Breast cancer remains a scare for
women and lately men, as statistics
show it is the leading killer type of
cancer in Kenya. Miriam Mutebi, a
breast cancer surgeon and professor
is among the oncology warriors leading the charge to stop the disease in
its tracks.
The president of the African Organisation for Research and Training in
Cancer says Kenya is rich in cancer
policy, but not much strategic investment has gone into rolling them out
to ensure significant gains.
Mutebi, Kenya’s first female breast
cancer surgeon, told the Star that millions of Kenyan women are yet to be
sensitised on breast cancer awareness.
Physical self-examination as part of
the strategy to detect the disease early
and heighten chances of survival, is
particularly low. She shared her insights.
From your position as a continental
leader in oncology, how is Kenya doing in terms of policy and resource
allocation to combat the scourge of
cancer, particularly breast cancer?
Kenya is doing relatively well with
efforts in improving breast cancer
care compared with other African
countries. It was recently ranked in
the top three African countries by the
World Health Organization, along
with Algeria and Nigeria in terms of
leadership, governance and financing
for cancer.
There have been a lot of efforts here
recently, including last year’s launch
of the Women’s Integrated Cancer
Services initiative which combines
screening for breast and cervical cancers.
We’re on the right track, but we
still have a way to go before we’re
providing comprehensive, quality
care for all women, from early detection and quick diagnosis, right
through the full treatment journey
and survivorship.
African women have the lowest survival rate of this disease. What do you
think is the issue and what could be
done differently?
Yes, too many African women are still
only getting diagnosed in the later
stages of breast cancer when it’s harder to treat. This is why the survival
rates are so low.
In higher income
countries, 90 per cent of women can
expect to survive five years after being
diagnosed; in Africa it’s just one in
two women.
Our message is that breast cancer
does not have to be a death sentence.
It’s treatable, but you have to catch
it early. We need better education
programmes to teach women how
to check their breasts and recognise
symptoms.
And we need to make
breast cancer early detection strategies much more widely available,
especially for rural communities.
What does the pattern of the disease
tell us?
Breast cancer is the most commonly
diagnosed cancer in our country, accounting for about 7,200 new cases
per year as of 2022.
In Africa, the
incidence of breast and other cancers
is increasing quickly. In Kenya, like
in most African countries, our patients tend to be much younger – the
average age of diagnosis is between
40-55 years.
With the intentional investment in
health systems and the expansion of
the workforce improvements, many
patients are now getting diagnosed
at earlier stages and completing their
care in comparison to ten years ago.
The increase in grassroots advocacy
through civil society organisations
has led to increasing awareness, particularly in urban areas.
Do you think the SHA framework
presents a credible intervention for
dealing with the disease and other
NCDs?
The Africa Breast Cancer Council, of which I’m a member, takes a
pan-African approach. We look at
how countries across the continent
are tackling breast cancer and we
draw out lessons from successful
approaches to share.
It would be difficult to comment on
a country-specific framework that has
been recently initiated, but what we
generally find is that countries with
strong national health insurance
schemes that reach broad swathes
of the populations tend to be more
successful in improving outcomes.
The key thing is to overcome the
situation we see in many countries
where we have many women putting
off care or interrupting it because of
financial hardship.
Given your vantage position, which
African country is leading the way
and whose practice can Kenya borrow?
As president of the African Organisation for Research and Training
in Cancer (AORTIC) which is a
continental body of health workers,
researchers, cancer advocates and
policy makers across the cancer care
continuum, we have seen a collective increase in many countries on
the need to do more to address the
rising cancer burden.
What we find when we look at countries with improved outcomes
for women is that they tend to have
certain things in common.
One is high-level political support to improve breast cancer management as
part of women’s health initiatives
coming from the very top of government.
Another is having a strong
national cancer-control plan. The
more successful countries have also
attracted a lot of investment into
their health systems to enable them
to bolster dedicated breast cancer
care.
Egypt, for example, has managed to dramatically cut the number of women diagnosed in the later
stages of breast cancer by boosting
early detection and screening programmes to reach 34 million women
in four years.
This happened under their Presidential Initiative on Women’s Health
which has fostered international
collaboration among scientists and
policymakers and provides a potentially replicable model for how other
countries can work towards better
breast cancer care.
Also, Rwanda just
recently announced it is now covering 98 per cent of the population for
cancer treatments, through the development of a national community
insurance fund.
They have managed
to do this through innovative financing models, for instance using road
traffic fines for speeding. It’s not a
simple ‘cut and paste’ approach from
country to country as systems differ
and what works in one health system
may not necessarily work in another.
