Breast Cancer in Nigerian Women

“Late presentation” is the deadly, distinctive feature of breast cancer in Nigerian women. More than 70 percent seek treatment so late in disease that there is little, if any, benefit from any kind of treatment. For reasons unknown, Nigerian women also develop breast cancer younger than women in the western world.

The incidence of breast cancer is increasing around the globe – rising faster in developing countries. Surveys of community-dwelling Nigerian women, across a broad spectrum of age, occupation and education, have found extremely low levels of knowledge about breast cancer. Only 32 percent of women knew that a breast lump was a warning sign for breast cancer; 58 percent were unaware of most warning signs. Fewer than 10 percent knew of methods for detecting breast cancer. Only 34.9 percent of women practiced breast self-exam; only 9.1 percent had ever had a breast exam by a health professional. Education and employment in professional jobs significantly influence knowledge about breast cancer.

The actual burden of breast cancer in Nigeria is unknown due to lack of statistics. Healthcare spending competes with spending for basic amenities and infrastructure, as well as control of childhood and parasitic infections. Until circumstances enable mammography screening, health education, through media and woman-friendly organizations, is the most effective method to raise awareness. All appointments with health care providers, even for unrelated concerns, are opportunities to educate and raise awareness about breast health and disease.

[MORE]: Breast Cancer Survivor Betty Anyanwu-Akeredolu: Reducing Stigma, Lifting spirits

Overview

A woman’s breast is composed of glandular tissue, connective tissue, fat, blood and lymph vessels. There are about 20 lobes, each with smaller sections called lobules, in which milk is made. Milk flows through ducts to the nipple, which is surrounded by darker-colored skin, the areola. The lymph vessels flow toward bean-shaped lymph nodes, near the breast, under the arm and throughout the body. The lymph system is one of the body’s defenses against disease and infection.
Cancer is a disease in which cells become abnormal and reproduce more cells in an uncontrolled way. The cancer cells may form a mass called a tumor. They may also invade nearby tissue and spread to lymph nodes and other parts of the body. The most common types of breast cancer are:

• Ductal carcinoma, which begins in the ducts and grows into surrounding tissues. About 80 percent of breast cancers are this type.
• Lobular carcinoma begins in lobules and grows into surrounding tissues. About 10 percent of breast cancers are this type.

After skin cancer, breast cancer is the most common cancer diagnosed in women. A woman should know how her breasts normally look and feel, so that she can tell her doctor about any changes.

Signs and Symptoms

Signs and symptoms of breast cancer may include:

• A breast lump or thickening that feels different from the surrounding tissue
• Bloody discharge from the nipple
• Change in the size or shape of a breast
• Changes to the skin over the breast, such as dimpling
• Inverted nipple
• Peeling, scaling or flaking of the nipple or breast skin
• Redness or pitting of the skin over the breast, like the skin of an orange

[VIDEO]: How to do a Self Breast Exam

Causes and Risk Factors

It is estimated that only 5-10 percent of breast cancers are linked to genes. Some of the genes have been identified. The two most common genes which are linked to breast cancer also increase the risk of ovarian cancer. What causes breast cancer is unknown, but there are some things known to increase the risk of developing it. It isn’t clear why some people with no risk factors develop breast cancer; other people with several risk factors don’t get cancer. Risk factors include:

• Being female.
• Increasing age.
• A personal history of breast cancer. Cancer in one breast increases the possibility of cancer in the other breast.
• A family history of breast cancer. If your mother, sister or daughter was diagnosed with breast cancer, especially at a young age, your risk of breast cancer is greater. The majority of people diagnosed with breast cancer, however, have no family history of the disease.
• Inherited genes known to increase risk
• Radiation exposure, such as previous cancer treatment
• Obesity
• Beginning of menstruation before age 12
• Menopause at an older age
• Having your first child after age 35 years
• Never being pregnant
• Postmenopausal hormone therapy
• Drinking alcohol

Diagnosis

In addition to physical examination, some tests and procedures used to diagnose breast cancer include:

• Mammogram. This is an X-ray of the breast, used for screening.
• Breast ultrasound. This may be used to distinguish a mass from a fluid-filled cyst.
• Biopsy. A sample of tissue is sent to a laboratory for analysis.
• Magnetic resonance imaging (MRI). This is used to create pictures of the interior of the breast.

Staging determines the extent of the cancer. The stage is based on: tumor size, spread to nearby tissue, spread to lymph nodes and other parts of the body. Many tests may be used to learn this information. Treatment depends on the stage. Often, the stage is not known until after a woman has surgery to remove the breast cancer.

Treatment

One or more of these treatments are used:

• Surgery – Surgery is the most common treatment for breast cancer. The goal of surgery is to remove all the cancer from the breast. Many women are able to have surgery that removes the cancer but leaves the breast intact. Other women may have their entire breast removed. Plastic surgery to rebuild the breast, called breast reconstruction, often can be done at the same time as breast cancer surgery. Women who are thinking about having reconstruction should talk to a plastic surgeon before having cancer surgery.

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• Radiation Therapy – High-energy x-rays or other types of radiation are used to kill cancer cells or keep them from growing.
• Chemotherapy – Drugs are used to kill cancer cells or keep them from dividing.
• Hormone therapy – The hormone estrogen causes some types of breast cancer to grow. Hormone therapy reduces the body’s ability to make hormones or stops their action to keep cancer from growing.
• Targeted therapy – Drugs or other substances are used to find and attack specific cancer cells without harming normal cells.

Prevention

Making changes in your daily life may help reduce your risk of breast cancer:

• Ask your doctor about breast cancer screening, including genetic testing.
• Become familiar with your breasts through breast self-exams.
• Drink alcohol in moderation, if at all.
• Exercise most days of the week.
• Limit postmenopausal hormone therapy. Talk with your doctor about the benefits and risks.
• Maintain a healthy weight.

Living as a Survivor

• Fatigue – Fatigue is a significant issue long into cancer survivorship. Researchers at the University of California studied the effects of yoga on fatigue, comparing it to other interventions for fatigue. The yoga group had significantly greater relief from fatigue than other interventions, but more research is needed.
• Learn what you need to know about your breast cancer. Ask for good sources of up-to-date information.
• Talk with other breast cancer survivors.
• Find someone to talk with about your feelings, such as a friend, family member, clergy or a counselor.
• Keep your friends and family close. As you begin letting people know about your diagnosis, you’ll likely get offers to help. Think ahead about things you may want help with, such as having someone to talk with when you’re feeling low, or getting help preparing meals.
• Maintain intimacy with your partner. Breast cancer may affect your self-image and erode your confidence in intimate relationships. Talk to your partner about your feelings and insecurities.

[MORE]: Breast Cancer Survivor Betty Anyanwu-Akeredolu: Reducing Stigma, Lifting spirits

More information

Breast Cancer Association of Nigeria (BRECAN): www.brecan.org

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