Breast cancer is not synonymous with death — Salako, breast cancer specialist

In this interview by SADE OGUNTOLA, Dr Bolaji Lateef Salako, a Consultant Radiation and Clinical Oncologist at the Federal Medical Centre, Idi-Aba Abeokuta Ogun State, says breast cancer cases are on the rise despite steps that can be taken to prevent and treat cases to ensure a cure if discovered early….CONTINUE READING

BREAST cancer incidence in sub-Saharan Africa is rising and it is the most common cancer among Nigerian women. Why is this so?

The reason is that the awareness of breast cancer is now getting better. Health education about breast cancer concerning breast cancer prevention, screening and available treatments information is now accessible in different media. People now see reasons for them to access medical treatment in our hospitals as a result of this increase in breast cancer enlightenment and more importantly voluntary and most of the time free breast cancer screenings had led to more available breast cancer data.

Leisure-time physical activity is said to be associated with a reduced risk of breast cancer; what is the link?

Naturally, regular exercise is good for our body apart from having positive impacts on cancer prevention. It has been proven by science that exercising for one hour between 3 and 5 days a week reduces our susceptibility to cancers, including breast cancer. The relationship is simple if you are physically active this will allow you to burn out all the unnecessary accumulated bad fats in your body, leading to the prevention of overweight and obesity. This bad fat serves as fuel for cancer cell development and aggression.

In addition, this fat in the body can also give room to other diseases and make cancer management somehow difficult.

What does the Nigerian national system of cancer registry say concerning the incidence of breast cancer from one region to another in Nigeria?

We don’t have a centralised cancer registry system in the country for now. But we only depend on data from the institutions and population-based data. The incidence varies across the geopolitical region in the country. Breast cancer incidence seems to be higher in the southern part of the country.

The cancer burden has been worsening in the country due to the lack of robust national cancer registries that could provide accurate and complete data for the research and public health programs planning for effective use of resources and understanding of cancer treatment, epidemiology and control.

Are there things that can be done to prevent this cancer, like say vaccination as in the case of cervical cancer?

The risk factors for breast cancer can be divided into modifiable and non-modifiable factors. We can work on the modifiable factors like a sedentary lifestyle; alcohol, smoking, obesity, lack of exercise and exposure to substances that have been researched to predispose people to breast cancer. These factors apply to all vulnerable ages. Howbeit, currently there is no available routine vaccine for breast cancer. Non-modifiable risk factors are age, sex, family history of breast cancer, personal history of breast and genetic composition of the patient. The age group most prone to developing breast cancer is between 35 and 65 years. It is not possible to change these factors.

Some genes are implicated in breast cancer development. The major ones are BRCA1 and BRCA2 if these genes are mutated they could result in breast cancer and other cancers. Other relevant genes are TP53, ATM, PTEN and CHEK2. These genes can be sequenced by using molecular diagnostic tests for detection.

Are there reasons why prevention and control of breast cancer in Nigeria may be difficult and thus increasing cases of this cancer?

Yes, screening facilities and personnel are not available to the masses and also the cost of screening is exorbitant and no effective communication to the right quarters. As of today, there is no national breast cancer screening protocol in the country. A national breast cancer screening programme would have helped to provide information about the age, how often, facility, tools and other criteria for breast cancer screening. This will help in the early detection of this cancer and increase the survival of the patients.

No bra day is a celebration observed on October 13 every year to raise awareness of breast cancer and encourage ladies to take care of their breasts. How effective has the campaign been in Nigeria and does wearing a bra have anything to do with the development of breast cancer?

Wearing the bra has nothing to do with breast cancer development; of course, if someone wears too fitted a bra there could be some discomfort. I think the no bra day celebration that started about ten years ago is gaining momentum. I hope this will create necessary awareness among our women so that they would be conscious of their breasts enough for taking essential and right steps when they notice something different in their breasts, not just for fashion or social sake.

What are those signs that many women overlook but later turn out as pointers or red flags to this cancer?

Many of our women feel less concerned when they notice a lump in their armpit not knowing that part of the breast tissue extends to the armpit, breast discharge especially the coloured and foul-smelling discharge, eczema-like lesions on the skin around the breast or rash-like lesions around the nipples. These are some of the signs you look for apart from the lump and pain in the breast.

Where does knowing one’s family medical history come to play in the early detection and treatment of breast cancer?

This is very important because someone with a family history of breast cancer needs to start screening earlier compare to others. This will also give us a hint on how to go about the treatment and follow-up. We will also need to counsel our patients on genetic counseling and testing of other members of the family

There are different treatment modalities for breast cancer such as surgery, chemotherapy, radiotherapy, hormonal therapy immunotherapy, target therapy and supportive care. Breast cancer is curable if caught at early stages (1 & 2). However, the challenge we are facing as oncologists is that majority of our patients presented to us late. We mostly see them at advanced stages (3 & 4) and the lack of funds for their treatment makes the matter worse. They pay out of pocket for their treatment.

However, individuals with a high risk for breast cancer can benefit from chemoprevention and prophylactic surgery to lower the risk of developing breast cancer.

I want to implore our women to always endeavour to do a self-breast examination at least once a month and submit themselves for clinical breast examination once or twice a year. Breast cancer is not synonymous with death, let’s visit our clinics when you notice a strange thing in your breast. Survival is excellent if the diagnosis is made early followed by urgent and right interventions. This is also a call on the government and other stakeholders in the cancer space to double their efforts so that together we can reduce the breast cancer burden in the country….CONTINUE READING