast cancer.
- Family history of breast cancer
- Drinking alcohol. This has shown a direct correlation with women’s risk of developing breast cancer.
- Obesity. Women who are obese have shown a higher risk of developing breast cancer
There are also different ways in which one can reduce the risk of developing breast cancer. These include living a healthy lifestyle, breastfeeding your children, drinking alcohol in moderation or leaving it, and avoiding taking medication that can affect your hormonal balance.
There are different ways in which one can be screened for breast cancer. One way is by the use of a clinical breast exam where the nurse or doctor feels for any lumps and looks for any abnormalities of the breast. One can also do this test at home regularly although cost-effective this test is not conclusive as one would need to undergo more tests for an accurate diagnosis.
The most common and effective way of screening for breast cancer is using a mammogram. It is used to detect early breast cancer in women without any symptoms. It can also be used in women experiencing the symptoms of breast cancer. These services are offered at several places in Zimbabwe for example the Diagnostic Radiology Center, Cancer Association of Zimbabwe that is currently offering breast cancer screening at a single dollar in October as a way to raise awareness of breast cancer and to make screening affordable for most. Therefore to reduce the risk of succumbing to breast cancer screening is important as we have seen that early detection equals a cure in most cases.
According to an article by Makurirofa et al, ‘in Zimbabwe there are 5000 new diagnoses of cancer each year and about 1000 cancer-related deaths. The incidence of cancer in Zimbabwe is on the rise; it increased from 2728 new cases in 2008, to 7165 in 2015. Breast cancer constituted a whopping 7 % of Zimbabwe’s total cancer incidences in 2015.’
Despite its aggressive nature breast cancer can be treated in several ways depending on the severity of the situation and some of these are:
- Surgery. This is a procedure in which the doctor cuts out the cancerous tissue or in some cases the whole breast.
- Chemotherapy. With this procedure, medicine is administered to the patient that is supposed to shrink or kill the cancer cells. This is done intravenously or by taking pills and in some cases both.
- Hormone therapy. This blocks the cancer cells from getting the hormones they require to grow.
- Biological therapy. This works with the body’s immune system to kill the cancer
- Radiation therapy. This uses radiation to kill cancer and is a non-invasive procedure.
However, according to Mushonga et al 2021 radiotherapy is likely underutilized for women with breast cancer, even in a setting with public sector availability. Exploring patient-level factors that influence adherence to care may provide clinicians with better tools to support adherence and improve survival.
All these treatment plans have shown to be effective in most patients especially those who had an early detection. However, treatment of those who had a late detection and that has metastasized have been the patients that usually succumb to the disease.
To date, countless new studies are being done to understand breast cancer more and how to effectively prevent and treat it. The Zimbabwean health sector has been working tirelessly to raise awareness about the disease. This is because there are two very important aspects in the prevention of breast cancer which are early detection and risk reduction.
In a nutshell, it is safe to say that early detection of breast cancer is of the most paramount importance to be cured. It is advised for women to get screened regularly especially those above 50 years of age(US Preventive Services Taskforce). In the event of a positive breast cancer test these are the following places that offer treatment in Zimbabwe:
- Harare oncology centre
- Oncocare Harare
- Cancer health clinic harare
- Radiotherapy centre Parirenyatwa
- SH oncology
- Dr Mutiziras Oncology and many more
Elmore SNC, Mushonga M, Iyer HS, Kanda C, Chibonda S, Chipidza F, Makunike Mutasa R, Muchuweti D, Muguti EG, Maunganidze A, Ndlovu N, Bellon JR, Nyakabau AM. Breast cancer in Zimbabwe: patterns of care and correlates of adherence in a national referral hospital radiotherapy center cohort from 2014 to 2018. Cancer Med. 2021 Jun;10(11):3489-3498. doi: 10.1002/cam4.3764. Epub 2021 May 10. PMID: 33973399; PMCID: PMC8178482.
Harbeck, Penault-Llorca, F., Cortes, J. et al. Breast cancer. Nat Rev Dis Primers 5, 66 (2019). https://doi.org/10.1038/s41572-019-0111-2
Makurirofa, L., Mangwiro, P., James, V. et al. Women’s knowledge, attitudes and practices (KAP) relating to breast and cervical cancers in rural Zimbabwe: a cross sectional study in Mudzi District, Mashonaland East Province. BMC Public Health 19, 109 (2019). https://doi.org/10.1186/s12889-018-6333-5
US Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009 Nov 17;151(10):716-26, W-236. doi: 10.7326/0003-4819-151-10-200911170-00008. Erratum in: Ann Intern Med. 2010 Feb 2;152(3):199-200. Erratum