According to the World Health Organization (WHO, 2018), breast cancer is the most frequent cancer among women, impacting 2.1 million women each year. It also causes the greatest number of cancer-related deaths among women. In 2018, it is estimated that 627,000 women died from breast cancer — that is approximately 15 per cent of all cancer deaths among women. Majority of deaths due to breast cancer in low-income settings is greatly because these cancers are detected in late stages where medical intervention is very limited. Once considered to be a disease of the developed world, the incidence of breast cancer is gradually increasing in developing countries. Almost 50 per cent of breast cancer cases and 58 per cent of deaths occur in developing countries, and this is projected to worsen over time. Also, breast cancer is increasingly being detected in the younger population and this is worse in developing countries (on average the diagnosis is at 10 years younger than in developed countries). This is partly due to the increasing elderly population, urbanisation and its associated lifestyle changes. This coupled with the increasing public awareness and the availability of screening and diagnostic tools for breast cancer has favoured more breast cancers to be detected in our populations According to WHO-Cancer Country Profiles (Rwanda 2014), breast cancer affected 576 Rwandans and accounted for about 8.5 per cent of all cancer deaths. A study was done in Rwanda on the possible causes of delays in patients presenting with breast cancer (carried out in Butaro and Rwinkwavu Hospitals in 2015) indicated that 76 per cent of the patients weren’t bothered by the symptoms, whereas 63 per cent of the patients thought there was no need to seek medical advice and believed the symptoms would go on their own. Breast cancer usually presents at an older age (above 50 years), although can in some cases manifests as early as the age of 35 years in some females. Any appearance of a breast lump(s), changes in the shape or size of the breast or nipple, swelling in the armpit or breast pain should warrant medical consultation. Up to about 90 per cent of breast cancers begin as painless lumps in the breast, usually after the age of 35 years. It is important to know that even though the appearance of a breast lump or any of these symptoms at a much younger age is usually not associated with cancer, medical consultation should still be sought for proper evaluation and guidance. Apart from female gender and advancing age, other known risk factors for breast cancer include; family history of breast cancer (more significant family history is; first degree relative with breast cancer at less than 40 years, family member with breast cancers of both breasts, male breast cancer in the family), alcohol consumption (increases risk by up to 30 per cent and risk depends on quantity and duration), obesity especially postmenopausal obesity. Other risk factors include use of long term hormonal replacement therapies, and to a less extent cigarette smoking. Breastfeeding is known to lower one’s risk of developing breast cancer. The treatment options for breast cancer depend on many considerations but mainly on the stage of cancer at the time of diagnosis, availability of additional treatment options such as radiation therapy, as well as the patient’s choice, and et cetera. After diagnosis and proper staging of breast cancer; for breast cancers caught in early stages, surgery can be done to only remove the cancerous breast lump and any suspicious tissues in the breast and then radiation therapy given to the remaining breast tissues. This enables breast cancer to be cured without having to remove the whole of the woman’s breast and is also termed as breast-conserving surgery. In countries or centres without radiation therapy, most breast cancers are treated with surgery to remove the whole affected breast, usually followed with chemotherapy drugs to improve the overall treatment outcome. In Rwanda today, we have a fully equipped high-level radiation therapy centre, situated at Rwanda Military Hospital, where women can go for radiation therapy after these breast-conserving surgeries for breast cancer. This has enabled women to be cured of breast cancer without losing the whole of the affected breast, and hence the associated health, physical and psychological benefits. However, it is important to understand that this breast-conserving surgery with radiation therapy can only be done for early-stage cancers for the best outcome. Thus, the emphasis on early medical consultations for breast symptoms, as well as routine screening through both self and medical assessments even without symptoms, especially as one approaches the forties and older. Dr. Ian Shyaka, Resident in Plastic Surgery, Rwanda Military Hospital
