It is time to consider gene testing to reduce the risk of recurrent breast cancer. PHOTO | FILE | NATION MEDIA GROUP
When
American actress Angelina Jolie had her breasts removed after a blood
test showed that she had inherited a defective gene that put her at high
risk of getting breast cancer, some people might have thought her
action a bit extreme.
Not so for Linet Amugozo and
Florence Ojode. Amugozo and Ojode are among the thousands of Kenyans who
have battled cancer and now know the benefits of early detection.
Every
year, 4,465 Kenyan women and men are diagnosed with breast cancer,
according to a Nairobi Cancer Registry. About 748 women are diagnosed
with ovarian cancer.
“I have tested six women for gene
mutations in Kenya in the last four years,” says Dr Frederick Chite, an
oncologist and haematologist at the Moi Teaching and Referral Hospital
in Eldoret.
Five to 10 per cent of breast cancer cases are caused by mutations in the BCRA1 or BCRA2 genes.
“For every 100 breast cancer patients, five to 10 have the disease because of gene mutation in the family,” says Dr Chite.
With
an increasing number of young Kenyan women getting aggressive and
recurrent breast cancer, Dr Chite says, it is time to consider gene
testing to reduce the risk of recurrence, as well as that of these women
later developing breast or ovarian cancer.
“When you
see so many young women developing aggressive breast cancer in their
20s, 30s and 40s, there must be an abnormality causing it. These women
are still young. Why are they developing a disease mostly found among
older women? This raises the red flag,” he says.
Dr
Chite, who also works at the Indiana University School of Medicine in
the US, says most American female breast cancer patients who visit the
clinic are in their 60s and 70s. But in Kenya, the patients fall between
the ages of 38 and 45 years.
“This is a very, very
young age. It is important to see if, as Kenyans, we are more
genetically susceptible, that we inherit the defective genes that cause
this cancer at a very young age. The breast cancer in our setting is
also very aggressive. You have a patient who comes in with a lump that
is two centimetres, within two to three months, it has grown to eight
centimetres if not treated,’’ he says.
About 40 to 85
per cent of the women and men who have BCRA1 or BCRA2 mutations develop
breast cancer, while 40 to 60 per cent also get ovarian cancer.
“We don’t do genetic testing for everyone. There are factors we look for before deciding if you need the test,” Dr Chite says.
“If
you tell me your mother, aunt, or sister had breast cancer, it raises
the alarm, especially if they had it before the age of 50. If you have a
family history of breast, prostate or pancreatic cancers, we ask you to
take a test for BCRA1 and BCRA2. If a woman develops breast cancer
before 50 and her father had the same disease, everyone in that family
is advised to undergo a test for the defective gene,” he adds.
The oncologist notes that even those with no family history can get breast cancer caused by gene mutations.
“The
mutation has to start from someone; even for those with no family
history, you might be the one to start that history,” he explains.
Dr
Chite advises that patients who cannot pay for gene testing go for
mammograms and magnetic resonance imaging (MRIs) scans every year, have a
trans-vaginal ultrasound and Serum 125 tumour marker test to check for
signs of ovarian cancer.
Meanwhile, Dr Catherine
Nyongesa, a consultant oncologist, says gene testing will help to detect
cases early, leading to early intervention for those found to have the
defective genes.
Although gene testing is not available
in locally, patients don’t have to travel abroad since their blood
samples can be sent to countries that offer the services, like India and
South Africa.
“The test costs between Sh178,000 and
Sh267,000,” Dr Chite says, adding that insurance companies and the
government should pay for the tests for women at risk because the cost
of treating cancer, or preventive surgeries, is much higher.
This
will also help create a registry of the counties, geographical
locations, and ethnic communities that are at risk of getting cancer due
to defective genes. It is also important to note that factors such as
hormone replacement therapy, dense breasts, early onest of
menstruation(before the age of 12) late menopause (after the of 55),
never having been pregnant, obesity after menopause and consumption of
alcohol can increase a woman’s risk of developing breast cancer.
Meanwhile, breastfeeding and childbirth can reduce a woman’s chances of getting breast or ovarian cancer.
But knowing that you have the defective gene has psychological implications.
