Long walk to fighting breast cancer

As the world unites in commemorating breast cancer awareness month, a month designed specifically to raise awareness of the disease, Malawi still has a long way to go in addressing the burden.

There are several factors that are being attributed as to the reason why the country still has a long way to go, according to a pathologist who specialises in breast cancer, Tamiwe Ng’ambi.

In a written response on Wednesday, Ng’ambi acknowledged of the efforts being implemented but highlighted a few factors as to why addressing the burden still remains Malawi’s biggest challenge.

For instance, she said the country does not have a national screening program as is the case with cervical cancer while mammography is only available in private hospitals. She said there are sporadic breast cancer awareness campaigns usually driven by individuals with messages on breast cancer and self-examination.

Ng’ambi also pointed out access to breast cancer pathway to diagnosis as one of the factors, emphasising that there is limitation as the country’s health system has limited capacity in general just like with most diseases.

She, however, said the country has managed to make huge strides on laboratory diagnosis, pointing out that Kamuzu Central Hospital (KCH) in Lilongwe now has a pathology laboratory with capacity to diagnose breast cancer on tissue samples sent from patients suspected to have breast cancer.

She said: “In addition, for the first time in Malawi, we are able to do special test on the breast cancer, that is, assessing for hormone receptors to guide whether a patient may need hormonal therapy or not, to determine aggressiveness of the cancer and likely prognosis.

“Previously, patients would just be treated with hormonal therapy without such assessments as to whether they need it or not. We need more pathologists, technologists and labs in all regions.”

On the part of treatment, Ng’ambi said despite chemotherapy drugs being readily available, they usually stock out and that there is no radiotherapy at the moment.

Further, she also pointed out human resource as one of the challenges the country continues to struggle with, saying the country only has two radiation oncologists for the 18 million population assisted by medical officers and nurses and no medical oncologists.

On research, she says there is scanty data regarding burden of breast cancer in the country.

“Our group at UNC project Malawi in collaboration with KCH established a breast cancer cohort study where women with breast cancer presenting to KCH are recruited.

“The aim is to follow up these women while they are receiving standard of care to characterise breast cancer in our setting in regards to risk factors, clinical presentation, tumour biology, treatment responses and survival,” she said.

She also said in terms of capacity, the country is moving towards the right direction. She however said capacity for breast cancer diagnosis and screening are only at central hospitals, but then if district hospitals could be equipped, there can be realisation of more patients.

In an earlier interview, two-time cancer survivor Blandina Khondowe, said the challenge currently is that there is no sufficient knowledge on the causes of breast cancer, therefore, early detection of the disease remains the cornerstone of breast cancer control.

“But fortunately, if breast cancer is detected early and if adequate diagnosis and treatment are readily available, then there is good chance that it can simply be cured,” she said.

Just like Khondowe, Ng’ambi agrees that it is difficult to say but the risk factors can be highlighted, such as limiting alcohol, controlling weight, breastfeeding, being physically active and avoiding exposure to radiation and environmental pollution, among others.

In a separate interview, Ministry of Health spokesperson Joshua Malango, said government is also implementing a number of initiatives as part of dealing with the burden.

He said: “What government is doing include awareness, health education, slef-breast examination plus counseling, early detection and surgical trainings among others.”