Breast cancer in Africa: What you need to know

 

By Oluwasola Samuel, Datelinehealth Africa Volunteer Freelance Writer, with editorial support from The DLHA Team

 

 

 

Introduction

 

The breast is a part of the reproductive organs in women. Its main function is to produce milk to feed babies in the post-delivery period.

Men also have breasts, but it does not have similar function as in women.

The breast is subject to various diseases and conditions. Abnormal growth of cells (i.e. cancer) in tissues contained within the breast is one of such.

Before we learn more about breast cancer, let us take a brief look at the structure (anatomy) of a woman's breast (see figure 1).

Figure 1: Showing structure (anatomy) of the female breast

 

Briefly, the female breast is composed of the following: 

• Fibrous tissues. These are also known as the connective or supportive tissues. They are lumpy or rope-like tissues that hold all breast tissues together.

• Glandular tissues. These consist of the lobes that produce milk, and the milk passes through a tube called the duct that carries the milk to the nipple.

Together, the fibrous and the glandular tissues are called fibroglandular tissues.

• Fatty tissues are fat cells that occupy the spaces between the fibrous and glandular tissues. These fat cells determine the size and shape of the human breast.

 

In this article, we will look more in-depth at:

• What breast cancer is?
• Signs and symptoms of breast cancer.
• Types and stages of breast cancer.
• The risk factors and how to limit them. 
• How to detect breast cancer. 
• Breast cancer in men, and 
• Some valuable questions that will add to your knowledge about breast cancer. 

 

 

What is breast cancer?     

 

Breast cancer is caused by genetic changes in breast cells, typically those in the lobules or ducts. These changes cause cells to divide uncontrollably, leading to the destruction of breast tissues. On average, the size of breast cancer doubles every six months. The aggressiveness and rate of growth of breast cancer can vary.

Breast cancer can spread to the outer part of the breast via lymph nodes and blood vessels in the breast. At this point, it's said to be metastatic breast cancer.

Breast cancer is the second most common type of cancer among women, and it is most likely to affect those aged 50 and older.¹ However, it is important to note that breast cancer can also occur in women under the age of 50.

 

 

How common is Breast Cancer in Africa?

 

Compared to high income countries, detailed information on the burden of breast cancer in Africa and sub-Saharan Africa (SSA) in particular is not robust and hardly population centered.

Notwithstanding, according to the global statistics on the burden of breast cancer in 2020, the rate of new cases of breast cancer in females in SSA countries in 2020 was estimated at 187,000, with a death rate of around 86,000.² Comparable global data is over 2.3 million new cases and 685,000 deaths yearly. In effect, 8.3% of global cases of breast cancer occurred in SSA, with a mortality rate of 12.5% of global deaths.

Interestingly, there is inequality in the burden of breast cancer within sub-regions of SSA as shown in Table 1 below.

Table 1: Showing age standardized incidence and mortality rates per 100,000 women in different sub-regions of Africa in 2020. World data included for comparison. Data source. 

 

Women aged 50 years and older represented 70% of new cases and 81% of death cases globally. This makes women in this age group to be at the highest risk for breast cancer.²

The projected new cases and mortality for breast cancer in 2050 are expected to double current estimates and the majority of this will be in SSA.³

Both men and women can get breast cancer although it is far more common in women ⁴. More on this later.

 

 

How do I know that I have breast cancer?

 

Early detection of breast cancer is critical, and it involves self-examination and screening. The majority of breast cancer patients are asymptomatic—that is, they never had any signs or symptoms of the disease.

It is important to stay informed about the signs and symptoms of breast cancer. Here is a list of what you should look out for:

• Lump in the breast
• Swelling in one part of the whole breast
• Unusual nipple discharge
• Redness in one part of the whole breast
• Breast or nipple pain
• Changes in the skin of the breast texture
• Retracted or inverted nipple

 

It is important to remember that lumps in the breast may not be indicative of breast cancer. They could be due to non-sinister breast conditions like, fibrocystic breasts or cysts instead.

