Pink October/ Breast cancer: Interview with Dr Kafui Améwoui, Obstetrician Gynecologist

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Extract from the article: In 2020, there were 2.3 million women with breast cancer and 685,000 deaths from breast cancer worldwide. Breast cancer results from a disorder of certain cells that multiply and most often form a mass called a tumour. It is a silent disease

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« Doing breast self-examination is the first way to detect breast cancer. Avoid all abuses, fatty, sugary and salty foods, and a sedentary lifestyle »

In 2020, there were 2.3 million women with breast cancer and 685,000 deaths from breast cancer worldwide. Breast cancer results from a disorder of certain cells that multiply and most often form a mass called a tumour. It is a silent disease, taking several months or even years to manifest itself.  Focus on the mechanism, risk factors, prevention and management of this disease in this interview with Dr. Kafui Dédé Benedicta Améwoui, Obstetrician Gynecologist.

Santé-Education: What is the situation of breast cancer management in Togo?

Dr. Dédé Améwoui: Breast cancer in Togo is detected earlier and earlier. Unlike previous years when the cases we encountered were really advanced with ulcerations.

With radiotherapy and chemotherapy, we are able to improve the survival of our patients. There is also progress on awareness. We are meeting more and more women and young girls who come spontaneously for screening when they have concerns and even when they don't have any concerns about their breast. They don't wait for the month of the fight against breast cancer. Since in cancerology we don't talk about cure, but remission, at the moment we have many patients in remission. If after the treatment and the controls, there is no sign of recurrence. They are under surveillance.

What is the reality of the fight against breast cancer in Togo?

Gynaecological and breast cancers are taking on very worrying proportions in Togo, especially breast cancer, which affects almost every household.  Togo does not yet have a cancer registry as such (an embryo of a registry is in the anapathology department of the CHU SO), which casts doubt on the reality of the growing number of cancers in general and breast cancer in particular. According to statistics from the hospital cancer registry in Togo, breast cancer has a rate of 27.1% (Integrated Policy and Strategic Plan for the fight against non-communicable diseases 2012-2015).

What are the warning signs?

As soon as an unusual change in the breasts is noticed, whether it is redness, deformation, retraction of the nipple, or induration of part of the skin. If there is an orange peel appearance or a discharge from the breast, a doctor must be consulted. As far as discharge is concerned, it must be specified that it is a discharge outside the breastfeeding period.

What are the different types of breast cancer?

There are several: non-invasive breast cancer, which can also be ductal carcinoma in situ (DCIS), the most common, or lobular carcinoma in situ (LCIS); invasive breast cancer or invasive ductal carcinoma (IDC); inflammatory breast cancer (IBC), a rare type of invasive breast cancer accounting for about 1-3% of all breast cancers. There is also Paget's disease of the nipple, another less common type of breast cancer; it accounts for less than 5% of all breast cancers.

What age group is most likely to get breast cancer?

Most cases occur between the ages of 45 and 65. This is sporadic breast cancer because there is the hereditary and sporadic form. In Togo, the case of sporadic cancer is high. Hereditary cancer represents 5 to 10% of breast cancers.

The sporadic form is linked to prolonged hormonal impregnation. A girl who has early puberty, before the age of 12, and a late menopause after the age of 55, is a person who has had a long hormonal impregnation, she has been exposed to hormones for a long time. And it is the repeated action of hormones on the cells in the breast that will eventually lead to breast cancer. As for the genetic form, from the age of 30 onwards, the risk is high.

What are the related expenses?

We cannot give an actual cost, because there are several breast cancers. It will depend on the results of the immunohistochemistry and the stage of the disease. In general, it is necessary to plan for a minimum of 300,000 FCFA per chemotherapy session. It takes 6 sessions of chemotherapy, i.e. 1800000 FCFA. There is radio therapy which is done when the disease is not advanced. It is necessary to provide about 1800000FCFA. At least 500,000 CFA francs are needed for surgery (mastectomy with lymph node removal). For metastatic breast cancer, it is even more complicated, depending on the results of the immunohistochemistry. Today, in addition to chemotherapy, we have targeted therapy, and immunotherapy has also been introduced. These therapies are very expensive. You have to pay several million for a session with targeted therapy or immunotherapy.

Breast cancer treatment is expensive everywhere, both in Europe and in Africa. One of the things that makes treatment expensive. It's the fact that we don't make the drugs. They are imported. 

In these conditions, can patients afford all these expenses?

Unfortunately, it is very difficult for our patients to meet these expenses. Asking someone to prepare 300,000 FCFA for a cancer chemotherapy session, hmmm, is not for everyone. Many families contribute but it's really difficult.

Are there any other difficulties they face apart from expenses?

They are family related. Patients often hide their diagnosis for fear of being rejected by their family. Many people still believe that cancer is contagious. Some husbands keep their wives apart. Many women have little acceptance of the fact that they have this disease. They need psychological support. Faced with the financial and family difficulties noted by the patients, it would be ideal if they could have free care.

As for family problems, we must continue to raise awareness, so that everyone understands that cancer is not a fatality, that they realise that cancer is not contagious, that patients need the encouragement and support of those around them. Women die because of their family situation, unfortunately.

How is breast cancer screening done?

Screening is done through breast self-examination, clinical examination by the doctor or midwife, mammography and breast ultrasound.

Self-examination should be done every month just after menstruation, and routine mammography every two years from the age of 50 (the average age of the most affected women in Togo is 52, with extremes ranging from 30 to 80) or from the age of 35 if there are risk factors (family history of breast cancer).

What are the specific needs for adequate management?

For adequate care, we need more equipment for the diagnosis and treatment of breast cancer.  Even though we have the equipment, it is very often defective or excessively expensive for our patients.

We need access to all the drugs used in breast cancer, whether they are used for chemotherapy, targeted therapies or immunotherapy.

What advice would you give to women?

Doing a breast self-examination is the first way to detect breast cancer. Women and girls should be able to do this. They should visit a doctor once a year. It may happen that they do their own breast examination and cannot detect a change. It is a good idea to consult specialists for a much more thorough examination. This recommendation is even more important for people who have had a mother, an aunt or a sister in their family who has suffered from this disease.

You have to live in a sober way. Avoid all abuses, fatty, sweet and salty foods, and a sedentary lifestyle. You must practice sports, avoid stress, which is a risk factor for all cancers, and alcohol abuse. You should breastfeed your child for at least 6 months and stop smoking. For this reason, we advise women who are around 40 years of age or who have a family history or abnormalities to be screened a little earlier. During the treatment cycle, the doctor's recommendations must be followed. After the treatment, it is important not to forget the regular visits to the doctor for check-ups.

Interview by Abel OZIH