World Breast Cancer Day is observed on October 19 every year to raise awareness about breast cancer, encourage early detection and treatment, and support those affected by the disease. It aims to promote education, research, and support services for patients and their families.

In October, as Rwandans and the rest of the world observe Breast Cancer Awareness Month, oncologists emphasise the importance of self-breast examination and early cancer screening. Detecting cancer at an early stage significantly increases the chances of successful treatment and cure. It is crucial to note that delayed or inaccessible cancer care reduces the likelihood of survival.

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According to Dr Fidel Rubagumya, the founder and board chair of Rwanda Cancer Relief (RCR) in Kicukiro, early detection is important because when cancer is detected at an early stage while still confined to the breast, the chances of cure after treatment are very high.

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"It can also mean less extensive treatment, such as surgeries where a breast mass can be removed and spared, while when breast cancer is detected at advanced stages, either surgery is not possible because the cancer has spread to other parts of the body or it is so advanced within the breast that it warrants removal (mastectomy) of the whole breast,” he explained.

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Rubagumya emphasised the importance of regular self-examination, specifically through visual inspection in front of a mirror.

He added that when there is a breast mass or lump, one may notice it during regular self-inspection. Additionally, skin changes are typically present in cases of cancer.

However, he cautions that the left and right breasts typically differ in size. Therefore, it is advisable to be aware of one’s own normality and abnormalities.

"A self-breast examination is also important. You lie down on a flat surface and use the pads of the three middle fingers to move in small circular motions, covering the whole breast and applying different levels of pressure. "It is better to do the first one in front of a clinician and the subsequent ones by yourself while knowing that the initial one was normal.”

He also urges doing a nipple check, by looking for any spontaneous discharge, retraction, or any abnormal changes.

Rubagumya added that not all risk factors for breast cancer can be controlled, but it’s better to maintain a healthy weight, limit alcohol consumption, stay physically fit and active, limit hormone replacement therapy (for postmenopausal women), and breastfeed.

Causes, when to see the doctor

Rubagumya said the exact cause of breast cancer is unknown, but it is a combination of genetic, environmental, and hormonal factors.

"Some risk factors include age (the older, the higher risk of having breast cancer), however, in Rwanda, we see young women with breast cancer, as young as the late 20s.”

Other factors also trigger breast cancer, such as family history of breast cancer or other cancers, genetics (having some mutations, for instance, BRCA1 and BRCA2 mutations), and never having children or having them later in life, among others, he added.

Rubagumya recommends seeing a doctor if an individual has a breast lump, unexplained pain in the breast or nipple, a change in size or shape of the breast, nipple discharge or retraction, or skin changes around the breast such as dimpling.

He said doctors recommend annual mammograms (an x-ray examination of the breast) starting at age 40, but some other scientific organisations suggest age 45 or 50. "We recommend starting screening earlier, often in 30s.”

Dr Achille Manirakiza, a consultant oncologist at King Faisal Hospital, explained that breast cancer is highly curable when detected early, stressing that multiple treatment options exist when the disease is found early.

Why is breast cancer common in women?

Manirakiza noted that breast cancer is common in women because of multiple factors, stemming from the interplay of hormones and the presence of a larger breast tissue when compared to men.

"Their tissue is more exposed to hormones than it is for men. However, it’s worth knowing that male breast cancer is on the rise too.”

Awareness

The theme for this year’s World Breast Cancer Day is ‘Keeping Her in the Picture’ — a plea to everyone to keep an eye on the well-being of the significant women in their lives.

Manirakiza said that raising awareness of breast cancer is a big task, involving patients, survivors, scientists, physicians, and general society.

"People are likely to listen when they hear real stories of disease and cure that transcend the stigma that is associated with cancer. We need to step up context-based research on our own realities and go with survivors to outreaches, but at the same time we need a deeper involvement of public health,” Manirakiza said.

He also added that Rwandans are lucky that such steps are being made through government and NGOs, but more is needed in terms of structured screening and prevention methods.

Raising awareness, and stepping up how we educate our patients and their families is still needed, in simple terms and with empathy. There are some initiatives that are in the form of patients’ associations and support groups which are essential at all points of care from survivors supporting newer patients.