Cancer is a generic term for a large group of diseases that can affect any part of the body.Other terms used are malignant tumors and neoplasm. One defining feature of cancer is the rapid creation of abnormal cells that grow beyond their usual boundaries,
and which can then invade adjoining parts of the body and spread to other organs, the latter process is referred to as metastasizing. Metastases are the major cause of death from cancer, (WHO).
Cancer arises from one single cell. The transformation from a normal cell into a tumor cell is a multistage process, typically a progression from a pre-cancerous lesion to malignant tumors. Cancer is a complex group of diseases with many possible causes.
The known causes of cancer, including genetic factors, lifestyle factors such as tobacco use, diet, and physical activity and certain types of infections, and environmental exposures to different types of chemicals and radiation.
These changes are the result of the interaction between a person’s genetic factors and 3 categories of external agents, including the following:Physical carcinogens, such as ultraviolet and ionizing radiation.
Chemical carcinogens, such as asbestos, components of tobacco smoke (a food contaminant) and arsenic (a drinking water contaminant) and Biological carcinogens, such as infections from certain viruses, bacteria or parasites.
Breast cancer is the most common cancer in women both in the developed and less developed world. It is estimated that worldwide over 508000 women died in 2011 due to breast cancer (Global Health Estimates, WHO 2013).
Although breast cancer is thought to be a disease of the developed world, almost 50% of breast cancer cases and 58% of deaths occur in less developed countries (GLOBOCAN 2012).
Breast cancer starts when cells in the breast begin to grow out of control. These cells usually form a tumor that can often be seen on an x-ray or felt as a lump. The tumor is malignant (cancerous) if the cells can grow into (invade) surrounding tissues or spread (metastasize) to distant areas of the body. Breast cancer occurs almost entirely in women, but men can get it, too, (American cancer society).
Normally Women and men both have breasts, but they have different breasts according to the shape and the size of the breasts.
In women, breasts are made up of milk glands. A milk gland consists of:
Lobules: where milk is made. Some cancerous cells starts in the glands that make breast milk and it is called (lobular cancers).There are also other types of breast cancer that are less common.
Ducts: tubes that carry milk to the nipples. Breast cancers can start from different parts of the breast. Most breast cancers begin in the ducts that carry milk to the nipple and it is called (ductal cancers).
A small number of cancers start in other tissues in the breast.
Cancer in the context of the world wide
Cancers figures among the leading causes of morbidity and mortality worldwide, with approximately 14 million new cases and 8.2 million cancer related deaths in 2012 (WHO) and The number of new cases is expected to rise by about 70% over the next 2 decades.
World health organization also estimated that among men, the 5 most common sites of cancer diagnosed in 2012 were lung, prostate, colorectum, stomach, and liver cancer and among women the 5 most common sites diagnosed were breast cancer, colorectum, lung, cervix, and stomach cancer.
Around one third of cancer deaths are due to the 5 leading behavioral and dietary risks, high body mass index, low fruit and vegetable intake, lack of physical activity, and tobacco use. Tobacco use is the most important risk factor for cancer causing around 20% of global cancer deaths and around 70% of global lung cancer deaths, (WHO 2012).
Breast Cancer is the number one silent killer of Somali women
Since the collapse of the federal government in 1991, the organizational and administrative structure of Somalia’s healthcare sector was deadly devastated by the civil war and the socialist government had put an end to private medical practice in 1972. Much of the national budget was devoted to military expenditure, leaving few resources for healthcare, among other services.
Somalia’s public healthcare system was largely destroyed during the ensuing civil war. As with other previously nationalized sectors, informal providers have filled the vacuum and replaced the former government monopoly over healthcare, unfortunately these informal private provides have got the opportunities of ruling the health care system with their motive for profit and this caused the cost of medical consultations and treatment in these facilities high.
Therefore, put aside their motive for profit, but the reliability of the providers has been the core point of discussion, which means that the population could not relay the medical equipments and drugs they provide to the population because of they lack genuine medical supplies and also the skills and experience of this field. Apart from all these there is another issue which is the point of repercussion; they opt solely selling high costs drugs which the population could not afford the cost of seeking medical help.
In Somalia the World Health Organization estimates that over 3,000 women die of cancer in Somalia every year. Experts now rate Somalia as having one of the lowest levels of awareness for breast cancer.
Although the general knowledge about this deadly disease is steadily rising, it provides little succor to communities with no health infrastructure.
World Health Organization report in Somalia, data on breast cancer prevalence is subjective. The country’s fledgling health ministry has not been documented any cases of disease relating to cancer, let alone the breast cancer, which is badly affects many Somali mothers.
In May 2014 WHO statistics indicated that cancer kills at least 3,200 women in the country every year. Of these deaths, breast cancer is the single leading cause, accounting for 19% of the deaths, followed cervical cancer and cancer of the oesophagus.
Although cancer is normally a genetic disease that is worsened by environmental conditions and probably the life style of the person, it is difficult to trace the genetic risk in Somali families, because most of them never know what has killed a family member.
Culturally against the odds among the Somali women
Breast cancer is a silent killer in many households in the horn of Africa country. Culturally, it is a disease treated in shame because it attacks the vital but extremely private parts of the female body. Most victims shy away from seeking medical help to avoid intrusion into their privacy parts.
Traditionally Somali women are shy and there are many things that they cannot discuss with doctors. Even when they feel pain in their breasts, they shy away and keep the clothes on. If they are asked to explain, they cannot mention the word breast and would be unable to get treatment. They are shy to display breast swellings or wounds.
