Breast Cancer in Nigeria and Treatment Facilities

Cancer is the highest contributor to morbidity and mortality globally. By the year 2020, WHO reports a hike to more than 15 million of cancer cases with over 12 million deaths due to cancer. And the maximum load would be in developing countries like Nigeria. These areas are more so at risk due to higher exposure to tobacco and lifestyle patterns like alcohol abuse, dietary status, industrial exposure and mainly lack of awareness about breast cancer.

Nigerian health care faces a looming public health issue in the form of Breast cancer. It has the highest prevalence of all the ailments affecting the Nigerian women. In Nigeria, the current scenario is sadly quite dismal as regards the numbers (more than 40% women) affected combined with the management of breast cancer in the country.

Nigeria has had a tough past and owing to a long history of turbulent governance, the country is faced by depressing health system. The statistics claim that in Nigerian women (aged 30 and more) breast cancer follows up with increased physical and emotional stress like elsewhere. Not to forget the increased incidence in this age group and also mortality. The numbers paint a very dis-heartening picture with WHO stating that highest mortality by cancer is in the sub-Saharan Africa. The numbers are quite evident of the inadequacy of the system to be able to manage the persistent increase of the disease incidence in the female population.

Nigeria as an isolated case has shown that massive burden of breast cancer and is apparent from having high incidence in the peak age of 42.6 years, as the patient is young when affected the disease runs an aggressive course. More than 12% of patients are less than 30 years of age. Maximum detection is during pregnancy and most of the times it is delayed. Also the tumors are bulky and Scirrhous.

Increasingly the issues which pose a problem in treatment in Nigeria for breast cancer are primarily lack of awareness, treatment available in select hospitals and also absence of availability of entire gamut of treatment facilities. Breast cancer in Nigerian women has majority contributor to the ratio by young women and premenopausal women. In the available health care structure the treatment compliance is worrisome with patients dying or being lost to follow up on a rise. The prime treatment modality for breast cancer is surgical intervention, wherein the malignant growth is localized. This is followed if required by chemotherapy, radiotherapy and for certain tumors with adjuvant hormonal therapy.  India with renowned hospitals like AIIMS and Tata Memorial, Dharamshila offer the best management of breast cancer. 

It has been estimated that in Nigeria we are looking at roughly 500,000 new cases of cancer annually. This is a hint of the mammoth cancer burden in the country, which also has a relative high incidence rate of male breast cancer. The disease takes up an aggressive course and poor prognosis adds to the sad situation. The burden is augmented by the poor awareness and delayed presentation to clinical setting which are devoid of required treatment modalities and facilities.

In Nigeria the detection, diagnosis and staging of breast cancer is dependent on typical investigations like biopsy, X-rays, abdominal USG scan. There is limited use of mammography, CT, flow cytometry, frozen section histology.  Thus modern and advanced third generation technology is not available. Also as there is delayed presentation the Lymphatic basin mapping and sentinel node biopsy are futile.  Simple mastectomy is still the predominant surgical intervention done in Nigeria and there is lack of targeted and multimodal therapy combinations. The facilities available in Nigeria are scanty, old and not evenly distributed. Radiation therapy is not available all over. The healthcare facilities also do not have access to state – of – the – art drugs, the effective drugs are pricey and not within reach.

Hospitals in India provide a management backed by multidisciplinary team in tandem with international guidelines.  Breast cancer patients for best treatment are divided as per the clinical parameters and categorized in risk category segments. Each segment or each individual patient is prescribed a subjective therapy treatment. Chemotherapy, hormone therapy, immune therapy, radiation therapy are the various treatment possibilities available.  The cost of cancer drugs available in India is affordable; modalities (third generation radiation technology) used for breast cancer treatment are modern and up-dated. Yes the disease is a terminal disease but the treatment facilities required for sustenance and life prolongation are available. India has hospitals that have radiotherapy and nuclear medicine facilities for effective cancer treatment. India is a prime destination for a positive outcome of the disease for the affected population. Poor prognosis in Nigerian women results in increased mortality and answer lies with hospitals that have treatment facilities for advanced cancer treatment.