‘WAIT AND SEE’ IS A DANGEROUS APPROACH TO BREAST COMPLAINTS.

(Input from Dr Moki Mwendwa) 

When I was in college, my undergraduate tutor once observed that the only two things that will take an African man to see a doctor are blood or pain. I have since learned to extrapolate those two symptoms to what they mean to any patient- scare or discomfort, respectively. 

This month, I encountered this phenomenon in a lady. I discussed it with my colleague Dr Moki who has added the final paragraphs of this piece. 

In her 70s, on this Tuesday morning, she queued with the rest outside my clinic. She had covered nearly three hundred kilometres from her village. Under her traditional garb she carried a monster that had been gnawing at her flesh. 

When she walked in, I allowed in her relative as a necessity. I needed him as a translator. 

She had a breast problem. I spent an agonizing length of time trying to decipher from the patient whether it was a lump or a disease.

“Anasema matiti ni mgonjwa,” the reply would come back from the translator. Simply that the breast was diseased. The same script replayed when I enquired about the duration of symptoms. I assumed the worst and went on to skip the rest of history taking and proceed to examination. 

I assumed it was going to be easy examining. After all, my eyes and fingers would do the talking and listening. How wrong I was. The translator seemed to be ordering her to jump onto the couch even when I felt my voice had been measured in my request. 

To start off, I asked her to lift her hands high above her head for me to examine the symmetry of the breasts, their movement and any obvious masses or skin changes. It was the same lengthy process. Instead of lifting her hands up, she carried up her legs to the head-side of the couch. It took another moment of instruction-interpretation-action cycle to go back to the beginning.

Her breast bore an ugly ulcer. ‘Of course, it is cancer’, I thought to myself as I proceeded to examine both breasts.  She giggled and wiggled when I touched her armpits to feel for the enlarged nodes. The whole encounter here bore the hallmarks of a tragicomedy. 

I wrote down the series of investigations that she needed. First, a needle core biopsy, then a mammogram and staging CT scans before the next course of action. 

I am happy she came to see a doctor. I would have been happier had she come 6 months earlier. 

The single most important determinant of outcomes in cancer management is the stage at presentation. When detected early, localized breast cancer has a 5-year survival rate of 100%. Meaning in 5 years the chances of this lady being alive would be similar to those without breast cancer. On the contrary, when it presents late with regional or distant spread, survival periods are as low as 18 – 24 months. 

Almost one in every four women sees the doctor with a breast related problem at one point in their life. Although pain is the commonest breast symptom, it is not a common presentation of breast cancer. Majority of cancers will be painless. 

The presenting signs and symptoms of breast cancer include a breast lump, nodularity, nipple discharge, nipple crusting or other changes in the nipple and its surrounding pigmented skin. Changes in the shape or size of the breast or skin dimpling and ulceration can occur, as in the case described. 

For various reasons, the number of Kenyans presenting with advanced breast cancer is disproportionately higher than the west. 

As we mark another breast awareness month, our plea is for every Kenyan woman who has a breast complaint to clear any doubts of cancer by getting evaluated by a healthcare worker. Even if you do not have any symptoms but you are aged 40 years and above, be safer than sorry. Get screened this October. Do not ‘WAIT AND SEE’. It is dangerous! 

***Part of this blog appeared as a column in the Daily Nation of 20^th October, 2020**