I had such grand plans for last weekend before I fell ill. My friends and I had planned to wear pink for the Spar Community Challenge Series #7 Run on Saturday and that afternoon some of us were attending a breast cancer fundraiser hosted by Masarati Aesthetics Spa. The fundraiser looked amazing with talks by GPs as well as cancer survivors, free on-site ultrasound breast screening, free foot soak and massage as well as refreshments and live entertainment. On Friday, I knew I definitely wouldn’t be able to run but I still had hope that I’d be okay for the afternoon. But on Saturday, I was in the thick of it – shivering one minute and boiling, the next!
So, it wasn’t to be, but my friends Elisa and Tapiwa attended and had a beautiful time. Elisa said she “loved the encouragement from the doctors to do self-checks on a regular basis. They gave demonstrations on how to check and what changes to look for. They also encouraged us all to get screened. This is why I went. I’ve had family members with breast cancer and I had been putting this off for a while”. Tapiwa expressed such gratitude that she had gone but said it was very hard to listen to the women’s testimonials, “I started crying but I was able to compose myself”.
After cervical cancer, breast cancer is the second most common cancer among women in Botswana. As with many countries in sub-Saharan Africa, Botswana faces the dual burden of cancer and HIV/AIDS. Over the years, Botswana has been hailed a success story in the fight against HIV, effectively diagnosing and managing patients with HIV on HAART (medication treatment approach). However, this situation means there are several people diagnosed with both breast cancer and HIV, presenting unique challenges in managing their treatments.
A week on from this event, I did a solo 5km RUN in PINK for Breast Cancer Awareness. It was a cloudy Saturday morning and I donned my pinkest of all pink outfits. I dedicated this run to all the survivors, all the departed warriors, and all those left behind to navigate life without them. And in today’s blog, I’m sharing five facts about breast cancer in Botswana. I’ve relied heavily on this article by Jacqueline Healey from the Rutgers Global Health Institute. In the article, Jacqueline summaries a lecture given in 2019 by Yehoda Martei, an assistant professor of medicine in the Division of Hematology/Oncology at University of Pennsylvania entitled, “Optimizing Breast Cancer Therapy Delivery in LMICs: The Botswana Experience.”
Five Facts About Breast Cancer in Botswana
1/ Disproportionate burden of cancer mortality: Without a national breast cancer screening programme and various health system delays, breast cancer in Botswana is often diagnosed in the later stages. A startling statistic from Martei’s lecture indicates that about 80% of breast cancer cases present at an advanced stage, compared with 17% in the United States, which is one of the reasons why breast cancer mortality is disproportionately high in Botswana. Martei reports that in 2018, the proportion of patients diagnosed with breast cancer who have died from their disease was 0.38 in Botswana compared to 0.14 in North America. At the breast cancer event, Elisa says “one of the things survivors said they were grateful for was catching their cancer early. These women had access to screening points, which women in the villages do not.”
2/ Gaps in cancer therapy delivery: The article highlights that “patients with lymph node positive breast cancer who complete 85% or more of an optimal chemotherapy dose for curative intent have an increased chance of survival compared to those who receive less”. However, in Botswana, the absence of standardized national treatment guidelines for breast cancer, means that patients are dropping off the treatment cascade at different stages. Martei emphasises the importance of evaluating the quality of chemotherapy delivery to ensure better survival rates, and not just that people are receiving some chemotherapy.
3/ Inconsistent access to essential cancer medicines: Another key insight reported from Martei’s lecture was that although Botswana has access to 80.5% of the essential medicines recommended by the WHO to treat cancer, in 2015, 40% of those medicines were out of stock for more than 30 days on average. Martei highlights that for 80% of breast cancer patients studied, at least one drug in the prescribed regimens was affected by a stockout and that “each week of stockout doubles the risk of a suboptimal therapy event.”
4/ Need for country-specific strategies: Another insight from the lecture and reported in the article is the need for the development and adherence of country-specific guidelines to reduce treatment drop-offs. In their development, it will be important to factor in patient needs and resources, including time and ability to travel to a medical facility, social and cultural beliefs, and psychological support for patients. There is also a critical need to expand the trained workforce and improve communication between clinicians in different departments, as well as with patients themselves. This last point really resonates with me as I knew someone who received a late diagnosis for breast cancer and was never given sound information about her treatment plan. When she died, I think it was a shock to both her and her family.
5/ There is hope: The Journey of Hope Botswana is a not-for-profit organisation of volunteers whose aim is to promote breast cancer awareness in the country. It started in 2008 when a group of women raised funds for a woman who could not afford urgent breast cancer treatment. They soon heard of other similar cases in Botswana and initiated a fund-raising campaign to buy 12 pink scooters, train a pool of women to ride them and embark on a Big Journey across the country to spread the message that early detection of breast cancer can save lives. The Journey of Hope has contributed greatly to spreading awareness throughout Botswana and is now equipped with a mobile mammogram, allowing for on-site screening.
Tapiwa said “I left the event with hope. I’m so glad I paid for that ticket. The Journey of Hope is doing amazing work around Botswana. Elisa concurred saying, “It was good to know that the little we gave in the purchase of tickets goes to Journey of Hope and together with their other fundraising initiatives will help take screening to the villages and other disadvantaged areas.“
Thank you to the work done by Martei and others in researching and providing insights on strategies for dealing with breast cancer in Botswana. What really stood out for me in the article as well as from discussions with Elisa and Tapiwa, was the importance of early detection, as well as the need to close the gap between those who have easy access to screening and good health care, and those who don’t. Excellent health care should not be limited to those who have, and breast cancer should not be a death sentence, in 2022. But there is hope – and I think more than any other year, several organisations and individuals in Botswana did their best to show up in pink this month and spread awareness in their different capacities. This needs to continue.
Have you had your mammogram this year? Have you been personally affected by breast cancer? Did you run in pink this month?