“A
woman can constantly worry that the cancer can strike at any time. And
if she cannot afford reconstruction surgery after a mastectomy, she
might feel an incomplete woman,” Dr Nyongesa says.
And because of this, Dr Chite suggests that patients discuss such issues with gene counsellors.
“You
have to consider whether you want children. And if you are young, do
you have children and then have your ovaries removed. Or do freeze your
eggs for later use? Or do opt for surrogacy?” he asks.
**********
Linet Amugozo, 37
Four
years ago, I felt a lump in my right breast but ignored it. Buy then it
started becoming painful, especially when it was cold. A reddish pimple
formed around the area where the lump was. It was itchy and when I
scratched it, it turned into a wound.
After a week, I
felt something like an electric shock strike my breast. That is when I
knew something was not right and sought medical attention The doctor
looked at the wound and referred me to another hospital, where I was
diagnosed with breast cancer.
No one else in my family
has ever had cancer. I was shocked, but when I saw many women suffering
from cancer with no breasts in a group in the hospital ward, I knew I
was not alone.
After four sessions of chemotherapy, the
boil dried up. I finished the six sessions and the doctor gave me two
options: go to India for specialised treatment to save my breast or have
it removed. I had my breast removed.
I couldn’t afford
treatment abroad and besides, I had gained courage after seeing many
women with no breasts. After that, I was put on hormonal therapy for
five years. But the doctor warned me not to get pregnant or to use
hormonal contraceptives.
Two months after I began
taking the drugs, I started feeling nauseous. I thought I was reacting
to the drugs so I went to see the doctor. But after running some tests,
he told me I was pregnant and suggested that I terminate the pregnancy.
But
I decided to carry the pregnancy to term and stopped taking the cancer
drug immediately. In fact, my left breast enlarged like that of any
woman during pregnancy and I was ready to breastfeed my baby with my
remaining breast.
After nine months, I had my baby. I
was told that he would be born with small limbs because I had taken
Tamoxifen during pregnancy, but when I saw him, he was okay; a normal
handsome babay. But a few hours, he developed breathing problems and
died.
However, it is not clear whether the cancer drugs caused his death.
**********
Florence Ojode, 67
I
felt a lump in my breast a month after we buried my younger sister, who
had died of breast cancer. We were only two girls in the family, so the
news of my cancer shocked the family. I had my right breast removed in
2007, but come 2010, the cancer recurred in the left breast, and I had
it removed.
The third time it struck my right ovary. My
nails, tongue, face and my toes turned black during the six sessions of
chemotherapy. My hair fell out, I could not eat and I was nauseous.
After chemotherapy, I underwent 25 sessions of radiotherapy, followed by
hormonal treatment.
Cancer is very expensive disease
to treat, and now that I know that my family has a history of breast
cancer, I encourage young women to go for frequent check-ups, yearly
mammograms and to examine their breasts often. If gene testing were
locally available, I would advise them to go for it.
I
discovered the lumps in my breast during self-examination. Women should
examine their breasts often and if they notice anything, they should
see a doctor immediately.
In 2010, I noticed that my
left nipple was inverting. The cancer was caught in its early stages, so
I did not have to go for chemotherapy, but I went for 25 sessions of
radiotherapy.
In 2012, I fell sick, lost my appetite,
and often felt nauseous. I felt tired and had a bloated stomach. I went
for blood tests, and tumour markers but they didn’t show that I had
cancer.
Then the doctor sent me for a body scan, which
revealed that I had a 9-cm tumour in my pelvis. He suggested I have the
tumour removed but my family decided to take me to Israel, where a
positron emission tomography (PET) scan (a detailed body image) revealed
that the tumour was actually cancerous, and it was in my right ovary.
Consequently,
it was removed. And fortunately, the cancer was caught early, so I
didn’t need chemotherapy or radiotherapy. I was not depressed, but the
third recurrence shocked me. I would have given up on treatment, had it
not been for the moral and financial support of my family.
You
never know when cancer will strike, so I go for tests frequently.
Although I have battled cancer, I’m living life as normal and performing
my normal duties. I have learnt that cancer is not a death sentence; it
can be cured if arrested early.
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