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Dr Anna-Mary Nyakabau
DID you know that according to the Zimbabwe National Cancer Registry, in 2017, over 7 000 women in the country were diagnosed with breast cancer up from 4 015 in 2005?
Was this the result of a spike in cancer cases, or a result of awareness campaigns?
Maybe, more women are now getting screened, hence the rise in the recorded cases.
Sadly, the majority of cancer cases are diagnosed during the late stages.
Regular cancer screening for all women is encouraged. Women living with the HIV may need more frequent screening.
My name is Dr Anna-Mary Nyakabau, an oncologist and founder of Cancerserve Private Voluntary Organisation (Cancerserve).
The organisation was birthed following the realisation that poor people suffered the brunt of cancer more.
Having served at public hospitals at national level for over 30 years, every day was a reality check. I witnessed cancer patients from poor backgrounds struggle. Cancer services at public health institutions are stretched.
Parirenyatwa Group of Hospitals and Mpilo Hospital are the only centres offering oncology services. I realised that it was time I played my small part. It is with this in mind that I founded Cancerserve, a not for profit organisation to mitigate the negative impact of cancer on the underprivileged, thereby complementing Government efforts. Together with stakeholders, this dream is becoming a reality.
October is breast cancer awareness month, however, at Cancerserve, every day is a day to mitigate cancer and raise awareness under #Accessamplifiesawareness campaign.
What fuels cancer growth?
Some breast cancer growth is fuelled by oestrogens. Oestrogens are the natural body chemicals (hormones) that make women develop feminine features.
Among the common breast cancer treatment options are surgery (removal of the cancer), chemotherapy (killing of dividing cells with medicines mostly given in the vein) and hormone treatment (altering the production of body hormones or blocking them from stimulating the cancer growth).
Tamoxifen is the most commonly used oral anti-cancer agent and is effective in controlling the growth (cell multiplication) of hormone responsive breast cancer.
Breast cancer is not one disease.
There are types of breast cancers that have features (receptors) on the cells that make them susceptible to stimulation of growth by oestrogens (about 2/3).
It is important for patients to access testing of the oestrogen receptors on their cancers because it is patients with demonstrated oestrogen receptors who benefit from this treatment.
Those with no receptors for oestrogens can be offered other treatments like chemotherapy or other treatments that target other kinds of receptors like HER2/neu receptors (trastuzumab).
Types of cancer
Depending on the type of cancer and how far it has developed and the age of the patient, the type of receptors on the cancer patient usually require a combination treatment, which is discussed by a team of doctors and tailor-made for individual patients.
It is precision medicine (personalised medicine) and not a one-size-fits-all.
Cancerserve will be offering free adjuvant tamoxifen therapy to identified registered and disadvantaged patients (male and female) with diagnosed and confirmed oestrogen receptor positive breast cancer.
Why this population?
This medication extends the life of women with hormone positive breast cancer after they have received other treatments deemed necessary, including surgery plus or minus radiotherapy or chemotherapy.
The women have to take it regularly (orally daily) for at least 5 years.
Supplies are not always available and the average cost at private institutions ranges from US$15 going up. This cost is unaffordable for most women considering that incomes have to cater for other competing needs like food, school fees and many other needs.
Risk to defaulting
The risk of defaulting from treatment is high and this compromises outcomes.
Cancerserve has partnered with a supplier of this medication and is committed to availing this treatment to registered disadvantaged patients at no cost. So far, Cancerserve has secured funding to support 380 disadvantaged patients per year for two years.
Special mention
Special mention goes to Innscor Africa Ltd and Providence Human Capital, Health and Services department, Mabelreign SPAR, Dr Lowel Schnipper, patients, colleagues, corporates and individuals for their generous donations that made this initiative a reality.
Globally, breast cancer awareness month is October, where we amplify the awareness message. However, at Cancerserve we talk cancer awareness throughout the year.
Cancer is not one disease; it is a group of diseases. There are 200 different kinds of cancers.
Cancers are abnormal cells growing in an uncontrolled manner. They infiltrate surrounding structures and have the ability to travel through the lymphatics and the blood.
Cancer does not spread from person-to-person. If the cancer starts in the breast it is called breast cancer, if it spreads, say to the lungs, it is then called lung metastatic cancer.
Diagnosis
For a cancer to be diagnosed, a biopsy has to be done, this involves taking a piece of tissue from the affected area.
For cervical cancer, we now know that it is caused by the human papilloma virus (HPV).
Cancer causation is something that promotes cancer growth. A weak immune system is a causation, so is the HPV, so it is called casino genesis processes, an aiding tool.
As I mentioned earlier, 4 015 cases of cancers were reported in 2005 while 7 000 cases were noted in 2017. These statistics capture only cases that were recorded cases, many more could have been missed.
This increase could either be a result of increased awareness and more people are getting screened and diagnosed. We need to increase awareness so that people get screened.
Frequent screening, early detection and early treatment saves lives.
Early detection
Eight out of 10 patients present themselves with late cancer in Stage 3 or 4. Advanced stage cancer is more complicated to deal with than early stage 1 and 2 cancer.
Late stage cancer will spread to the lungs, bones or other parts. We need to keep amplifying frequent screening.
Signs and symptoms
It is important for women to know what is considered normal and then it will be possible to tell when there is an abnormality.
For breast cancer, the most common symptom is a lump in the breast which is painless, abnormal discharge or bleeding from the nipple, changes of breast size, or change in colour of area around the nipple (areola), swelling or thickening of the skin, reddening of the skin on the breast resembling an orange peel usually when disease is advanced.
Treatment
Breast cancer can be treated, especially when it is presented early, the lump or breast can be removed. Depending with type of cancer or extent of the spread, radiotherapy or chemotherapy can be used as treatment regimes.
In Zimbabwe, patients are afraid of X-ray treatment (kupisa), but it is not burning, it is X-ray treatment. Chemotherapy can be given orally or intravenously depending on stage.
Chemotherapy attacks the multiplying cells, the fact that it attacks cells may result in hair loss and skin darkening.
The normal cells require to recover, that is why chemo is given at intervals.
Hormone treatment can be used to treat breast cancer. The anti-hormone medication slows down the process, for example, tamoxifen goes to block the areas where the hormones go and stimulate the growth of cancer.
Besides treatment, a cancer patient requires pain killers, nutrients diet, emotional, spiritual and physiological support.
Let us advocate and keep working together for the establishment of a Cancer Fund.
It is possible if we care enough, we did it with success for HIV/AIDS.
Dr Anna-Mary Nyakabau is the founder of Cancerserve Trust.
Online Reporter