Most women with breast cancer symptoms never tested – ministry

Most women found with breast abnormalities after ultrasound and mammography tests are never referred for diagnosis, a Ministry of Health survey shows.

The health facilities — mostly health centres and Level 4 hospitals — do not even follow up on them, though some of the abnormalities are likely to be early-stage cancer.

The ministry surveyed 439 facilities, all with ultrasound, to identify gaps in breast cancer management.

The results are contained in the 'Breast Cancer Facility Baseline Assessment Report', released in Nairobi on Thursday.

The ministry complains that most of the 6,799 annual breast cancer cases in Kenya are later diagnosed too late and most of the women never survive beyond five years.

The country reports about 3,100 breast cancer deaths every year.

“Only 27 per cent of facilities offered follow-up after an abnormal breast examination with either or both ultrasound and mammograms, while 21 per cent of these facilities linked patients with abnormal imaging results with further management,” the ministry says.

Most abnormal findings usually show a benign (not cancer) breast condition and only a small number of women have breast cancer.

However, immediate referral has been shown to substantially reduce mortality in women with breast cancer.

Dr Mary Nyangasi, head of the National Cancer Control Programme at the ministry, said cancer diagnosis is also a problem.

Screening is the regular check even in the absence of obvious signs or there are symptoms, such as bleeding or a lump.

Dr Nyangasi said most hospitals have no capacity to diagnose cancer.

“Very few facilities in the country, we would say about 10 county referral facilities, are able to offer some form of cancer diagnosis,” she said.

The ministry will launch a new cancer control strategic plan on Friday to help build capacity.

“We're looking at scaling up cancer diagnosis so that all  47 counties, all county referral facilities should actually be able to do diagnostic biopsies for cancer patients.”

Cancer of the breast is the most commonly diagnosed cancer in Kenya and the second most-common cause of all cancer-related deaths in the country.

Most cases are diagnosed at stages three and four, which require aggressive treatment, including surgery.

According to the World Health Organization’s Global Breast Cancer Initiative Framework released in February 2023, breast cancer should be diagnosed within 60 days of initial presentation. Treatment should start within three months of first presentation.

On paper, the Ministry of Health says it intends to align with the WHO Framework by 2025.

“Every facility should be actively involved in early detection of breast cancer to identify clients who may have signs and symptoms consistent with the disease and link them to diagnosis and treatment without delay,” the ministry said its Breast Cancer Screening and Early Diagnosis Action Plan 2021-25.

The plan says all dispensaries should be able to conduct clinical breast examinations on women and refer suspected cases for screening.

Subcounty facilities should be able to offer biopsy services and ultrasound, the plan read.

Tests and procedures used to diagnose breast cancer include breast exams, breast ultrasound, biopsy and breast magnetic resonance imaging.

The WHO said in 95 per cent of countries, breast cancer is the first or second leading cause of female cancer deaths.

Nearly 80 per cent of deaths from breast and cervical cancer occur in low- and middle-income countries such as Kenya, the WHO Framework said.

“Countries with weaker health systems are least able to manage the increasing burden of breast cancer. It places a tremendous strain on individuals, families, communities, health systems and economies.

"So it must be a priority for ministries of health and governments everywhere,” Dr Tedros Adhanom Ghebreyesus, WHO director general, said

The framework recommends countries focus on breast cancer early-detection programmes so that at least 60 per cent of cases are diagnosed and treated as early stages. It aims to save 2.5 million lives from breast cancer by 2040.