29 June 2009
Kampala — UGANDAN women have for long only rushed for clinical breast cancer screening to ascertain whether the lumps in their breasts are cancerous or not. But with the introduction of mobile breast cancer screening in communities, the National Cancer Institute, Mulago is moving away from diagnostic screening to a more preventive clinical procedure, where the pre-cancer cells are identified long before women even notice the lump.
"That is why most of the reported cases have poor treatment outcomes because the women come after developing lumps, which have overgrown, are painful and have abscess (pus)," Dr. Fred Okuku, the programme coordinator, says.
Dr. Okuku says the new initiative, starting in July, has the capacity to detect the smallest cancerous cell before it manifests as a lump. He says the move has been made possible by the refurbished mobile mammography van, which was donated to Mulago Hospital by Dr. Ken Miller, an oncologist from Yale University last year.
"In a poor economy where there are hardly specialised oncologists, no drugs, leave alone space to accommodate the many patients for a long time, prevention assumes a pivotal role. It is much less expensive to burn the cancer cells or remove a lump than to do a mastectomy (cut off the breast) and a long series of chemotherapy treatments," Dr. Okuku argues. But that is only possible, he says, with early detection.
He discloses that they have been conducting breast cancer awareness campaigns sensitising women about self-examination, benefits of screening and available treatment options. "We have reached over 1,000 women with our educational messages. We have been to universities, banks, markets. Sensitisation campaigns allow women to familiarise themselves with the machines, understand associated side-effects of cancer treatment and book for screening," he says.
Dr. Okuku says they plan to screen women at risk first - those whose father, mother, or other immediate relative has ever suffered from breast, ovarian or prostate cancer.
He says this would limit screening to women aged 35 years and above because 'below 35, visibility of cancer cells is low.' However, they will also screen women as young as 25 if they have risk factors.
He advises: "Women should not test while they are in their menstruation periods because visibility of cancer cells is also low at this time. They should come 5-10 days later. They should not also apply perfumes or powders because they appear as artefacts on the films. They can cause false results."
The mammography films will be interpreted at the hospital. Women with suspicious lesions will be contacted and urged to return for further testing and treatment at their own expense.
However, he noted, not every swelling in the breasts is cancerous. "In fact, 60% of swellings are not. The problem is that when we sensitise people, they develop fears and keep running to the unit, consequently overwhelming the already stretched services," he said.
He added that they only have the capacity to screen 20 to 30 women daily. Breast cancer in Uganda is the third commonest cancer in women, second to cervical cancer and Kaposi's sarcoma.
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