Moving beyond policy to curb breast cancer

In 2020, 6,799 people had breast cancer, and nearly half of them (3,107) died, says the latest data from the World Health Organisation.

Clearly, cancer is on the rise in Kenya, but so are the advancements in medicine to prevent and treat it. The government’s strategy has in the past centred on investing in infrastructure and human resources for health to screen, diagnose and treat people with cancer.

However, a lack of awareness, stigma, poor uptake of screening and the other services continue to compromise cancer outcomes. Preliminary unpublished data from the Kenya National Cancer Registry 2014–19, show that seven in 10 cancers are diagnosed at advanced stages – three and four, when it is too late. These are discouraging statistics. The Breast Cancer Action Plan 2021–25 changes tack by looking at cancer beyond the hospital and treatment.

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Screening is critical in detecting certain cancers early. But with hospitals overwhelmed with medical emergencies, women may hesitate to seek care when there is no pain. However, they religiously take their children for vaccines and in lower-level hospitals in rural areas where the facility is at a walking distance. We have prioritised the integration of cervical cancer and breast cancer screening within primary health facilities where women seek other services.

Primary health services occur in Level 2 facilities comprising dispensaries and medical clinics, and Level 3, which are medical centres, health centres and nursing homes. They account for 94 per cent of the total health facilities in 2021, according to the Kenya Master Health Facility List.

Lower-level hospitals can also address another stumbling block in curbing cancer: myths, misconceptions and stigma. Kenya’s community health system is one of the most robust, and has been instrumental in encouraging positive medical-seeking behaviour for illnesses such as malaria and HIV through health education.

Also read: Why awareness of breast cancer issues is important

Community health volunteers can increase awareness of women’s cancers and link these women to dispensaries and health centres within their catchment population. With better awareness, the community will seek screening services at these facilities.

The county governments should ensure that when the community members seek care, they will get services in the primary facilities. Through partnerships, the Ministry of Health has trained more than 200 lecturers in local colleges in screening and treating women’s cancers using less invasive technology.

Kenya has a ratio of 13.8 nurses, physicians and doctors for 10,000 people, according to the Kenya Health Workforce Report 2015, far below the WHO-recommended 44.5. To ensure women access quality cancer care when and where they need it, all hands of all healthcare workers should be on deck.

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Cancer presents differently in each woman. Trained health workers will recommend and perform appropriate screening for the woman based on age, personal risk, family history, genetic profile and the possible benefits or limitations.

After taking their history, healthcare workers in lower-level hospitals can identify people at a higher risk of developing cancer. They then refer them, alongside those who are symptomatic, to the higher-level facility for advanced diagnostic tests and treatment.

Through the managed equipment scheme, all referral hospitals in the 47 counties in the country now have mammogram machines for screening and diagnosis.

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To address the systemic barriers that disproportionately impact people living in remote locations and the low-income brackets, the ministry intends to work with counties to establish at least five breast “one-stop shop” clinics in five regional county cancer hospitals and three breast care centres of excellence at the three national referral hospitals.

For instance, Kenyatta University Teaching and Referral Hospital has already established a breast care centre of excellence to enable women with symptoms such as breast lumps, pain or discharge access “triple assessment” and diagnostic services within a few days. This is to ensure that within 60 days of presentation with symptoms and diagnosis of cancer, the women are immediately linked to care.

There are many possible causes and treatment paths for breast cancer, and the solutions will need efforts from all quarters.

The Health ministry will collaborate with medical and non-medical partners to ensure Kenyans access quality care for breast and other cancers.

Dr Mary Nyangasi is the head of the Division of the National Cancer Control Programme at the Ministry of Health and co-chair of the National Cancer Taskforce in Kenya, while Dr Stephen Mutwiwa is country director for John Hopkin affiliate, Jhpiego