By JINA AMBA
THE Breast Cancer Awareness Month, marked the world over every October, helps to increase attention and support for awareness, early detection and treatment as well as palliative care for patients.
According to World Health Organisation (WHO), currently there is insufficient knowledge on the causes of breast cancer, therefore, early detection remains the cornerstone of control.
When breast cancer is detected early, and if adequate diagnosis and treatment are available, there is a good chance it can be cured. If detected late, however, curative treatment is often no longer an option. In such cases, palliative care to relieve the suffering of patients and their families is needed.
In Papua New Guinea some organisations, business houses, hospitals, and even national leaders are in the frontline addressing breast cancer and other forms of cancer in the month of October.
A lot of Papua New Guineans have died from this deadly disease.
According to specialist oncologist Dr Peter Olali from the Port Moresby General Hospital, breast cancer is not a death sentence once someone is diagnosed with it.
Olali says if diagnosed at a very early stage breast cancer can be cured. He says cancer becomes a problem when it has already spread beyond the localised breast site.
He says with the current facilities in the country, surgery and chemotherapy alone can cure breast cancer if diagnosed early and managed.
Olali says there are certain factors that prevent women from getting early treatment.
Firstly it is from ignorance; most women, despite feeling a lump on their breasts, don’t want to seek medical attention until the cancer has spread.
Secondly there is fear. Generally, once a woman is diagnosed with an early stage of breast cancer, she thinks of surgery and chemotherapy and is very scared to go through it and disappear for months or years until the cancer has spread and there is no option left but to go to the hospital.
Olali says thirdly, women go for other treatments. Many women resort to herbal treatment and divine intervention for healing.
Herbal cures unproven
“I have not seen an herbal medication cure cancer in the last 13 years I have been managing breast cancer,” he says.
“There are people who market products on the streets and social media but none of them has come forward to see me at the cancer clinic to prove that their medicines work.
“In fact most patients I see with late cancers were initially on herbal treatments in their early stages.”
Fourthly, women are held back from seeking help due to family pressure and obligations. Olali says once a woman is diagnosed with early stage breast cancer and is in discussions of surgery, this is not easy for the family.
“Many will oppose surgery because they want the woman to have children and to continue to breastfeed,” he said.
Delays in treating cancer
Women who have gone for early treatment at the Port Moresby General Hospital, are faced with technical issues within the health system that delay treating early stage cancer.
Olali says the availability of cancer screening centers is the primary cause of delays . Most hospitals in the country do not have cancer screening facilities so patients do not have a pathway to follow when they suspect they have cancer.
Also the country has scarce diagnostic facilities. Port Moresby General Hospital is the only center that receives all specimens from around PNG for histopathological diagnosis. Olali says there are less than five doctors who sit inside the laboratory and do diagnoses.
“Those who are lucky receive results quickly while others might wait for months. Cancer does not wait, it keeps growing and spreading.”
He says further that Port Moresby General Hospital has limited ultrasound scan and mammogram machines.
“Patients can wait for months to get a scan done,” he says.
There is limited capacity for treatment consisting of surgery, chemotherapy and radiation. Olali says they have a good number of general surgeons who can do breast surgeries but they do not have chemotherapy centers in all the hospitals except for PMGH, Angau and Kundiawa.
He says radiation facilities in Angau are currently not working. PMGH is currently is building a new cancer center which will also include radiation facilities.
He says there is also an ongoing drug shortage. Covid-19 has affected the supply process.
PNG needs a cancer unit with all the machines to treat cancer but currently has no such set up. The new PMGH cancer unit is likely to be completed next year.
According to the hospital’s CEO, Dr Paki Molumi the two cancer bunkers are already going up with the roof to be completed by next month and depending on the funding next year, the rest of the facility will be completed.
Molumi says PMGH has signed an agreement with a company to have a machine for screening and testing for breast cancer.
“We had this facility 15 years ago, from a machine that was donated by Rotary. Because it’s a donated equipment when it stopped working, we stopped providing that service.”
He says the completion of the new cancer facility will be good news for women because they can start screening for breast cancer.
Molumi says two latest linear accelerators will be installed in the new facility. A linear accelerator is a cancer machine that is very precise and targeted to the cancer, compared to a cobalt machine which burns the skin, the muscle and all the surrounding structures before it actually gets into the cancer, whereas for linear accelerator it is targeted. It subtracts the skin and muscle, and targets the cancer.
“We need to have a better screening programme, a better early diagnosis programme so we are in discussions with NCD Health through the office of the governor so that we can have a better screening programme for the city before we can roll out to the rest of the country to compliment this cancer facility that we are building. So a lot of things have been happing in terms of cancer and I am sure many of us will benefit from that,” he said.
