Breast cancer can be treated successfully when it is found early. The problem is that too many women in Rwanda are finding out they have it when it is already advanced. In 2023, 73 per cent of breast cancer cases with staging information in the national cancer registry were diagnosed at stage three or four. At that stage, treatment is longer, more expensive, and less likely to cure. About 800 women were diagnosed with breast cancer in Rwanda in 2022, and roughly half that number died. Some of these deaths could have been avoided if women had recognised the signs earlier and reached care sooner. Men also get breast cancer, although it is uncommon. According to the World Health Organization (WHO), about 0.5–1 per cent of breast cancer cases occur in men and about 99 per cent in women. October is Breast Cancer Awareness Month, a good time to talk about what women can do to reduce their risk and find the disease early. But many women still face challenges, including not knowing their risk, ignoring a painless lump, fearing the disease, struggling to afford trips to health facilities, or facing stigma after diagnosis. Knowing the risk Some breast cancer risks cannot be changed, including age and family history; for example, a woman whose mother or sister has had breast cancer has about twice the risk of developing it, and the risk is even higher when two close relatives have had the disease. Knowing the family history can help women understand their risk and share it with a health worker. Other risk factors are linked to lifestyle. Drinking alcohol, smoking, being physically inactive and gaining weight after menopause can increase the risk of breast cancer. Breastfeeding can lower the risk, with longer breastfeeding offering more protection, while regular exercise can help reduce the risk regardless of a woman’s weight. Recognising the signs A woman who knows her breasts is more likely to notice changes. A lump in the breast or armpit, skin that dimples or looks like orange peel, a nipple that turns inward or leaks fluid or blood, or a change in breast size or shape should prompt a visit to a health worker. Checking the breasts can help women notice changes, but it does not replace a clinical breast examination by a trained provider. Mammography is the only screening test proven to reduce breast cancer deaths, mainly in women aged 50 and above. For most women, a clinical breast examination at a health facility is the practical first step. Why women delay seeking care Several problems continue to delay care. Many women do not know the risk factors or early signs. A painless lump may be ignored until it grows or breaks the skin. Fear, stigma, and myths also keep women away from care. A 2024 study with community health workers in Burera found that women with breast cancer may be treated as a burden at home, abandoned by partners, considered unproductive at work, and subjected to gossip. Some are even called a “walking corpse”. The belief that a woman must have two breasts can add shame and affect marriage. Distance and poverty also make it harder for women to complete care. Those living far from cancer centres may struggle to pay for transport, take time away from work or find money for childcare. The National Cancer Control Plan identifies poverty as the main reason some women do not complete referrals. Only a handful of facilities in Rwanda have mammography (breast X-ray) services, while cancer treatment is concentrated in three hospitals. The country also does not yet have a national breast screening programme, and in 2024, only about four percent of eligible women were screened. Improving early detection and support Community education should continue throughout the year through community health workers, schools, churches, radio and social media. Women need clear information on breast cancer signs, risk factors, and where to seek care. Survivors can also help reduce fear and stigma by sharing their experiences. Limiting alcohol, avoiding tobacco, staying active, keeping a healthy weight, and breastfeeding all lower breast cancer risk. Most of these habits also protect against diabetes, heart disease, and other cancers. Early detection can be improved by training health-centre nurses to examine breasts and quickly refer women. A programme in Burera showed this can find cancers earlier and should be expanded. The National Cancer Control Plan 2025–2029 aims to provide breast ultrasound and biopsy at district hospitals, reach 50 per cent screening coverage by 2029, and pilot mammography. These plans need funding and follow-through. Women facing financial difficulties need support with transport, lodging, counselling, peer support, and breast prostheses after surgery. The writer is a medical doctor and public health advocate.
