The deaths in very recent past of prominent Nigerians, Professor K.D.K Koki, Dr. D. Fiberesima , Yinka Craig, Chief Gani Fawehimi and a host of others unreported, will have severed as a wake up call to experts and primary health care practitioners about the urgent need to look at cancer in Nigeria as a public health problem and no longer a diseases of the White race.
No known curable drug for cancer has been discovered, and in resources limited countries like Nigeria, studies have shown that of all the several approaches towards healthcare, the most beneficial with regards to costs and benefits is in the province of preventive health care.
Surveys across the globe have shown that 7 to 10% of all cancer related deaths are attributable to factors that can be curtailed . These include
– Reproductive / sexual behaviors
– Diet and life style
– Environmental pollution
– Geographical features
– Genetic factors
What follows hereunder contains materials suitable for the medical, academic, allied medical and other categories of people interested in or involved with the subject matter. The lay public can benefit greatly by taking out what they can and then seek clarifications where necessary.
Amongst women, questions are being raised with regards to the changing patterns of cancer; is cancer changing from the cervix to the breast? What trends are we seeing with respect to our environment and carcinogens. Do we now have a place for the old but rejected and disregarded BSE (Breast Self Examination)? How effective is Breast Self Examination in primary level care particularly amongst uneducated rural women compared to women in high socio-economic class in whom breast cancer is most common?
In any case, the issues are worth considering;
Cancer is Greek World for Crab, which arose, because of the need by Ancient Anatomist to define a new growth, (neoplasia) that had gone beyond the confines of it’s tissues and developed the structures with which it can spread to distant sites,(usually un encapsulated). That scientific enquiry by Anatomist gave birth to the word cancer as it is known today.
The smallest morphologically identifiable and functional unit of an organism is the cell. Cancer is said to have occurred when a group of cells arising from the same origin become selectively and abnormally favored in such a away that the normal regulatory mechanism for cellular growth, is lost, with the result that the cells expand and invade neighboring tissues, neurovascular channels and then spread to distant sites.
Breast cancer is now being referred to as the ultimate cancer in women, because the organ undergoes morphological (structural) changes throughout the life of a woman. According to SEER (Surveillance Epidemiology and End Results), the probability of a woman developing breast cancer increases throughout life from birth to death.
World wide 43,000 women out of reported cases die each year and on the average, 1000,000 women develop breast cancer each year. Studies in the US show an age adjusted rate of 27 per 100,000 deaths and Globally it has been estimated that 1 out of every 11 women will develop breast cancer in their life time.
In Nigeria, breast cancer afflicts an estimated 12,000 women annually. About 5% of cases of pregnancy associated breast cancer have been seen and in most studies mortality is as high as 80 90% adding to the burden of care associated with perinatal and maternal morbidity.
The Problem
The form (morphology) function (physiology) and diseases (Pathology) of the human female breast are major concerns of not only physicians, but families and societies.
The organ(breast) is located in an exposed part of the body, but sexual health is taught sparingly in most Nigerian Schools, Cultural and religious barriers forbid detailed conversations of the nature expected of that private part of the human body. In deed and in some parts of the Country and the world, only female medical practitioners are permitted to carry out detailed medical examination on women. More over, because signature symptoms and signs of breast cancer are subtle, emerge later or even absent from the onset, some affected women die without ever knowing what killed them. Breast cancer patients of the Nigerian African descent at the time of presentation, are on the average 10 to 15 years younger ,compared with women in the Western countries and it is in the younger age group that pregnancy associated breast cancer(PABC) though uncommon present with very challenging obstetric and gynecological situations.
The whip lash of the economy cuts deepest into the underserved who live in abject poverty, have no access to radio and television and are too far away from primary health care facilities. How do we mainstream these vulnerable and under reported group? The answer is not far to fetch; we create awareness and encourage participatory health care delivery system, in the spirit of self realization because health education and health promotional activities yield better and sustainable results when you start from the known to the unknown.
To ascertain health status of the breast, detect and diagnose early abnormalities and treat or be treated. It is of paramount importance that, every woman(age not a serious barrier), first responders, paramedics, general practitioners, family Physicians and other specialists at various levels of the system understand the anatomy of both the glandular and connective tissue components of the breast, and of the inter relationship between these components..
Research findings suggest that if there is increased awareness and improvement in the capacity of women to understand themselves and members of their families, to enable them cultivate risk avoidance behavior and seek medical attention early enough, further substantial reduction in breast cancer and other cancer related death is achievable. Awareness may not translate to knowledge all the time, but according to Ancient Chinese Public health practitioners,
“When I hear about something I forget it”
“When I see something, I remember it,”
“When I do something, I know it.”
Indeed, physical examination of the breast by self, Sister, Aunt, Mom, is in fact a demonstration of its Anatomy, in a living subject. The same concepts apply as when a physician does breast examination in the consulting room.
Clinical Anatomy
The breast; nor Mamma is a modified skin appendage of appocrine sweat gland specialized for milk production. It is the major anatomic structure, by virtue of which modern humans as Homosapiens are placed in the class Mammalia.
Prepubertal male breast is nearly always the same as the female, and just like females males can develop cancer of the breast and die even faster from it’s complications. In the growing human, distinct anatomical differences develop soon after under the influence of gonadal (Ovarian) hormones. Indeed, the male breast can be made to enlarge and even produce breast milk, if the appropriate hormonal regulatory factors are supplied in controlled amounts.
Embryology
Development of the breast begins by about the 4th week of intra uterine life, through the 8th to the 12thweek . This falls within and a little beyond the period of human embryogenesis .it is during this period that agents which are capable of disrupting or aborting the normal process or program of development are best avoided. By puberty, the human hypothalamohypophyseal gonadal axis becomes more active and releases it’s hold on Ovarian activities, leading to the growth and development of the female breast.
At the appropriate time, pregnancy pumps estrogen and progesterone into the female circulation reinforced by placental uterine , thyroid and adrenal hormones, all leading to enlargement of the glandular and connective tissue elements of the breast, changes which in most cases are only slightly but significantly reversible with cessation of lactation.