 

 

Types of breast cancer

 

There are various forms of breast cancer, including:
 

• Invasive ductal Carcinoma (IDC) 

 

This is the most prevalent form of cancer that develops in your milk duct and spreads outside of it, attacking the tissues of your breast. It can travel to other parts of your body, spreading to your lungs, liver, heart, and brain.

Invasive ductal carcinoma is a type of breast cancer that is usually identified by thickening of the breast, a lump in the breast, changes in the size or form of the breast, dimpling of the breast skin, and nipple discharge. 
 

• Invasive Lobular Carcinoma 

 

This type of cancer is the second most common type of cancer after ductal carcinoma. It starts in your lobules (milk-producing glands), and it invades the tissues in the area before spreading to other parts of the body.

 

• Lobular Carcinoma in Situ (LCIS) 

 

This type of cancer (non-invasive) grows in your lobules but has not yet spread to your breast's surrounding tissues. Lobular Carcinoma in situ is identified following a breast biopsy (i.e., a small sample tissue that is surgically taken out of a suspected breast lump) when cells in the lobules have abnormal shapes or become disorganized. These abnormal cells grow but remain in the breast and do not spread to other parts of the body. However, if left untreated, the abnormal cells may eventually become invasive cancer cells.

This type of cancer is not life-threatening but it is important to be monitored closely. A regular screening program can help detect any changes in the breast that may indicate a more serious problem. With proper care and monitoring, Lobular Carcinoma in situ can be managed and treated effectively.
 

• Ductal Carcinoma in Situ: 

 

This type of cancer develops in your breast duct but has not yet spread to the nearby tissues in your breast. It begins with the cells that line the milk duct becoming cancerous and not going beyond the duct, making it a low-risk form of cancer. However, without treatment, the abnormal cells could become invasive cancer cells.

Ductal Carcinoma in Situ (DCIS) is a form of non-invasive breast cancer that can be detected through mammography or a biopsy during breast cancer screening. Treatment is important because, if left untreated, it may develop into a more invasive form of cancer. Early detection and treatment can improve a patient's chances of survival.
 

• Triple-negative breast cancer 

 

This type of breast cancer does not have any of the three most common types of receptors known to fuel most breast cancer growth: estrogen, progesterone, or the HER2/neu gene. Triple-negative breast cancer is more aggressive than other kinds of breast cancer and more difficult to treat because it does not respond to hormone therapy or drugs that target the HER2 protein.

 

The screening, diagnosis, and treatment of all types of breast cancer involves a team approach, comprising a breast surgeon, a medical oncologist, and a radiation oncologist.

 

 

Stages of breast cancer

 

An oncologist conducts research and analysis on cancer before starting any kind of treatment. This includes assessing the severity of the disease, the scope of its growth, where it has spread, and the size of the tumor. These are components of the staginng of breast cancer and the process helps the care team to determine the best treatment plan and prognosis.

 

Breast cancer has five stages, (see figure 2) and the sooner it's detected, the more likely the patient is to survive and receive successful treatment.

Figure 2: Showing breast cancer staging. Cick on image to enalrge. Credit

 

Stage 0 of breast cancer 

At this stage, the cancerous cells in the lining of the breast are contained within the duct and have not yet spread to other tissues. This condition is called ductal carcinoma in situ.

 

Stage 1 of breast cancer 

Breast cancer that is at stage 1 is confined to the breast tissue or has spread to a few nearby lymph nodes. Generally, tumors at this stage are small, measuring no more than 2 cm.

 

Stage 2 breast cancer 

This is an early stage of breast cancer where cancerous cells are present in the breast tissue and/or the nearby lymph nodes.

 

Stage 2 cancer is also further divided into two categories: Stage 2A and Stage 2B.

Stage 2A means that the tumour is larger than 2 cm but has not spread to the lymph nodes. While stage 2B means that it's larger than 2 cm but has only spread to 1-3 lymph nodes. 

