‘Breast cancer screening should start at age 40 for most women’

Dr. Matthew Obinna Nwaneri is an Associate Professor at Carver College of Medicine and Medical Director, Iowa Oncology Network, medical oncologist at the University of Iowa Health Care (UIHC), and part of the Breast, Colo-rectal, and Genitourinary Multidisciplinary Tumor Boards. is an Associate Professor at Carver College of Medicine and Medical Director, Iowa Oncology Network, medical oncologist at the University of Iowa Health Care (UIHC), and part of the Breast, Colo-rectal, and Genitourinary Multidisciplinary Tumor Boards. Having worked with diverse cancer cases and grown through the ranks in his over 30 years of practice, he speaks with IJEOMA THOMAS-ODIA in this interview on the need for people, especially women to pay attention to their breasts alongside their general wellness. Excerpts

What is responsible for breast cancer in women?
Breast cancer is the abnormal growth of cells in the breasts. Just as cancer is the abnormal growth of cells in the body; and this can occur in any part of the body, whether bone, brain, skin, breasts, bladder. All the tissues in the body can develop cancer. It is due to uncontrolled/abnormal cell growth. Breast cancer occurs in men (with worse outcomes due to delay in getting medical care). Women have more breast tissue than men; breast cancer ratio is about 100 in women, 1 in men (100:1).

How is breast cancer discovered, diagnosed and treated?
We have three main ways to treat diagnosed breast cancer – chemotherapy, surgery, and radiation. Most women find a breast mass, which is then reviewed with a mammogram and a breast ultrasound. The best way today (as of October 2019) is to first take a very small piece of the breast mass, called a Tru-Cut biopsy. This is evaluated in the laboratory to determine the best treatment options to use.

The testing is expensive but is the most important part of the treatment because it tells the doctors the best treatments to use and is used to plan for this. Then for most of my patients, we now recommend giving chemotherapy first to shrink the breast mass so that the surgery (to remove the breast mass) will be easier and much easier to perform. Many surgeons, some of whom are not breast expert surgeons, frighten women to go to surgery first. This is wrong. Any woman or man diagnosed with breast cancer should spend time and money to get a second opinion from an academic (university) centre or a specialist medical centre – even if you will eventually see your regular doctor. This will give you the whole picture and a different perspective of the treatments. It is not an easy thing to have your breast cut off. It is also always good to go with trusted and objective people to see the doctors (good friend, close relative or most importantly, your spouse). Take many notes on all the visits, ask questions, and do your homework.

Are there natural/alternative remedies to tackling breast cancer besides chemotherapy?
Beyond chemotherapy, there are several current biological or targeted therapies (also technically chemotherapy), which have much fewer side effects and hormonal therapies (which still have fewer side effects). The best option I know is that there are many different types of chemicals used, which are generally called chemotherapy – chemical therapy. Most people associate chemotherapy with medicines that cause hair loss and low blood counts, however, chemical therapy is a very general term. There is always a lot of fear associated with chemotherapy, but these medications have changed the outlook for millions of breast cancer patients and survivors today.

The term chemotherapy includes your commonly used Panadol, ibuprofen and even multivitamins. There are many alternative therapies, and many are undergoing clinical trials today. Once these have been tested, proved that they work, they are then approved by such organizations like NAFDAC in Nigeria and the Food and Drug Administration (FDA) in the USA. These are then available for general sale and use by the general public. Many people sell all sorts of concoctions/supplements of no proven value. The only thing common about these supplements and varied preparations is that they are not free. They should be bought with caution and carefully assessed before use. It is also best to review these with your doctors before using them. If you cannot discuss these with your doctors then look for doctors you can trust and be truthful with, this is your life.

Are there different treatments for African women compared to European women?
Everyone gets the same treatment whether African or European; there is just less than one percent difference in races, which is mostly in skin type/colour. We do not treat women of African descent different from women of European descent.

Is the number of victims rising or declining and what is responsible?
I feel that this is currently on the rise because people are living longer. Cancer is generally a disease of older individuals. Additionally, I think there are environmental chemicals affecting all of us, people are also more aware, some are also delaying childbirth – women who delay childbirth are at slightly more risk to develop breast cancer, and some women do not have any children at all.

Do you think there are more survivors compared to victims?
People are living longer and there are more breast cancer survivors. Our treatments and outcomes are much better than 30 years ago when I graduated from the University of Nigeria, Enugu.