This scenario I translated from face book page and it’s took place in Mogadishu in July 2016 and it’s what caused me to think more and more the deadly disease which takes every year the lives of many our mothers.
There was a woman who labors in a casual work, she used to move house to house in the surrounding neighbors for the sake of searching an employment, she used to wash clothes and get paid after washing the clothes.
One day she noticed a swelling on her breast and she did not seek medical help. She kept secret to herself because of the tumor was bulged from an area which is very sensitive to expose others and she was overwhelmed with worry for years until the disease spread to other parts of her body and later on, the disease moved to third stage of breast cancer which is irreversible, even if she gets the most sophisticated treatment. After several months she died and her family did not know what has killed her. This is how our women die in every year with preventable diseases.
One of the commenter’s on face-book says that, the Somali woman, they do not feel comfortable with others looking at their private bodies, unless they are having babies. That is the only time they might allow the doctor to look at their private parts. That’s what causes them to have greater risk for cancer.
Culturally, if a mother or sister has a lump, they will hide it. They don’t tell their husband.
They don’t tell their brothers, or their sisters or their mothers. So what happens is that they keep the lump for some time until it becomes attached to the cloth and obviously starts to discharge. Somali women have a long history of adopting cultural beliefs and this largely affects the lives of many women to be the victim of culture.
The other issues which is a very prominent issue within Somali society is traditional burning of cancerous cells that might cause eventually death. This retrogressive practice, which is still practiced by many communities, involves burning a cancerous growth with red-hot iron, massaging the wound with hot water and taking herbs.
The level of awareness for breast cancer in Somalia
Somali has lowest level of awareness for breast cancer, according to medical experts and this hinders the early detection of cancer.
Although few women knew this deadly disease but majority have misconception about breast cancer and probably due to the prevalence of traditional beliefs. Breast cancer awareness is low in Somalia and there is limited cancer diagnosis, modern treatment options, and the cases would present very late in stage when treatment may not be viable.
Therefore, Somali women tend to have a fatalistic view about cancer in general and worryingly call it an incurable big wound. Identifying early of this silent killer would help the treatment of breast cancer and the prognosis of the many lives.
Somali culture that places sanctity on a woman’s body has also fuelled the spiral of silence about breast cancer, worsened by the fact that most oncologists in Somalia are male. In fact the few male oncologists would not worsen the situation but to get them is the question and their experiences.
A study that has done on the knowledge of Somali doctors about cancer classification from other diseases suggested that small numbers of doctors can classify cancer cells from other diseases and the rest are undoubted. Also accessibility has its huge effects on breast cancer, since the majority of hospitals in Somalia do not provide comprehensive cancer treatment and one has to go abroad to get treatment.
Breast cancer has strong linkage with traditional beliefs in Somalia communities which hinders the early detection of cancerous cells at their early development.
Apart from traditional beliefs, there is good news about breast cancer these days. Treatments keeps getting better as new technologies gets more advanced, but Women who live the third world may not know the simple steps to reduce the risk of breast cancer and this is probably caused by low level of education and awareness among Somali women.
Practically speaking, breast cancer can be reduced by using different methods/techniques and approaches which is very applicable to every women and also culturally adoptable.
In this scenario I am not going to talk about modernized cancer treatment such as chemotherapy, Radiation therapy and hormonal therapy and targeted therapy including immunotherapy, but I am going to talk about the natural way of treating breast cancer and why is it important to be vigilant about breast cancer development.
Preventing breast cancer in a natural way
We live in an extremely toxic world from the macro to the micro level and so it is very important to learn to reduce that as much as you can.
There are literally thousands of published studies that prove the power of natural medicine. I mean, there is everything from every herb, every type of food that has shown the benefits of boosting the immune system and weakening the cancer and preventing breast cancer.
The following essential steps would reduce the risk of getting breast cancer and the burden of breast cancer in the society.
Perform breast self-examination once a month. If you find any abnormalities, seek medical help immediately. Early detection is vital to successful treatment.
Minimize over the counter and prescription drugs. Substitute natural herbs whenever possible. Drugs clog the liver and have adverse effects on hormone detoxification.
Avoid constipation: “in almost every case of breast cancer, a history of constipation can be demonstrated.” (Pelton), thus plenty of water, fiber, fruit, and exercise are very helpful.
Exercise regularly. Women who exercise aerobically four hours a week have less disease and stress.
Do not wear tight bras. Take your bra off whenever you can. Studies have shown that wearing tight bras contributes the development of breast cancer.
Do not use any harsh anti-per spirants, deodorants, soaps, detergents, lotion, and make-up. Every chemical you put on your skin enters your body, thus increasing detoxification requirement on your liver.
Massage your breasts daily as massage stimulates blood flow and oxygen thus increasing lymphatic drainage.
Based on these above essential steps would help you reduce the risk of getting breast cancer, if you opt to do these steps and taking them as your daily activities.
Recommendations and Conclusions
Cultural misperceptions and attitudes need to be addressed by developing culturally appropriate interventions to improve screening uptake for Somali women.
Cultural barriers should be addressed specifically to younger and older groups. Culturally informed beliefs can be integrated into intervention development, preventive care and screening promotion.
Tahlil Ibrahim Abdi (Yarow)
Master of Public Health (MPH)
Tel: +252612114603/+252619011155-Mogadishu- Somalia.