 

Stage 3 of breast cancer 

At this stage, the skin on the breast or chest wall has been affected by the cancer's spread. The tumor is greater than 5 cm and has expanded to 4 lymph nodes at this point, or it has spread to several lymph nodes.

 

Stage 4 breast cancer 

At this stage, cancer is at an advanced stage and has spread to other parts or organs of the body like the bones, lungs, liver, etc.

 

Other characteristics will additionally be considered by your doctor in staging your cancer.

 

Unfortunately, stage 4 breast cancer is difficult to treat, and its survival rate is low. But recently, there have been advancements in treatments for stage 4 breast cancer, so survival rates have increased significantly and will continue to increase as medical research continues in the future. 

 

A patient's survival rate is affected by various factors, including age, how far the cancer has spread, and the type of treatment they receive. Treatment options may include chemotherapy, radiation, targeted therapies, and in many cases, surgery.

 

 

What increases my chances of having breast cancer? 

Certain conditions (risk factors) for breast cancer have been identified. They include the following:
 

• Early menstruation start 

Beginning menstruation at the young age of 12 can be an elevated risk factor due to the extended lifetime exposure to estrogen. Estrogen is a hormone proven to heighten the chance of developing breast cancer.
 

• Late menstruation stoppage

Menstrual cycles that stop later than afterage 55 years increases your risk of breast cancer. This is because later periods can throw off the natural hormone balance in the body, leading to longer exposure to certain hormones, like estrogen, which may increase the chance of developing breast cancer.
 

• Alcohol abuse

Consuming an excessive amount of alcohol increases your risk of breast cancer due to a component called a carcinogen. This component increases estrogen levels in your body, resulting in the potential development of cancerous cells in the breast tissue.

Consuming alcohol can raise your odds of developing a type of breast cancer known as triple-negative. The more alcohol you drink, the higher the risk. To reduce your risk of breast cancer, it is recommended to limit your alcohol consumption.
 

• Age 

You become more susceptible to breast cancer as you grow older. Your risk increases with age, as the majority of breast cancers are diagnosed in women over the age of 50.
 

• Gender 

The risk of developing breast cancer is higher in women than in men, and certain factors may increase a woman's risk even more. These include having dense breasts, a family history of breast cancer, and certain genetic mutations, such as those in the BRCA1 and BRCA2 genes.⁴
 

• Giving birth at an older age 

You are at risk of having breast cancer if you give birth to your first child after age 30. Having your first child at an older age can increase your risk of developing breast cancer. Women who give birth at an older age may be at higher risk of developing breast cancer due to increased levels of estrogen and other hormones associated with pregnancy.  
 

• Overweight or obese 

After menopause, having an excessive amount of body fat can lead to an increased risk of breast cancer. Excess body fat can cause increased levels of certain hormones, such as estrogen, which can cause breast cells to divide more quickly, thus increasing the chances of cancer growth.

Additionally, being overweight or obese has been linked to higher levels of inflammation, which may also increase your risk of breast cancer.
 

• Radiation 

Radiation exposure, such as X-ray and CT scans can increase your risk of breast cancer in two ways. First, radiation is a known carcinogen, meaning it can directly cause changes in the structure of genes (mutation) that lead to breast cancer. Second, radiation exposure can damage the cells in the breast, leading to an increased risk of breast cancer.

Radiation exposure at any age can raise the likelihood of developing breast cancer, but it is particularly high if the exposure happened during childhood or adolescence.
 

• Family History 

If you have a close female relative (sister, mother, grandmother) in your family who was diagnosed with breast cancer, your risk of developing breast cancer yourself is higher than average.

Additionally, having multiple relatives with a history of breast cancer, or a relative with breast cancer at a young age, can increase your risk even greater.

 

• Personal History 

If you have had breast cancer or other non-cancerous breast disease in the past, you are at hgher risk of having breast cancer again. 

 

While some of the listed things that increase your chances of having breast cancer are under your control to change, others are not. It is valuable to be aware of all factors that increase your risk. It is also very important to talk with your doctor about things that you can do to lower your breast cancer risks.

