Better education about breast cancer treatment in Africa

Bookmark and Share
Published: 5 Jun 2019
Views: 1387
Dr Beatrice Wiafe-Addai - Peace And Love Hospital Breast care International, Accra, Ghana

Dr Beatrice Wiafe-Addai speaks to ecancer at the Global Health Catalyst Summit 2019 at the Dana Farber Cancer Institute in Boston, Massachusetts about breast cancer in Africa.

She begins by highlighting some of the common problems faced in Africa regarding breast cancer, including cultural and religious attitudes. She describes some ways they are trying to change the misconceptions surrounding the disease.

Dr Wiafe-Addai outlines some of the great progress she has experienced so far, and the importance of collaboration.

The issue about breast cancer in the African woman and in the Ghanaian woman is something that actually has been bothering me for a lot of years, for so many years. As a breast surgeon I realised that the women were not coming early to the hospital and their reasons were multiple. I found that a lot of our people are not knowledgeable, they are not educated, they cannot read nor write so their understanding and knowledge about breast cancer is very limited. There are a lot of myths and misconceptions surrounding breast cancer because people think it’s caused by witchcraft, it’s a spiritual disease, it’s an incurable disease, it’s a curse on their family, especially when there is a positive family history. So because of all this breast cancer is still stigmatised and we needed to do something about it.

That something had to do with education – educating them, going through the women and not sitting in the consulting rooms to wait for them to come when it’s too late. Going to them in the churches, in the marketplace, at the workplaces, in their communities and educating them about breast cancer and the fact that it’s a disease. It’s one of the non-communicable diseases and it’s happening in Africa as it happens in America or Europe. So our women need to know that and the fact that when they go to the hospital early they can be cured.

So we started looking out for the breast cancer patients who have been cured, the survivors, and to use them as the face of breast cancer. So we invited survivors, we formed the association for them and empowered them to teach them how to share their story. So we have a programme called the HOPE – Helping Others through Personal Experience. So these survivors share their stories with women, especially with the newly diagnosed women, and they help navigate them as peer navigators through their cancer journey.

We also realised that educating the already grown woman is quite challenging because of their social beliefs, psychological beliefs, their cultural beliefs. So we needed to go down to their children and, by the way, breast cancer strikes quite early in our women. Most women are diagnosed with breast cancer when she’s about 30 years, 40, when her children are still young so it’s a challenging situation. The kind of disease our people have is mostly triple negative disease which is difficult to fight. It has become a cycle – the women are scared to come to the hospital because they don’t want to undergo mastectomy because of the defect that they will get on their bodies. But then when they roam and roam they go to their prayer camps, they go to traditional healers. At the end of the day they will come back to the hospital when their disease has advanced too much that you cannot even cure her. But then they believe that their condition got worse when they went to the hospital. So we need to do a lot of education and that’s why we sent our education to the schools.

In Ghana we have a lot of senior high schools. For the past two years we’ve been having the free senior high school so a lot of children are in school now so we use that platform to educate them. Recently we started with the girls’ ambassadors to train some of the girls to also start girl clubs, the breast clubs in their schools to start educating and engender the idea about breast cancer and the fact that it’s a disease that is in the whole world, it’s a global disease, it’s not a spiritual disease like their mothers are telling them. We believe that whilst we train the girls they will help us to educate their mothers, their grandmothers and their aunties. And by the time they grow up they wouldn’t believe that breast cancer is caused by witchcraft.

Again, these days we are finding very young girls with breast cancer. In fact, the youngest patient we have is a 13 year old girl who presented with a phyllodes tumour, a huge phyllodes tumour of one breast. After three months it had transferred to the other breast and the other breast had an intermediate one. So we had to do a double mastectomy for a 13 year old girl. In fact she was even pleading that we should take the tumours away because for two years she hasn’t been able to go to school because of the stigma, they were laughing at her in school. So if we are getting young girls with huge tumours then it’s very important that we educate them whilst they are young, to catch them young, to teach them how to know their bodies, how to screen themselves, to examine their own breasts so that when there is some abnormality they will be able to detect it early enough and go to the hospital.

