I was recently working with my student volunteers when one of them asked me, “Ms. D, from what I have learnt from you, breast cancer awareness should be a daily occurrence. Why is October the month for breast cancer awareness?” I realised that other people may also be wondering, why October? Breast Cancer Awareness Month is a global campaign lasting the month of October with intentions to increase awareness about breast cancer. The first organised effort to bring widespread attention to breast cancer occurred as a weeklong event in USA in October 1985. Since then, campaigns to increase awareness about this disease, to educate people about methods of prevention, early detection and to raise money to support research have extended to countries around the world. Today, non-profit organisations, Government agencies and medical institutions work together to promote breast cancer awareness. People choose to walk, run, cheer and innovate ways to show support for this great cause. Current state According to the World Health Organisation, breast cancer is the most common cancer among women worldwide and in low-income countries like Rwanda, it is the second leading cause of death after cervical cancer. According to RBC and Rwanda Cancer Registry, 52% of breast cancer patients present their cancer with stage III and 24% with stage I. This is due to patient related delays (being unaware of the importance of early detection and lack of transportation means), or system delays in diagnosis due to inadequate infrastructure and specialisation. Although breast cancer remains a big challenge, Rwanda has made major strides in addressing cancer in general. A cancer registry has been established and with increasing interest in research. Strategies for early detection with awareness of early signs, symptoms, screening by breast self-exam and clinical breast exam practice are integral to BCIEA program. Cancer awareness for the general population is gaining Government attention; promotion of comprehensive breast cancer control is part of the 5-year-National Cancer Control Plan launched in March 2020. Cancer patients are receiving chemotherapy at Butaro Cancer Centre and Radiotherapy at the Rwanda Cancer Centre in Kanombe which has greatly reduced the need to refer patients outside the country. Now we have Butaro Cancer Centre of Excellence, Rwanda Cancer Centre in Kanombe and the five major hospitals with specialised staff—of course, we need more medical infrastructure and capacity building, but it is incredibly inspiring to know that a breast cancer patient no longer has to leave the country for treatment. Expanded availability of surgery, chemotherapy and radiation therapy services means that Rwandans have the option to receive treatment at home. However, the cost of cancer care remains a major challenge. The community-based insurance pays only 90% of non- chemotherapy medical bills and the remaining 10% still remains unaffordable to many patients with breast cancer. Setbacks from the pandemic COVID-19 affected breast cancer care in many ways: because of its highly contagious nature, any medical procedure considered elective or not necessary to save life was cancelled or delayed. Because of this, some patients developed anxiety, fear, stress and panic in addition to their cancer. In practical terms, the impact is heavy this October; without our annual Ulinzi Walk and Ulinzi Fundraising Dinner, our major awareness events and source of funding, it is going to be tough on the program. It is a fact; cancer does not stop when crisis happens. In fact, the crisis amplified and exposed our shortcomings. Social distancing and lock down severely disrupted our work in promoting awareness, prevention and treatment. The majority of program activities are community based interactions, with social distancing, they all came to a standstill. The essential human connectivity suffered especially for rural beneficiaries without cell phones. For patients, it increased behaviour risk factors: physical inactivity, unhealthy diets, delayed regular check-ups/follow ups, depression and mental issues.This calls for everybody on individual basis, to pay more attention to the 2020 October Breast Cancer Awareness Campaign. BCIEA’s role A pink ribbon symbolises breast cancer awareness hence all the pink you see around you. For me, pink has become my life-purpose since I met breast cancer head-on - it killed my sister; I survived it and in defiance of it and memory of my sister, I became a fiercely passionate advocate against breast cancer. When you see me, you see pink- a permanent reminder of the urgent need to fight this disease until we find the cure. BCIEA is the vehicle through which this fight is conducted. Because of BCIEA’s campaign as well as from other stakeholders, mobilisation and community outreach-education, breast cancer awareness is gaining grounds in Rwanda but much more remains to be done. BCIEA’s revamped innovative project called Fighting Breast Cancer One Smartphone per Village that integrates technology of a smartphone, BCIEA Breast Health Educational App- both of which are implemented by medical students and village ambassadors, will boost awareness starting from the village level. There is no confirmed cause of breast cancer and this makes early detection the cornerstone of breast cancer control. It is a known fact that when breast cancer is detected early, with adequate, timely and accurate diagnosis and treatment, it can be cured. If detected late, curative treatment is difficult or impossible and palliative care becomes the option for the patients and their families. Majority of deaths, annually 269,000 in low in-come countries (according to WHO) are due to lack of awareness, early detection and disparities in the health care systems and services. BCIEA’s logo illustrates the determinants of low survival rates in underserved settings of the world like Rwanda. Our pink Logo is in harmony with the universal fight against breast cancer. It also symbolises the African woman who is ever so busy, that she never has time for herself. She is at the forefront of the physical, emotional and spiritual needs of her family. She strives and toils to meet the needs of her children and the whims and desires of her husband. She is far too busy to afford time-off. Sick leave is not an option. She is afraid to express her weakness for this makes her vulnerably replaceable – “What about my children?” constantly haunts her and she must hide her pain. Her socio-economic status does not include any health care insurance, so “Why bother about what’s wrong with me if I have no power or means to change it?” She laments. Her situation is compounded by geography, the few ill-equipped health clinics in the rural area where she lives, even if she visited the clinic nothing much would be done to help her. This woman’s dilemma is real. She must learn to take charge of her health. She must be empowered to change so that she can truly play her role as the backbone of her society. Ben Franklin, an American polymath said, “An investment in knowledge always pays the best interest.” Early detection remains is crucial, raising awareness is a must and reducing risk factors is necessary. Financial support for above issues is essential at individual, local, national and international levels: we are all in this together. For how you can get involved in what BCIEA Inc. is doing to address Breast Cancer in Rwanda and beyond, please visit our website: https://breastcancerafrica.org or visit our Pink Wellness House: KK 130 Nyarugunga, Kanombe, Kigali, Rwanda. The writer is the Founder and CEO, Breast Cancer Initiative East Africa (BCIEA) Inc.