 

 

How Can I control or reduce my risk of breast cancer? 

 

While some risk factors are beyond our control, there are steps you may take to lower your risk of developing breast cancer. These include:

• Be aware and undertake regular breast exam for early detection of any breast changes.
• Maintain healthy weight.
• Get enough sleep.
• Maintain a healthy diet.
• Exercise regularly.
• Reduce exposure to harmful chemicals.
• Limit alcohol usage. 
• Breastfeed your child.
• Reduce exposure to radiation.
• Reduce the use of birth control pills.

 

 

How is breast cancer detected and diagnosed?

 

There are several methods for detecting breast cancer, which are as follows:
 

• Self-Examination 

This method entails using your hands to examine your breasts for lumps, unusual pains, or signs.

Here is a step-by-step guide on how to perform a breast self-examination: 
 

1. Begin by standing in front of a mirror while looking at your breast, with your arms on your hips. 
 

2. Look for any unusual changes like the shape, size, appearance of the breast skin, or color of your breasts. Note any dimpling, puckering, or bulging of the skin or changes in the nipples.
 

3. Lift your arms and look for similar changes in step 2.
 

4. While you’re looking in the mirror, look for any signs of an inverted or inward nipple, changes in skin texture, or fluid coming out of one or both nipples (this could be milky, watery, blood, or yellow fluid).
 

5. Next, use your right hand to feel your left breast while lying down, and then your left hand to feel your right breast.
 

6. Use the first few fingers of your hand to place a firm and smooth touch, keeping the fingers flat and together.
 

7. Apply different levels of pressure on the breast to feel different depths of the breast and all the breast tissues.
 

8. Start at the nipple and work in a spiral (circle) pattern that gradually increases in size until you get to the edge of the breast.

 

The essence of self-examination is as follows:

1. To detect changes in the size of the breast
2. To detect changes in the size of the nipple
3. To detect the position of the nipple
4. To check for any lump in the breast
5. To check for discharge from the breast

          

Other tests that are performed in diagnosing breast cancer, include:

• Mammogram 

This is an X-Ray examination that is conducted by a specialist technician. It shows an X-ray image of the breast obtained during the examination. It helps to spot alterations in the breast tissues even before any symptoms appear. You should be aware that in some cases, a mammogram might miss some breast cancers.
 

• Ultrasound 

Ultrasound imaging is a commonly used technique for diagnosing breast cancer. This technique utilizes sound waves to generate pictures of the interior of the breast. This can assist in recognizing lumps or other modifications in the breast tissue. Ultrasound is often employed to figure out if an area seen on a mammogram is a solid tumour or a fluid-filled cyst.
 

• Breast magnetic resonance imaging(MRI)

Magnetic Resonance Imaging (MRI) is a type of imaging test used to detect potential breast cancer. This test uses a powerful combination of magnetic fields and radio waves to generate a detailed image of the inside of the breast. It is commonly used to detect any potential cancerous areas, but it can also be used to pinpoint the potential location of a tumour. Doctors recommend this type of test to those who have a higher risk of developing breast cancer. 
 

• Biopsy 

This kind of test involves the surgeon extracting a small sample of breast tissues for laboratory analysis by a pathologist (a doctor who specializes in the structure of cells, tissues, and organs in health and diseases). If you have a suspicious lump or other breast cancer symptoms, a breast biopsy may be advised. 

 

These tests help the doctor to know the size of the tumor, how far it has spread, and the best form of treatment to go for.

 

 

Breast Cancer in Men

 

Breast cancer is not exclusive to women. Men can also be affected, though it is much less common.

