Breast Cancer: A Worldwide Struggle for Equitable Care
~~ Dr Wey George Danlami Consultant-Family Physician
Breast cancer is a leading cause of cancer death in women worldwide. In 2022, 2.3 million women were diagnosed, and 670,000 died. The disease affects every country, with significant disparities in incidence and mortality rates based on human development index (HDI). While high-HDI countries see a lower lifetime risk of diagnosis (1 in 12), mortality remains relatively low (1 in 71). Conversely, low-HDI countries have a lower diagnosis rate (1 in 27), yet a much higher mortality rate (1 in 48). Approximately 0.5–1% of breast cancers occur in men.
Breast cancer begins when abnormal cells in the breast grow uncontrollably, forming tumors. Early-stage (in situ) cancer is treatable. As cancer invades surrounding tissue, it can spread (metastasize) to lymph nodes and other organs, becoming life-threatening. Treatment depends on the individual, cancer type, and stage, typically involving surgery, radiation therapy, and medication.
While female gender is the strongest risk factor (99% of cases occur in women), several other factors increase the risk, including: increasing age, obesity, harmful alcohol use, family history, radiation exposure, reproductive history, tobacco use, and postmenopausal hormone therapy. However, approximately half of breast cancers develop in women with no identifiable risk factors beyond age and sex. Genetic mutations (BRCA1, BRCA2, PALB-2) significantly elevate risk.
Early breast cancer often shows no symptoms, highlighting the importance of early detection. Later-stage symptoms may include a lump (often painless), changes in breast size/shape/appearance, skin dimpling or redness, nipple changes, and abnormal nipple discharge. Any abnormal breast lump warrants immediate medical attention. Spread to other organs can cause additional symptoms (bone pain, headaches, etc.).
Treatment options depend on cancer stage and subtype. Common approaches include surgery (lumpectomy or mastectomy), radiation therapy to reduce recurrence, and medication (hormonal therapies, chemotherapy, targeted biological therapies). Early and complete treatment is crucial for positive outcomes. The selection of medications is based on the biological properties of the cancer and most are already on the WHO Essential Medicines List.
Mortality rates in high-income countries have decreased significantly (40% reduction since the 1980s). Further progress requires strengthened health systems, including reliable referral pathways from primary care to specialized cancer centers. The WHO Global Breast Cancer Initiative (GBCI) aims to reduce global breast cancer mortality by 2.5% annually, averting millions of deaths by 2040. This involves promoting early detection, timely diagnosis, and comprehensive management.
This reorganization prioritizes the most impactful information, making it easier for readers to understand the breadth and depth of the breast cancer problem and the need for global action.
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