Have you seen any recent progress?

A lot and that has been keeping us going. If at the time we started, about twenty years ago, we couldn’t get even one woman to come out and say that she’s a breast cancer survivor because of the stigma. Now we have them coming out in their numbers and saying it with pride that they are survivors, they have survived it and it’s not their fault that they got breast cancer. Unfortunately a lot of men divorce their wives when they are diagnosed with breast cancer, that has been a challenge. Because of that some women do not want to disclose their diagnosis with their partners because a man can divorce her. So these days when we go to a church we educate both the women and the men. The men are getting breast cancer, they don’t want to believe it because they think they don’t have breasts but we are diagnosing men with advanced stage breast cancer. We also want them to listen to the lectures that we are giving because they need to know that the women develop the disease not because she wanted it, not because she had done anything wrong. It’s a disease, it’s a global disease so every woman is at risk of developing it so our men also need to be knowledgeable to know how to handle their wives, their sisters, their mothers when they are diagnosed with breast cancer.

What kind of impact do partnerships have?

I think a lot. No one organisation, no one institution can handle everything and be successful. We need to learn how to collaborate, share ideas, see where we can partner. Because, for example, when we take research, we need to do research into the psychosocial attitudes and psychosocial problems that we have in our society because it’s different and we cannot also pick one practice and go and plant it in a country. We need to learn what is happening in that country and know how to impact. That is why we need to look out for country champions – people who are in those countries that can help move the fight, be it in the psychosocial world, be it in the diagnostics, in treatment, rehabilitation because a lot needs to be done as we move on. So collaboration is something that I think we can do.

I always say that we are in a global village. We can’t afford to sit and keep sleeping whilst the rest of the world is running. We need to learn how to run after them and also catch up. The narrative of Africa is too bad but we can help. There are lot of things we can do. I don’t believe that we don’t have resources, I know that we have the resources so we can collaborate and see the way Harvard, for example, can help us to unravel the kinds of resources that we have to make use of the people we have and see how we can transfer ideas and knowledge. Even when it comes to human resources we can see how to transfer some of the ideas, how to bring some people. These days with ICT we can just do some calls and do some training, e-learning that is happening. We have to take advantage of all the positive things and move further and faster than we are doing. Because already we don’t need to reinvent the wheel, a lot of things have been done already. We just need to look up to them and pick the good things, the best practices, and make use of them so that we can save more people. There is no point in bringing all the people over to Harvard to come and cure and treat them, no, but we can do a lot by sending a few specialists to go and impact the knowledge so that a lot of people will benefit from that transfer of knowledge.

Has there been much screening and vaccination for cervical cancer?

Yes. For cervical cancer a lot has been done. There have been projects here and there that have helped but they have been sporadic. We don’t have a national programme to vaccinate the girls, not yet. We need to educate the people, the population, for them to understand that that is feasible and is going to be helpful. The government has to be involved in this. We are already doing some screening so we use the breast cancer platform to educate women about cervical cancer. Then as we are doing clinical breast examination for women we do cervical screening, the VI, the visual inspection, with acetic acid. Those who have suspicious areas are then referred to their gynaecologist who decides on what to do – the PAP smear or those who need hysterectomy further or biopsies to do.

But for preventive measures we need to talk a lot about it. We need to have a serious discussion with the government. Here the Ghana Cancer Board has picked this up and is having serious discussions with our Gender Ministry so that they will know how to channel this and involve the schools, the Ghana Education Service, so that parents will agree for their children to be vaccinated. Because we already have the precedents elsewhere so it’s up to us to explain to our people that other countries are doing it and if we don’t do it in the future it’s going to be an epidemic on us. Cervical cancer is something that can be eradicated and if the world is doing it we should not sit sleeping.

This is true for all the African countries and, as the President Elect of AORTIC, it’s something that we are still talking and we are going to make sure that a lot of African countries will buy into this. Some countries have already started but the majority of the countries haven’t touched it.