Approximately 4 cases of male breast cancer have been reported for every 100 cases of female breast cancer. This gives a male to female breast cancer ratio of 0.042 in Africa. This figure is comparatively higher compared to the 1% ratio seen in other populations. Also the average age of male cancer patients in Africa is 54.7 years, which is 7 years above that of females. Male breast cancer usually develops in the small amount of breast tissue found behind the nipples, and men over the age of 60 are more susceptible to this disease in high income countries.^{5, 7}

Male breast cancer often goes undetected due to a lack of awareness, poor access to medical care and stigma surrounding the disease, even though its symptoms, risk factors, prevention methods, and treatments are largely the same as with women. But there are some differences in the presentation of breast cancer in men when compared with women.

As in women, infiltrating ductal carcinoma is the most common histological type of male breast cancer in Africans.

 

 

Frequently Asked Questions (FAQs)

 

When should I visit the doctor? 

 

You will need to visit your oncologist (Specialist cancer doctor) if you notice any of the following:

• An unusual discharge from your nipple.

• Redness, pain, or swelling on your breast.

• Unusual thickness or fullness of your breast.

• An inverted nipple(s) instead of your nipples pointing outward.

• Lump in your breast.

• Ridges or dimples on the skin of your breast.

 

Is breast cancer very serious? 

 

Yes, breast cancer is a serious health issue that should be addressed promptly. Early diagnosis and treatment can help stop the disease from progressing and affecting other organs. Self-examinations and regular check-ups are recommended to catch any possible signs or symptoms of breast cancer in its early stages.

 

Can breast cancer be cured? 

 

Yes, early diagnosis of breast cancer greatly increases your chances of successfully treating it. If breast cancer is detected in its later stages, it may be difficult to cure and even if it is, there is a high chance of relapse.

 

Are there food to help fight breast cancer? 

 

Eating a healthy diet and exercising regularly can help reduce your risk of breast cancer. Eating plenty of fruits and vegetables, whole grains, and lean proteins such as beans, fish, and poultry is recommended.

Some studies suggest that eating soy products, such as tofu and soymilk, may also help. Additionally, limiting your intake of red and processed meats, as well as alcohol, may also reduce your risk.

 

 

Summary

Every year, breast cancer sadly takes many lives. In developed countries, the knowledge and awareness of breast cancer is greater than in developing or underdeveloped countries. Unfortunately, screenings for breast cancer can be expensive or completely unavailable in some places.

For people to be more aware of early symptoms and the necessity for routine checkups, hospitals and governments should launch programs to educate people regularly about this condition.

Detecting breast cancer early is essential, as it increases the likelihood of survival. 

 

 

Related: Breast density: What African women need to know.

 

 

References:

1. CDC Breast cancer. What are the risk factors? Last updated, September 26, 2022. Accessed May 7, 2023.

2. Arnold M, Morgan E, Rumgay H, Mafra A, Singh D, Laversanne M, Vignat J, Gralow JR, Cardoso F, Siesling S, Soerjomataram I. Current and future burden of breast cancer: Global statistics for 2020 and 2040. Breast. 2022 Dec; 66:15-23. doi: 10.1016/j.breast.2022.08.010.

3. Anyigba CA, Awandare GA, Paemka L. Breast cancer in sub-Saharan Africa: The current state and uncertain future. Exp Biol Med (Maywood). 2021 Jun; 246(12):1377-1387. doi: 10.1177/15353702211006047.

4. National Institute of Environmental Health Sciences USA Statistics. Breast cancer. Last updated April 6, 2023. Accessed May 7, 2023.

5. Casaubon JT, Kashyap S, Regan JP. BRCA 1 and 2. StatPearls. US National Library of Medicine. National Centre for Biotechnological Information. Last updated September 19, 2022. Accessed May 7, 2023.

6. CDC Breast Cancer. Breast cancer in men. Centers for Disease Control and Prevention. Last updated, September 26, 2022. Accessed May 7, 2023.

7. Ndom P, Um G, Bell EM, Eloundou A, Hossain NM, Huo D. A meta-analysis of male breast cancer in Africa. Breast. 2012 Jun;21(3):237-41. doi: 10.1016/j.breast.2012.01.004. Epub 2012 Feb 1. PMID: 22300703

 

 

 

Published: May 15, 2023

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