Wubalem Bedilu, MD; Radiologist; Fellow in Beast and Women’s Imaging
Saint Paul Hospital millennium medical college (SPHMMC), Addis Ababa, Ethiopia
Last week I happened to meet this lovely 35-year old woman with three kids in the breast and women’s imaging unit in our hospital in Addis Ababa, Ethiopia. She came to have a biopsy taken from a right breast lump. She was so nervous that I had to calm her down by talking to her. She said she has three kids, the youngest being just 1 year old. Nine months back, when her youngest child was 3 months old, she discovered a lump in her breast and she went to a doctor. A sample was taken from the lump and it turned out that she had breast cancer. Her treating physician at that time advised her that she needed a mastectomy. But given the fact that she was breastfeeding and for fear of the potential stigma associated with having her breast removed she refused the mastectomy and she insisted on having only the lump removed. So lumpectomy was done and no further treatment like chemotherapy or radiation therapy was done post operatively. Now, nine months after the lumpectomy the patient came back after noticing multiple right breast masses and right axillary swelling. After discussing with her, a sample from the right breast and the right axillary swelling were taken and revealed breast cancer which has spread to the axillary lymph nodes. Unfortunately she was only 5years old when her mother died from breast cancer 30 years back and her mother was only 37 years old. Her mother was also advised to have mastectomy at the time of diagnosis but she refused to do so and she died of advanced breast cancer. This is an example of the many similar heartbreaking medical stories which is shared by many Ethiopian women. And it is sad that after 30 years, people’s awareness regarding breast cancer, breast cancer diagnosis and treatment has not made marked progress.
Breast cancer is becoming the number one cancer in women in Ethiopia. A report based on a study aimed at estimating the prevalence and types of cancers in Ethiopia in 2015 using population-Based registry data revealed a total of 21,563 and 42,722 incident cancer in males and females, respectively. The most common adult cancers were: cancers of the breast and cervix, colorectal cancer, non-Hodgkin lymphoma. Breast cancer was by far the commonest cancer, constituting 33% of the cancers in women and 23% of all cancers identified from the Addis Ababa cancer registry. It was also the commonest cancer in four of the six Ethiopian regions . Breast cancer is the number one cancer seen in women but enough attention is not given to it even if it is taking the lives of our mothers, sisters, daughters and aunts. For the past many years many advances have been made in the medical field in our country: many hospitals have been established and many new types of equipment have been installed. But surprisingly, enough effort has not been put towards breast cancer diagnosis and treatment .Patients with breast cancer, if they are lucky enough and they can afford, will go abroad for treatment. Otherwise they are only treated with mastectomy and chemotherapy. There is only one Radiation therapy center in the country, which is in Black lion hospital and given the fact that waiting list, is very long most of our patients actually will not get the opportunity to have radiotherapy.
Breast cancer is taking the life of many women in Ethiopia. There is no national screening program yet and the awareness on breast cancer is very low. This problem has been there for many years but breast cancer diagnosis and treatment has been neglected for years. Recently Saint Paul’s hospital millennium medical college (SPHMMC) which is located in the capital city, Addis Ababa, took the initiative to improve breast cancer prevention and care, by establishing fellowship programme in breast surgery and breast and women’s imaging and soon it will start a fellowship programmme in breast and women’s pathology. It has been now almost seven months since the start of the breast and women’s imaging programme by the radiology department. The department works in collaboration with Kansas University. Currently there is one mammography machine capable of taking images, but doing stereotactic biopsies is not possible since the machine lacks some necessary accessories. We are doing mammography images and ultrasound guided biopsies but given the lack of stereotactic biopsy, we are short handed and we cannot do much for those lesions which cannot be accessed by ultrasound. So patients with lesions which are not accessible by ultrasound are either followed with repeated imaging at short intervals or like in the old days, we tell the surgeons the area of suspicion and a more invasive surgical biopsy is done.
We are trying to do what we can inorder to make a difference in women’s life by creating awareness and by establishing breast screening programme. Since the start of the programme, we are seeing many breast cancer patients, the youngest patient we have seen so far being a 25 year old woman diagnosed with bilateral breast cancer. Though we are going slowly through a long bumpy road to improving breast cancer diagnosis and treatment, we are committed and sure that we will eventually make a difference, and we will succeed at the end of this journey to save the lives of breast cancer patients.
 Solomon T, Mahelet K et al. Estimates of Cancer Incidence in Ethiopia in 2015 Using Population-Based Registry Data