Need to move a step further with breast cancer awareness in Ghana

“Perhaps this is what the stories meant when they called somebody heartsick. Your heart and your stomach and your whole insides felt empty and hollow and aching.” Gabriel García Márquez

Bereavement is not a pleasant experience. Anyone who has suffered the loss of a loved one will attest to this. In the last week, I have seen posts made by many close friends who have lost close family and acquaintances. As I express my condolences on each occasion, I have also paused to look at the ages at which these unfortunate deaths are occurring. In recent times, I have come to believe that any loss of life that occurs in Ghana before age 63.5 years is avoidable and must give cause for concern.

With this age being our average life expectancy, I cringe when I read the phrase “Rest in Peace” on many of these obituaries. I do because as a health professional who has occasioned to be at the bedside of dying patients, I have seen what it means to pass away in peace and what it means to depart this earth in anguish. Any health professional can tell you the anguish with which patients speak about their children, family and spouses in the final moments before their life is cut short prematurely in their prime. In a world full of cruelty, many are even unsure how the future of their children is going to turn out.  If anything, I am inclined to believe in the cliché that many turn in their graves.

What even gets to me is the fact that we have all become accepting of these happenings, throwing up our hands as though we are hapless. The truth is we are not. Currently, health is progressing at a pace where many of these deaths can be predicted and avoided. Having lost my mother to endometrial cancer back in 2015 and knowing that many cancers are genetically modulated, I have always been an advocate for early screening. Sadly, many of us place little value on the information inherently stored in our genes.

Every October, I am gratified at the level of awareness breast screening is giving all be it under the pretext of “freeing the tatas.” However, I cannot help but wonder if we would not be better off getting our women to test for mutations of BRCA1 and BRCA2 human genes, the best predictors currently of female breast and ovarian cancers. Especially when these genes have also been associated with increased risks of several additional types of cancer. Would it not be better knowing the risk even before a lump however small appeared in the breast?

Let’s look at the statistics on breast cancer for a while. Data available from the United States National Cancer Institute and corroborated by other cancer centres indicates that “about 12 per cent of women in the general population will develop breast cancer some time during their lives.”

A recent large study published by Kuchenbaecker and associates in the Journal of the American Medical Association (JAMA) estimated that about 72 per cent of women who inherit a harmful BRCA1 mutation and about 69 per cent of women who inherit a harmful BRCA2 mutation will develop breast cancer by the age of 80. Is this not enough reason to push for genetic screening?

On May 14, 2013 Angelina Jolie in an article in the New York Times decided to open up on her decision to have a preventive double mastectomy. She explained that her mother fought cancer for almost a decade and died at 56. “She held out long enough to meet the first of her grandchildren and to hold them in her arms,” she said. But my other children will never have the chance to know her and experience how loving and gracious she was. Before then Jolie had lost her grandmother to the same disease.

Reading the article again this morning, I could feel the anguish in her words and roundly understood why she opted to undergo testing for these mutant genes and acted the minute she was found to be a carrier of these mutations. But what got me thinking was her decision to go public with such a deeply personal story. Suddenly, it all made sense. She was not prepared to take chances with her life and miss out on family moments as her mother and grandma had. She also knew that with her status, speaking up was a way to empower many women without a voice. She was thus prepared to put her head above the parapet so that neither she nor those willing to read and take heed will have the phrase “Rest in Peace” on their obituary earlier than it was otherwise necessary.

The real challenge in going down this route of pre-emptive testing for Ghana would be education. In a country where post-mortems are frowned upon by many and little value is put on their importance by families, convincing the majority to test for a gene especially when there is no sign of ill health will be a tall order. Should they even agree to test, having the result with no obvious signs of disease will lead many to procrastinate. Then there is the issue of cost and who should be paying for these tests based on the low spending ability of many Ghanaians. Much as these are real obstacles, I am one who believes when there is the will there is always a way.

My belief that this can be done is not without basis though. I listened to a podcast on BBC that indicated that a start-up 54gene led by Abasi Ene-Obong identifying that only about two per cent of genomics research worldwide has been undertaken on African subjects and the serious disadvantage this puts us all at, they have set out to build the largest collection of African DNA. This for me is the beginning of the process of availing Africans to the potential that lies untapped in genetics. Ambitions like this for me are worthy and I just hope others will jump on board.

We cannot continue to see people feel heartsick and empty in a world where knowledge in health is expanding exponentially and expect that they rest in peace. To do so will be to betray our intelligence and to let down many loved ones. Just so you know, when my mum passed, I advised all females in my matrilineal line to get screened for Braca1 and Braca2. It was the least I could do to assuage their pain.

By Kwame Sarpong Asiedu

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