October is Breast Cancer Awareness Month, an annual international health campaign organised by major breast cancer charities to increase awareness of the disease and to raise funds for research into its cause, prevention, diagnosis, treatment and cure. Rwanda joins the rest of the world in creating awareness, however, challenges still prevail, mostly because people seek medical attention when the disease is at an advanced stage, despite calls to test early. Fighting breast cancer Breast cancer is one of the most commonly diagnosed malignancies in women, according to a newly established Rwanda Cancer Registry, with 2,382 cases diagnosed, data covering 2007-2018. Globally, breast cancer accounts for 1 in 4 cancer cases. In 2020, there were about 684,996 deaths from breast cancer. However, when breast cancer is detected early and treatment is available, the survival rate is very high. Unfortunately, in many low-and middle-income countries, 50 to 80 per cent of breast cancer cases are diagnosed at an advanced stage. This increases the cost of treatment and makes it usually incurable. According to Rwanda Biomedical Center (RBC) and Rwanda Cancer Registry, 52 per cent of breast cancer patients present their cancer with stage 3, and 24 per cent with stage 1, due to patients being unaware of their status. 60 per cent go to health centres with late presentation of the disease, mainly during stages 3 and 4. Last year alone, there were 741 new cases of breast cancer, a number received from all health facilities in Rwanda, but indirectly present the total number of cases. Dr Marc Hagenimana, Director of Cancer Diseases Unit at RBC, says this simply means an estimated number and not the actual one as they are not getting all people turning out for tests at health facilities. Why are people reluctant to go for early detection? Dr Hagenimana says poor awareness of the general population about breast cancer is one of the main reasons, where most of them confuse the signs with other diseases, ending up seeking traditional help instead of going to proper medical facilities. “Patients end up coming when the disease has advanced itself, making the whole process of treatment almost impossible and costly as well,” he says. Dr François Uwinkindi, Manager of Non-Communicable Diseases Division at RBC, says the way breast cancer manifests itself makes it hard for one to realise there is a problem. He says breast cancer, among other cancers, and most of the Non-Communicable Diseases (NCDs) are diseases that progress slowly. “They are mostly known as silent killers because they are asymptomatic (have no signs), as one realises they have them at a late stage,” he says. This, Dr Uwinkindi says, means that at an early stage, they do not have symptoms, and for this reason, people consult once they have started experiencing some of the signs, which is considered a late-stage already. Dr Nima Wangchuk, Program Coordinator for The Defeat-NCD Partnership United Nations Institute for Training and Research (UNITAR), RBC, cites ignorance of people in rural areas about the importance of early screening, detection, and treatment as one of the major challenges. Also, he mentions that shyness in undergoing screening procedures and seeking treatment, fear of being diagnosed as cancer positive and being shunned by society, as well as inadequate health infrastructure, screening, diagnostic, treatment facilities, and supplies are also making the early detection of cancer complicated. What should be done? According to Dr Wangchuk, aggressive advocacy on breast cancer screening, in urban and rural areas, and making sure that prompt diagnosis and treatment facilities are there on the screening spot is important. Otherwise, he says, most of the patients do not follow up. Dr Uwinkindi says there is also a capacity building gap when it comes to health care providers/health facilities. He says it is evident that the late presentations by breast cancer patients are due to lack of awareness among the public, as well as some health system delays. Dr Florence Sibomana, a medical doctor and member of Global Youth Leaders for Nutrition, mentions that there is a need to build the capacity of health care providers. “This can be rectified by training different health providers in different areas of cancer management,” she says. Dr Uwinkindi says strengthening and streamlining the referral process so that it doesn’t take long from referral centres to central hospitals, where the diagnosis and treatment are done is important. Dr Sibomana says there is a need to change the mind-set and culture, as well going for check-ups at least once a year before one falls sick. “The campaign for breast cancer awareness and early detection of cancers should start from the advocators. They should practice what they preach and become a role model for other people to follow and look up to. Health care providers and managers should set an example by themselves,” Dr Wangchuk says. The Ministry of Health has embarked on equipping health facilities in order to provide all the services needed as far as detecting cancer in its early stage is concerned. Also, they are working on improving awareness among the population about different types of cancer, and breast cancer awareness serves to ensure the public is enlightened on this disease to avoid further complications. In referral hospitals, they are improving the capacity on the level of detection, diagnosis, treatment to ensure a full package of cancer management in general. Recent data from RBC indicates the new cases among the common five cancers; breast cancer takes the lead with 741 newly diagnosed cases, followed by cervical cancer with 627, and prostate cancer with 410. Stomach cancer new cases stand at 373, while liver has 293 newly diagnosed patients.