There are many myths about breast cancer, especially in Africa, where people are diverse and have different genetic backgrounds and ancestral histories.
For example, an advertising campaign in the United States claims that one in eight women will develop breast cancer in her lifetime.
This statistic has permeated other parts of the world and is accepted as fact. However, in sub-Saharan Africa, women have a much lower lifetime risk of developing breast cancer. For example, in South Africa, a black woman’s lifetime risk of developing breast cancer is 1 in 43.
However, breast cancer remains one of the most prevalent cancers in the region and is associated with high mortality rates due to socio-economic factors that hinder early diagnosis and access to treatment.
As researchers studying diseases in African populations, we aim to use scientific research to directly benefit patients.
Here, we highlight four misconceptions faced by women with breast cancer in Africa. Dispelling these myths is important so that breast cancer treatment focuses on the serious socio-economic issues faced by patients.
Myth: Breast cancer is a single disease
In reality, breast cancer has different forms based on the expression of proteins on the surface of tumor cells called receptors.
• Hormone receptor-positive breast cancers have receptors that use hormones, estrogen or progesterone, to help them grow.
• HER2-positive breast cancer uses human epidermal growth factor receptor 2 to promote growth. (HER2 is a protein involved in normal cell growth.)
• Triple-negative breast cancer refers to cancer cells that do not have estrogen, progesterone, or HER2 receptors. These cancers tend to grow and spread faster than other cancers.
Knowing which type of breast cancer you have is important in determining the treatments available to you, your chances of surviving the cancer, and your chances of recurrence.
Myth: Cancers in one part of Africa are the same in other parts of Africa.
African women who develop breast cancer are generally thought to have aggressive cancers, such as triple-negative breast cancer.
There are differences in the distribution of different types of breast cancer due to diversity at both the regional and individual levels. A review of 63 studies from 24 African countries found that triple-negative breast cancer was most likely to be found in patients in West Africa.
Women in eastern and southern Africa were more likely to have hormone receptor-positive breast cancer. Our study and others have shown that in South Africa, women of African descent are more likely to have a type of hormone receptor-positive tumor with a favorable prognosis, regardless of the presence or absence of HER2. In a study of more than 1,000 breast cancer patients (black women) in Johannesburg, 55% had hormone receptor positive cancer, 27% had HER2 disease and 14% had triple negative breast cancer.
This diversity is further emphasized when genomic assays are used to examine tumors at the molecular level. This testing method examines tumor tissue at the genetic level to identify the type of cancer in more detail. This is used to help optimize treatment plans and predict the likelihood that the cancer will come back.
Myth: Breast cancer cannot be treated
This myth is still widespread among some groups in Africa.
In fact, both hormone receptor-positive and HER2 cancers have well-established treatment options in addition to surgery, chemotherapy, and radiation therapy. These cancers have good survival rates, especially if diagnosed early.
Treatment options for triple-negative breast cancer are more limited and include surgery, chemotherapy, and radiation therapy.
Recently, improved understanding of triple-negative disease has led to the development of new treatments that target the biology of this cancer.
Examples include immunotherapy, which boosts a patient’s own immune system to recognize and eliminate cancer cells, and cancer therapy, which blocks the enzyme (PARP) that tumor cells use to repair damaged DNA. There are PARP inhibitors, which are targeted drugs that kill it.
However, the sad reality is that these new generation treatments are mostly out of reach of patients due to socio-economic factors.
Myth: HIV causes breast cancer
HIV and other viral infections are associated with the development of several other cancers, but this is not the case with breast cancer. The relationship between HIV infection and breast cancer is complex.
When HIV-positive patients have hormone receptor-negative tumors, there is little difference in survival and recurrence rates. However, HIV-positive patients with hormone receptor-positive cancers have even worse outcomes, even though the hormone receptor-positive cancer itself has a good prognosis.
Removing the stigma of breast cancer and HIV will help women receive treatment earlier.
How to beat breast cancer in Africa
It is important to dispel myths and give women knowledge and understanding about breast cancer.
But the reality is that obstacles still exist for breast cancer patients.
The biggest challenge is to overcome the socio-economic problems plaguing the continent.
Early detection is critical to improving survival rates and we need to further increase awareness of breast cancer. Screening programs must be effectively extended to low-resource settings.
Training primary health care providers to perform clinical breast examinations on all women would help detect abnormalities earlier. They then need to help patients navigate the complexities of the healthcare system so they can receive timely treatment.
Finally, to better understand the burden of disease, pathways to improve care, and how to tailor treatments to our unique populations to achieve the best outcomes, we We are looking for research that focuses on patients.
