October is Breast Cancer Awareness Month, a time to highlight the importance of early detection and screening. Breast cancer occurs when cells in the breast grow uncontrollably. The breast consists of three main parts:
1. Lobules - Glands that produce milk.
2. Ducts - Tubes that carry milk to the nipple.
3. Connective tissue - Fibrous and fatty tissue that supports the breast.
Most breast cancers start in the ducts or lobules and can spread to other parts of the body, a process called metastasis. While breast cancer can affect both men and women, it is more common in women.
According to recent studies, about 2.1 million new cases of breast cancer are diagnosed each year worldwide, accounting for 24.2% of all cancer diagnoses in women. This means that 1 in 4 cancer patients is diagnosed with breast cancer. In Kenya, breast cancer is the most commonly diagnosed cancer, with around 6,000 new cases annually according to The National Cancer Institute of Kenya. It is responsible for about 2,500 cancer-related deaths each year, making it the second leading cause of cancer death in the country.
There is a worrying trend; breast cancer rates are rising among women under 40. A study published in the - Journal of the American Medical Association - found that the incidence of invasive breast cancer in women aged 20 to 49 has increased significantly over the past two decades, particularly in early (Stage 1) and late (Stage 4) cancers.
Experts recommend that women begin annual breast cancer screenings at age 40, a shift from the previous recommendation of 50. However, the starting age may vary depending on individual risk factors.
It's important for women to have a baseline exam with their primary care provider in their 20s. At that time, they can discuss when to start regular screenings. Women with a family history may need to start screening even earlier than 40.
For those at higher risk, such as individuals with a family history of breast cancer, screenings may start as early as age 35 or 10 years before the earliest diagnosed relative. If a woman's lifetime risk of developing breast cancer exceeds 20%, a more rigorous screening protocol is recommended, which includes imaging every six months. For the average woman, annual mammograms are typically sufficient.
While breast cancer is increasing among younger women, studies show that women of color, particularly Black and Indigenous women, face more severe and deadly forms of the disease. Research by the American Cancer Society found that although the incidence of breast cancer is highest among white women, mortality rates are highest among Black and Indigenous women. Specifically, Black women are 38% more likely, and Indigenous women 31% more likely, to die from breast cancer compared to their white counterparts.
It is crucial for women to have open discussions about screening with their healthcare providers, whether they are primary care physicians or OB-GYNs.
In sub-Saharan Africa, breast cancer prevention and treatment present significant public health challenges. Survival rates five years after diagnosis are only 40%, compared to over 90% in many high-income countries. Countries that have successfully reduced breast cancer mortality rates typically diagnose patients at earlier stages when treatment is more effective.
In sub-Saharan Africa, many women are diagnosed at advanced stages due to late detection and limited access to quality care. This leads to higher death rates, as advanced treatment options are often costly and less likely to be curative.
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In response to these challenges, various resources aim to make breast cancer screenings and treatment more affordable. For instance, in Kenya, The Nairobi West Hospital is offering free screenings for breast and cervical cancers during October. They are also providing discounted CT scan and MRI services to help with early detection.
Local health facilities are dedicated to raising awareness and improving access to breast cancer care.
In conclusion, breast cancer awareness and early screening can save lives. It is crucial for women, especially those at higher risk, to begin discussions with their healthcare providers about the right time to start screening. By prioritizing early detection, we can improve outcomes and reduce the impact of breast cancer in our communities.
The writer is a Clinical Oncologist at the Nairobi West Hospital
