A year ago a good friend was diagnosed with breast cancer. Bongi is considered lucky. The company she works for provides medical insurance that guaranteed she could afford to have mammograms every two years and therefore her cancer was detected early. Her course of chemotherapy was also paid for and, after her first round of the treatment,her cancer is now in remission.
Not so for many other women. Breast cancer was previously an illness that many just heard about. Now many of us know at least one person who has it — if we are lucky enough to be the ones not diagnosed with it. Although the government provides the cancer drug Herceptin, which costs half a million rand for a year’s course, there is still much more that can be done either as a preventive measure or to provide care.
Most South Africans, who are less privileged than my friend Bongi, get diagnosed when the disease is at an advanced stage. This is because there is an insufficient number of oncologists in public hospitals. Even when women are in pain, they may have to wait for weeks before they can be seen. The country is training enough oncologists, according to an oncologist friend, but too little money is in the budget to pay enough health specialists in different fields. South Africa is battling with the problem that medical specialists move into private care immediately after their studies, despite the need for them in the public health sector.
Second, more funds are needed for research so that therapies for different types of breast cancer can be tailored. Yes, I know. Until a few weeks ago I thought there was only one type of breast cancer. Turns out there is oestrogen receptor positive, progesterone receptor positive, human epidermal receptor positive and triple negative breast cancers. Of them all, triple negative is the most aggressive and the one that affects most South African women. And yet research institutes are not funded adequately so that treatment can be matched to the type of breast cancer the patient has.
I recently found out that, despite much fanfare about the provision of Herceptin in public hospitals by the government, the drug does not work for every form of breast cancer. Indeed, only 26%of people with breast cancer in South Africa have the cancer that requires the drug and, of those 26%,only four out of 10 will use the drug in conjunction with chemotherapy to try to prevent its recurrence after a year.Why then would much of the medical funds be dedicated to this instead of perhaps only 26% the department of health has dedicated to breast cancer, assuming they have done this?
Finally, there is a need for a serious breast cancer awareness campaign. In the 2000s, public clinics and hospitals had campaigns for nursing sisters to inform those seeking treatment of the need to test for HIV. There were also adverts on radio and television. Indeed, I remember my then three-year-old coming home from crèche and chanting, in response to being asked what he had learnt that day:“My friend with HIV is still my friend.”He then asked: “Mama, what is HIV?”We need a similar type of campaign to sensitise people to breast cancer.
Not for me the social media exercises that ask me to put in my status the colour of the bra I am wearing during breast cancer awareness month. I would rather oncologist friends and government campaigns make women aware of where to have a mammogram, what to do when they find out they have breast cancer and some of the things they can do to reduce the risk of getting the illness if one is not genetically predisposed to it.
For instance, prolonged oestrogen exposure creates abnormal cells and puts one at high risk of the illness. But no one tells us this when we have been on oestrogen-based birth control for years. I recall years ago trying to have a tubal ligation because I had no intention of having another child. The gynaecologist refused to perform the operation on the grounds that I had only one child. Instead, he continued my birth control course, which, I now know, is oestrogen-based and puts me at risk of getting breast cancer.Spare a thought then, for other 42-year-olds who may have started using certain forms of birth control from the age of 14 and the dangers they have been exposed to.
Perhaps this awareness should not be something that is left for the month of October alone. Rather, this should be a concerted campaign that continues throughout the year.
May you and your loved ones be breast cancer free. But if you should be diagnosed with it, here is hoping that, like my friend Bongi, you have an oncologist who is up to date with research on the illness and can give you the best advice on the necessary treatment for you. Oh, and if anyone you know and love is a woman over 40, do please tell them to have a mammogram every two years.