Chronicle Editor
Robin Muchetu, Senior Reporter
ABOUT 50 percent of women with breast cancer in Zimbabwe die within the first three years of diagnosis as they present themselves very late at health institutions with stakeholders urging women to take periodic breast cancer screening seriously.
Annually, 2 000 new cases of breast cancer are recorded in the country. At the United Bulawayo Hospitals (UBH), at least two to three women test positive for breast cancer weekly. Dr Munyaradzi Magara a specialist breast cancer surgeon at UBH said the statistics were worrisome. He encouraged women to take breast cancer screening seriously at an early stage.
“According to the National Cancer Register, the latest information available from 2020, we are looking at about 2000 new cases of breast cancer in a year in Zimbabwe. Unfortunately, more than half may not survive beyond three years, it is really sad but that is the truth, this is because women come in very late to the hospital.
“The same registry notes that eight out of 10 of our women come with advanced breast cancer, so it is not surprising that most of them do not live beyond three years,” said Dr Magara. He highlighted alarming statistics recorded last week at UBH.
“In our doctor’s clinic, we see an average of 15 to 20 women a week, but during the week, the nurses see more than that as they do screening to see which women need to see the doctor and those that do not. Unfortunately, we tend to pick quite a few significant problems, this week alone, on Monday, I did five biopsies in one clinic and that is too much if we see 15 women and five of them are positive for cancer.
“That is too big a number, suppose we get five every week, in a month that will be 20 positive cases and in a year, it is too much that we expect about 150 new cancers in one unit each year. We usually see two to three positive cases a week that are advanced,” he said.
UBH currently is running a clinic that is still in its infancy where they screen women for breast cancer, which was initiated following the influx of women who required the services.“We have the clinic coupled with cervical cancer screening and we are working from there, it started in 2015 and how we got to be there is that we observed that women were coming very late to seek help in our general surgical clinic.
They would come in as emergencies with lumps they had had for three or four years and they waited because it was not painful and when it got to a point where cancer opened a wound on the chest or it is now causing so much pain because it is attached to the ribs, then they come to the hospital. Some come when they are now breathless, or after having lost a lot of blood from the cancer wound that would have developed,” said Dr Magara.
Following that realisation, the institution discovered that they were now offering end-of-life care for those who come with advanced cancers and could not be treated and saved.“Observing that, we spoke to the hospital administration to find a way to get women at the early stages of breast cancer and one place that we knew we could find women easily was the cervical cancer screening unit in the hospital.
We asked to use that place whenever needed. If any woman was doing the cervical cancer screening, we asked the nurse to offer breast cancer screening and a few women heeded that call, that way we figured that we could pick some pumps that women were not aware of. This is how that clinic came about,” said Dr Magara.
He said the clinic grew from that time in 2015, however, the institution discovered they were not able to deal with the small lumps that women were now presenting with as they were used to seeing women with extensive disease. They are now faced with women who never knew they had breast cancer and require different treatment from those with stage four disease.
Dr Magara said this spurred him to find a place where he could learn more about the treatment and management of breast cancer. “This culminated in me going to the United Kingdom in 2020 to 2022 doing breast work only. Now, I am back and I have the skill and I engage women in screening, early detection methods and diagnostic and treatment from the surgical point of view,” he added.
In a survey carried out by UBH from 2019 to 2020 in Bulawayo Province in the City of Bulawayo Clinics, central hospitals and the six district hospitals of Matabeleland South Province, through interviews, questionnaires and focus group discussions, Dr Magara said women do not seek early treatment for various reasons.
“Some of the reasons include lack of knowledge from the communities about breast cancer, how it presents and what to look out for at a personal level. They also did not know where to go if they discovered they had any problem with their breasts such as lumps or abnormal nipple discharge. It was also not only with the community but among ourselves as healthcare professionals, there was inadequate knowledge of the condition.
We interviewed doctors and nurses too, they would not know 100 percent what to do if a patient came with the condition. The level of knowledge varied from district to district and years of experience but on average it was not satisfactory,” he said.
The survey also highlighted belief systems as a factor as respondents said if they faced a problem like that they took it to be spiritual and required traditional medicines. The respondents also highlighted that costs were a factor. “Perceived but also real because some people get to the first port of call, which is their nearest clinic and they are referred to the provincial hospital or Bulawayo, some will be coming from Beitbridge, it is quite a distance, so costs are involved there. Our system does not have a direct pathway for helping such patients,” said Dr Magara.
Some of the key symptoms of breast cancer include a bloody discharge from the nipples, skin flaking around the nipples, a change in breast appearance and texture, an orange skin texture forming, sunken nipples and lumps in the breasts or armpits. Women are encouraged to seek medical help as soon as they notice these symptoms. —@NyembeziMu
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