Breast and cervical cancer

To commemorate Breast Cancer Awareness in October, Global Health Strategies hosted a webinar titled Breast and Cervical Cancer — a conversation on risks, prevention, screening and support. Speakers were Professor Lynette Denny, Gynaecological Oncologist, Professor and Chair, Obstetrics and Gynaecology, University of Cape Town and Director, SA Medical Research Council (SAMRC) Gynaecology Cancer Research Centre; Dr Jenny Edge, Head of the Breast and Endocrine Unit at Tygerberg Hospital and Founder and Director of the NPO: Breast Course for Nurses; and Mawisa Chauke, Triple Negative Breast Cancer Survivor and a founder of MTS brand. It was moderated by Marcelle Gordon, Anchor on TV news channel eNCA.

When Professor Lynette Denny was undergoing chemotherapy for breast cancer, she stopped in at a public bathroom at Cape Town’s V&A Waterfront one day. “I went into the ladies, and a woman came up to me and said: ‘Excuse me sir, this is the women’s toilet.’ I said to her: ‘but I am a woman!’”

Having breast cancer, said Denny, is about so much more than just surviving. “There are many aspects to this, from losing your breasts to losing your hair, to being sick, to being a patient,” she said. There’s a huge need for psychosocial support for those with the disease. “It made me understand how disempowered we are as women and as patients.”

Thirty-two year old Mawisa Chauke can speak to that feeling of disempowerment. In December 2018, she felt some pain and discomfort in her left breast. Her doctor told her that it couldn’t be cancer, because “cancer is not painful”.

Following an ultrasound at the hospital she was told that the lump was probably caused by fibroids, which commonly affect women of her age. They told her to go home for six months and return because “maybe that lump would have shrunk”. But Chauke refused. “I know there’s a family history of cancer,” she said. At her insistence, the doctors proceeded with a biopsy the following month.

A week later, she was told she had triple negative breast cancer. Accounting for 10% – 15% of all breast cancer incidences, this disease does not have any of the receptors that normal cancer does. It often affects women younger than 40, spreads faster than other types, and the prognosis is generally worse. “Within a space of a month, already I was on stage three,” said Chauke.

Dr Jenny Edge said that many patients are initially misdiagnosed in the same way Chauke was. “Triple negative breast cancers both look and feel like fibroadenoma. So it’s quite complex,” she said.    

Edge, who also founded non-profit organisation Breast Course for Nurses, said that they are teaching young health workers that every patient above the age of 25 who presents with a lump in their breast requires further investigation. “Hopefully as this generation of doctors grow up, we will not have as many stories as Mawisa’s.”

Simply being a patient puts one in a position of dependence on a health worker, but the panellists highlighted how poverty further disadvantages the ill. “There are many, many barriers to the access to care,” said Edge.

An informal poll conducted amongst her clinic patients found that 40% did not access the necessary healthcare and screening because of the logistics and cost of transport. Apart from the considerable cost to get to the clinic, one patient described a common scenario: “I have to get up at 6am, leaving my 12-year old to take my four-year old to school.”

But the need for learning in this area doesn’t begin and end at grass roots level. Breast cancer, despite being the most common type of cancer among South African women, is a field where many questions in the science remain unanswered.

“We don’t know why many women have breast cancer,” said Edge. “We know that it is associated with being female (although men can get breast cancer too); we know that it is associated with getting older (the average age of Edge’s patients is 55) and we know that it’s associated with family history.”

What has been confirmed is that merely being female puts you at risk of contracting the disease. “No woman is at a low risk of getting breast cancer,” said Edge. “We have normal risk, we have high risk and we have very high risk.” Regular checks are therefore paramount. Best practice calls for women aged 40 and over to get a mammogram every year.

And then there’s cervical cancer, which occurs almost as regularly as breast cancer. Breast cancer gets “a lot more press” than cervix cancer, because cervical cancer is about that “down there, dirty area”, said Denny. But regular screening remains just as important. It’s recommended that women ages 21 to 65 get a pap smear every three to five years.

Regular checks by well-trained professionals could help curb the mortality rate of these two cancers. Denny is outspoken in her call for South Africans to expect better support from the healthcare system in this regard. Nine years after being diagnosed, she calls herself a breast cancer survivor because she got the right treatment from the right doctors at the right time.

 “The premature death of women from treatable or preventable cancers is just not acceptable,” said Denny. “We should be horrified by women dying from cancers that could be prevented or cured if caught in the early stages.” — Thalia Holmes

To view the webinar, click here