Molumi says on the first floor of the new cancer centre they plan to build a histopathology as well as molecular diagnostic centre. Histopathology is the diagnosis and study of diseases of the tissues, and involves examining tissues and or cells under a microscope
They also will have a database for the entire country so that they can assess the risk of cancer at a genetic level.
“There are certain indicators in your blood or in you genes that will tell you, you are prone to develop breast cancer. If we can have that database in this facility then we can be able to do the appropriate screening or alert you to come and do the screening,” Molumi says.
This will start in 2022 onwards to get this facility moving.
“PMGH is driving this fight in a bigger way so that we address cancer in a more holistic way. Previously the cancer service has been fragmented which means the specialists do surgery here at PMGH and we give one small treatment and then we had to fly patients somewhere to get another treatment.
“The programme that we are developing is holistic. It will enable early diagnosis and early treatment. It will have a database for molecular profiles for the entire country as well a treatment facility for all forms of cancer,” he says.
Speaking at the 2020 Pink Breast Cancer Awareness Month in Port Moresby recently, cancer patient Maggie Oala from Central urged all women to go for early cancer screening and detection.
Oala said she had breast cancer since 2018 and was diagnosed in Lae where she had her mastectomy, a surgical removal all breast tissue from a breast to treat or prevent cancer.
“And I went into revision for about a year; it has come back quite aggressively. I cannot walk unaided,” she said.
Oala said the theme of the celebration “The best protection is early detection”was true for her because that was what she had failed to do which resulted in her having a mastectomy.
“Cancer is quite interesting and you cannot seem to understand it; it has a mind of itself and so as other sicknesses, but then it depends on how we look after ourselves.
“My husband wondered why it has come back. I probably was too complacent and though it was okay. I probably didn’t watch my diet, but then I can’t blame anybody. It has come back, I just have to deal with it the best way possible that I can. The hospital staff are doing all they can with the limited resources that they have,” Oala said.
She urged everyone to be mindful towards cancer patients and those who take care of patients.
“Breast cancer is not like some other sicknesses because I have to rely on pain killers every day to manage my pain, without the pain killers the doctors have prescribed, I can’t do anything, I am helpless. That’s what happens when you have cancer.”
She urged NCD women to get tested now that the Governor Powes Parkop has announced that there would be free Pap smear tests in the city health facilities.
“If your body doesn’t feel right, don’t brush that aside and say later. Go to the doctors. Let a doctor tell you, it is not for you to make your own diagnosis,” Oala said.
“I have cancer but that won’t stop me from living a normal life,” she said.
Another cancer patient from Jiwaka is seeking help overseas because no facility or treatment in-country can help.
Pawa Wai, 46, from Anglimp-South Waghi electorate in Jiwaka is married with three children. He has been contesting in elections since 2002 and is currently chairman for youth and sports in the Jiwaka provincial executive council.
According to his brother Stanley Namba, Wai was with tongue cancer earlier this year and has been receiving treatment at the PMGH.
However, with the limited treatment options available at PMGH in terms of advanced chemotherapy and radiotherapy Wai was told to seek treatment overseas.
“Wai’s case started at the end of 2017. He had a sore on his tongue which he thought was nothing. After some months the sore did not heal up so he went to Mt Hagen Hospital for checkup. He was tested and a sample was sent to Port Moresby for testing and the doctors said that it was cancer.
“Doctors in Mt Hagen wanted to do an operation and remove the sore from his tongue but he had high blood pressure so he was given medicine and told to wait until he was normal.
“He did not go for that operation. Last year he came to PMGH and the doctors removed the sore on his tongue and told him to return for a review later.
“However, he did not go for the review as he had family commitments. Because of the Covid-19 restrictions he stayed in Mt Hagen and when he went to PMGH for review this year, the cancer had already spread,” Namba said.
“He does not talk much at the moment. His family is feeding him with soft foods and liquids.
“We give him only pain killers, there is no other medicine,” he said.
The total cost of the medical treatment overseas is about K200,000 and the family is planning to bring the patient to China if they raise enough money.
Namba said the Government was spending millions on Covid-19 and other diseases but if they could divert some of that money into building a cancer hospital, that would definitely save lots of lives.
The family is raising money to send the patient for overseas treatment. Anyone wanting to help can send donations to the Pawa Wai Medical Appeal Account No. 7020751298 (BSP Boroko), or call Christy Wai on 73278103 or Stanley Namba on 72447451 for more information.
By JINA AMBA