I have just returned from the AORTIC conference in Durban.  AORTIC is an organisation concerned with cancer from an African perspective.  The majority of the talks I went to were about breast cancer and cancer registries in Africa.

Karposi's sarcoma, breast and cervical cancer account for the majority of cancer cases in women in Africa.  In some countries, cervical is commoner.  In others, breast.  Unlike breast cancer, cervical
cancer is associated with an infection: papilloma virus.  In general, deaths due to infectious diseases are decreasing in sub saharan Africa.  Conversely the disease burden due to non communicable disease is increasing as women here adopt a more western life style.

As I have alluded to in previous blogs, women in this country are seen with more advanced disease.  We have referred to the phenomenum of women presenting late.  Dr Joe Harford (NCI) has pointed out that this only tells half the story.  Women in Africa are diagnosed at a later stage.

There are many reasons why women do not seek medical attention.  Doctors are a scarce commodity in Africa.  Ines Buccimazza (Durban) gave an excellent talk looking at the number of doctors in Africa. Africa has 24 % of the global health burden and 3% of the global health spending.

More sobering facts emerged: in Nigeria, 38% of women are divorced within 3 years of having a mastectomy.  In Tanzania and the Congo, over 90% women with breast cancer have locally advanced disease at the time of diagnosis.  We need African solutions to the health crisis in the continent.

On Saturday morning, there was a workshop discussing the training of health professionals in Africa.  How are doctors, once trained as a specialist, persuaded to stay in their country of origin?  Prof Lynette Denny (UCT) emphasised the need for appropriate training for overseas doctors.

The conference was illuminating, sobering and yet full of exciting initiatives.  However, I came to the conclusion that although we spend a lot of time discussing different prognostic factors, the main prognostic factor in the outcome of breast cancer is geographical location.

Let me know if there are geographic disparities in health care in your part of the world.


Your stories

It has been my intention to start a new section to the blogsite which is a space for you to publish your stories.  Please feel free to send your stories about your breast cancer journey to me at: jmedge@mweb.co.za.


School cancer campaigns

My son is lucky enough to go to St George's Grammar School.  It is the oldest independent school in South Africa and prides itself on both it's academic achievements but also on it's community involvement.
Last week, they had a civvies day and wanted to raise funds for a cancer support group.  My son asked me which organisation they should raise money for.  I gave the matter some thought and suggested PLWC: people living with cancer.  They support women with breast cancer but I had to ask my self why I had come up with PLWC and not a breast cancer specific group.

There are several reasons. Firstly, it is a local (Cape Town) based organisation.  I get quite irritated when I see money being raised locally that will be spent either in another province or internationally.  Secondly, it supports people with many different cancers.  It is, after all, November: prostate cancer awareness month.

During October, there were a couple of local schools who ran breast cancer awareness campaigns.  I am not aware of any doing a similar project for prostate cancer.  In the USA, there have been high profile cases of schools taking individuals to court for wearing bracelets considered inappropriate for
school girls.  In Cape Town, the campaigns have been a lot more appropriate.

Should school girls be taught about "breast health" whilst at school?  I would argue that it causes more anxiety than anything else about a disease which is not known to affect women until their late 20s.  If we accept that just as many parents will have had treatment for prostate cancer as for breast cancer, why don't schools do more in November to support prostate awareness month?

There are several reasons for this:
1. There are far more female teachers than male teachers so more of the school's community are likely to have been affected by breast cancer than prostate cancer
2. If a member of the school community (either mother or teacher) is having chemotherapy for breast cancer, the baldness is obvious: in males it is less so.
3. Women are more likely to be upfront about their illness than men.
4. Community initiatives are often lead by the girls in the class.
5. A staggering nearly 50% of South African school children have an absent father
6. In South African schools, November is exam month.

What do you feel about promoting breast awareness in schools?  Please comment on your thoughts or your experience.


Vincent Pallotti Oncology Centre

Last week, the new oncology centre at Vincent Pallotti Hospital opened.  There are a number of oncologists and breast specialists working there: Dr Gudgeon, Dr Boeddinghaus, Dr de Villiers and Dr Jacqui Hall.  They are to be joined by others at a later date.

Shortly, the new radiotherapy machine will be working.  One of the major challenges of treating with radiation is to minimise the damage to the surrounding healthy tissues.  The new machine will allow treatment to be administered more precisely.   I see a number of women who have had their radiotherapy in neighbouring African countries where there are only old machines.  It serves as a constant reminder of how lucky we are to have several modern oncology centres in the Western Cape.

The chemotherapy room has been open for sometime.  It is light and airy.  What caught my attention were the quotes on the walls.  In the chemo room, there was a quote from Mother Theresa:

Life is life, fight for it
Life is beautiful, admire it
Life is a challenge, meet it

Outside the chemo room are a series of blocks. Different women have added their pictures or their thoughts.  Dr Anne Gudgeon (who is a breast cancer survivor) has written the following:

"Life is not about weathering the storm.  It is about learning to dance in the rain."

What inspirational quotes helped you get through your treatment?

The last word has to go to Nelson Mandela:


Tops and Flops

Over the last month, there have been a number of interesting initiatives. I thought it would be good to compile a tops and flops list.  You may not agree with my list but here are my thoughts:

One prize goes to Cancer Alliance for their blog.  They have posted a blog every day through the month of October and are going to continue the project which is excellent.  It is a combination of individual stories and features which cover many aspects of breast cancer management.   The topics covered are ones bought up frequently by my patients: fear of recurrence, the impact on partners and children, weight issues and dealing with anger and fear.  It is not only doom and gloom and there are some excellent photos!  Well done to them

One of my gripes about October is that the issues discussed are not confined to one month of the year.  They are ongoing issues and my next heroes are the ever consistent local Reach to Recovery group who will visit any woman in Cape Town who has had breast cancer and are always available to discuss fears or share thoughts.  October has meant I have had more contact with them and I know they will continue to be there for the other 11 months of the year.  A big thank you.

The PLWC photo exhibition was excellent.  Sure, it did not give us facts and figures about issues facing women with breast problems in this country but it is a start.  We must gather more information about the challenges of the silent majority of women in this country with breast cancer problems if we are to make a change.

Lastly, my flop has to go to the group of women trying to popularise "mamming".  In my opinion it is a bunch of people trying to invent something for the sake of it and not doing anything to improve the lot of survivors/imrove breast care.

Who are your tops and flops for the month?