How can women who had mastectomy cope with living with this?
The way to help people cope with this is to first have a very long discussion and support before the surgery of cutting off the breast (mastectomy) is done. This is done so the patient is ready (in mind and spirit) and is aware of what they need to do and how they can cope with making the choice. The ability to shrink the breast cancer, remove the lump and perform radiation to the breast has reduced the number of women undergoing a mastectomy. The issue of whether one of their breasts should be removed or not is very serious, and so the women need to talk to their doctor who will give all the detailed information they need. This is a very important discussion. A great reason for a second opinion, always.

Following the theme of this year’s breast cancer awareness month, ‘Give hope, save life’, how relevant is this?
I guess this is a good idea because early detection does save lives so, this is not something that can be treated at the primary health care unit, they must go to a specialist. This is expensive; there is no cheap way of taking care of this situation or is there a cheap healthcare. A lot of people do not go to the best they can afford, it is not about buying the best cars, but paying close attention to their health. So if you have a lump, have it checked out by a specialist.

Breast cancer is the second leading cause of death in women, is there any other form of cancer people should be wary about?
Worldwide, lung cancer kills more women, that is why breast cancer is number two. In Nigeria, cervical cancer is also very common. This can be prevented with immunisation with Gardasil 9. This immunisation is 99 per cent effective for all females and males aged: 9 to 45 years and requires two doses given 6 months apart. Immunisation for Hepatitis B – 3 doses; is also very protective for liver cancer.

There are also cases of cancer in children, what is responsible?
All cancer is uncontrolled/abnormal cell growth – lymphomas, sarcomas, and leukemias are quite common in children. Children are more likely to be cured and recover fully when diagnosed and treated promptly and appropriately.

Do you think the government should substitute the effort of numerous NGOs fighting this cause and how can they effectively lend their support?
The best government healthcare facilities in Nigeria are not patronised by the people in charge of funding the facilities. Individuals who can afford should have some form of health insurance to prepare for any health calamity, which is usually unpredictable. No government in any part of the world is able to take care of all its people with health challenges. Individuals should always be prepared for the unknown. People have car insurance (mandatory by law). Some have life insurance. Healthcare bankruptcy is the number one reason people lose their life savings.

Sadly, hopes and prayers do not stop illness. People do not leave their doors open and pray that thieves do not come, be prepared. NGOs are dependent on foreign and domestic donors; if the donor is broke, then the NGO is unable to function. Many NGOs in Nigeria today dealing with cancer are one-man organisations which are not sustainable. My recommendation for any persons, companies or governments supporting any NGO is to give support to those organisations that are large and have a clear/demonstrated national reach. Many current Nigerian NGOs are sadly suboptimal.

Appropriate due diligence must be done before such support is afforded. Some are doing good work, but many are not. Nigerian NGOs should be able to raise funds within Nigeria for Nigerians. That in my mind will be the true test. An NGO that is unable to garner local Nigerian support because of the visible good work they do has no business soliciting for funds outside Nigeria. Their work must speak. NGOs should be supported by philanthropy (we have many millionaires in Nigeria) and the evidence of the good work they do; and NOT the government-federal, state or local.

You talked about getting proper medical care from a specialist even as cancer treatment doesn’t come cheap, what is the way out?
I agree that this is not cheap. However, I remain of the opinion that any woman or man diagnosed with breast cancer, or any cancer, should spend time and the money to get a second opinion from an academic (university) centre or a specialist medical centre – even if they will eventually see their regular doctor. It is a life and death matter. A cancer diagnosis may be the time to get the best care you can afford. There should be no excuses or regrets for not getting your best care possible. Breast cancer screening should start at age 40 years for most women. All women should perform breast self-examinations periodically, at least monthly annual physical examination by a health care professional properly trained on how to examine and detect abnormalities in the breasts – nurse, midwife, nurse practitioner, medical doctor for women with an average breast cancer risk and who can afford it, a mammogram should be done annually starting at age 40. After 15 years of normal examinations or age 55, consider doing the mammogram every other year, based on discussion with your health care provider. Women with a first or second degree relative with breast cancer should start screening at least 10 years before the relative’s age of diagnosis. For example, if the relative was diagnosed at age 45, start screening at age 35. There are no standard breast cancer screening recommendations for men. Your healthcare provider should check out any abnormality immediately, at any age.