Breast cancer screening

Every week, I am asked about breast screening.  The BCN (Breast Course for Nurses) highlights the importance of clinical breast screening which has been largely overlooked in many high income countries in favour of radiological screening (mammography).

The question remains: How often should a woman with an average risk of breast cancer go for a mammogram?

I have blogged about this before and summarised the Marmot report findings.  Last month, the US Preventive Services Task Force came out with their new guidelines for discussion.  Many of the points are similar to the recommendations from the Marmot report but their website is very user friendly and summarises a lot of the evidence for their conclusions.

How often have you been advised to go for a mammogram?  Have you commended on their proposals?


Malawi breast course for nurses day 2

On the second day of the course, we generally start with lectures about breast cancer management in general then concentrate on the specific facilities available locally.

Dr Innocent Mhango
Dr Innocent Mhango (an intern at Kamuzu Hospital) expressed interest in being more involved with teaching the course.  He gave the lecture on the complications of breast cancer treatment.  Although he is still an intern and hasn't done an oncology rotation, he spent time reading up on breast cancer treatment and gave an excellent summary of the problems: thank you Innocent.

Dr Satish Gopal
Dr Satish Gopal, director of UNC oncology programme in Malawi for the last 3 years, gave a talk about cancer treatment in Malawi.  Malawi is one of the poorest countries in the world with an average GDP around $300 per annum and has no radiotherapy facilities.  rather than dwelling on inadequacies, Satish stressed the importance of looking at the services available.  For example, as a result of collaboration between UNC and the ministry of health, Malawi has a good pathology service with the capacity to do some immunohistochemistry (hormone receptors).  Many countries in the Southern African region do not have an efficient or reliable pathology service.

Cancer cannot be treated if it cannot be diagnosed.

Dr Agnes Moses
The palliative care session was run by Dr Agnes Moses who is head of the palliative care service in Lilongwe. Only 11/53 countries in Africa have access to morphine.
Dr Moses: many thanks for making time in your day to give the lecture and chair the discussion groups.

Blandina and Vanessa
The final session of the day was about community networking.  There are not many cancer support groups in Malawi.  We were joined by one of Malawi's most well known and vocal breast cancer
survivors: Blandina Khondowe.  Since the diagnosis and treatment of her breast cancer (I have told her story in previous blogs), she has become an avid campaigner for the rights of women with breast cancer.  She has launched a 2 pronged campaign.  She is campaigning for better diagnostic facilities to be available to all women and for comprehensive cancer management to be available in Malawi.  She was in a privileged position and had the resources to travel to India for her treatment and believes that all women with breast cancer should receive the same level of care.  

I would like to thank the UNC and the ministry of health in Malawi for inviting us to be part of their oncology project and once again thank Dr Lily Gutnik and our sponsors for ensuring the course's success.

The course participants standing outside the Tidziwe centre


Malawi breast Course for Nurses Day 1

We have just finished the first day of the Breast Course for Nurses in Lilongwe.  It is the first time I have been in Malawi.  I have heard what a beautiful country it is and I haven't been disappointed.  It is small  country surrounded by Zambia, Mozambique and Tanzania.  Running along the country is Lake Malawi: the largest lake in the world

The course is being held in the Tidziwe centre, Kamuzu Central Hospital, Lilongwe.  It is the result of a collaborative project between the University of North Carolina, the Ministry of Health and Kamuzu Hospital.  Dr Lily Gutnik has been in Malawi for the last 11 months training health care workers to do clinical breast screening.  Six months ago, she asked if we would be interested in doing a joint project which was extended to training nurses from both the central hospital and peripheral hospitals and clinics.

Dr Vanessa Msosa
We have about 26 students and they are a mixture of doctors, (some registrars, some interns), nurses and clinical officers.  Clinical officers have a diploma in clinical medicine from the Malawi College of Health and Sciences which is based Blantyre and Lilongwe.  For the first time, we have a group made up of 50% males.

One of the topics covered on the first day is"Investigations of the breast".  Although there are some sonar machines, there is one mammogram machine in Lilongwe which is based in the private hospital.  The majority of the students have never seen a mammogram.   At the end of the day, we had a lecture about the management of wounds.  At the last minute, Dr Vanessa Msosa agreed to give the lecture and emphasised the need to consider the management of the underlying cause of the wound (breast cancer) as well as applying topical dressings.

Many thanks to all of you who have made my visit to Malawi possible.  An especial thanks has to go to Jessica Knight and her sister who have completed their gruelling Joburg2C bicycle ride.  They were one of 11 female teams who have successfully completed the race.

Jessica: I hope you are resting at home.

Dr Lily Gutnik supervising the students

Washing hands after an excellent lunch