Breast cancer burden and its implications on the Nigerian Patient

Abstract

The fact that breast cancer is the commonest female cancer worldwide is no longer news. The more intriguing information, however, is the increasing incidence of the disease in African populations that previously had low incidence rates. The rising incidence of breast cancer in Africa has been attributed to many factors acting synergistically including increasing life expectancy, decreasing fertility, lifestyle changes and environmental factors. Moreover, the peculiar epidemiological, demographic and clinical characteristics of the disease make it a matter of grave public concern. Added to these are the persisting challenges of treatment delays, inadequate management modalities, cost of care, and poor survival indices. In addition to discussing these issues, this presentation focuses on the social, economic and psychological burden of breast cancer on Nigerian women. Findings from a mixed method study on the social, economic, psychological impacts and quality of life of breast cancer at the surgical oncology division, University College Hospital, Ibadan, Nigeria revealed that most patients were artisans and petty traders, presented late, and were low-income earners. The average cost of care per patient amounted to US$11,600, of which 39% was spent on chemotherapy and 32% on quantifiable losses. The main sources of funding of care were family members and spouses supporting an assertion in a publication that ‘breast cancer in Nigeria is a family disease’. The psychological morbidities they experienced included loss of self-esteem, depression and sexual dis-satisfaction. Late presentation was significantly associated with worse self-esteem and quality of life parameters. Nine out of ten would rather not attend social functions because of their appearance. Depression was worsened by an unsupportive spouse while many experienced a lack of spousal advances post-diagnosis. However, married women had higher emotional function and a significantly better quality of life, while breast padding as camouflage post- mastectomy significantly enhanced their QoL and body image perception.