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NATIONAL ANTHEM
“UNIBEN ANTHEM”
“ARISE
MIGHTY UNIBEN”
Preamble
• Mr. Vice-Chancellor Sir, I thank you most sincerely for the
approval for me to deliver this lecture today, this 28th day of July
2016. I thank you and your Management team for the support
you have given us at the School of Medicine where I am the
current Dean
• I am obviously very delighted to be at this epoch making event of
my academic career, but wish that my parents are physically
present.
• Assured by the faith into which my siblings and I were born that
my parents, are watching this from above. Also comforted by the
substantial presence of my siblings and my clan here
• As it is said, to live in the hearts of those you love is not to die.
Our parents loved us dearly and gave their best and all for our
education and training. This event is of one of the results of their
devotion and dedication to our sound education and training.
Dedication
• I dedicate this lecture to my creator the almighty God, my Lord
and Saviour Jesus Christ and my parents Chief Christopher
Kekenomonobenosude Momoh the Egboise of Ivhiukasa and
the Okhunape of Avianwu and Chief Mrs. Grace Agnes Naluba
Momoh (nee Egabor) the Aimienakhue of Avianwu and the
Iyonosomhi of Weppa-Wanno
• Each parent guided me at the two stages of choice of career
and specialty
• In the late 60s and early 70s there was a clarion call that the
future greatness of Nigeria was tied to science and technology.
Being in the Science class was therefore a patriotic response to
a national call
• At the famous St. John's College Fugar run by
American Catholic Marianists Missionaries we had
excellent laboratories and I would come home on
holidays to dazzle my siblings and parents with
some of the experiments we had performed in
school
• My mother then naturally asked me where all these
science was leading to and I said to physics and
space technology, obviously fascinated by Neil
Armstrong landing on the moon in 1968
• She queried why not Medicine and being a Doctor
and I responded that the seven years it took to study
Medicine was too long. "Seven years" my mother
responded was a twinkle of an eye compared to the
tales of 15 to 20 years voyages abroad that studying
Medicine was associated with when she was
growing up. Studying Medicine was thus the choice.
• On return from national service in 1981, I worked in
the Emergency unit till 1983 when my father requested
his political associate, foremost educationist and
politician and the then Chairman of the UBTH Board,
Chief Hon. M. C. K. Orbih to advice me on the choice
of specialty, In his words “ I appreciate more the
specialist who can treat ailments with prescriptions
and can in addition do operations”. The rest is history
• I am a consultant surgeon and Professor of Surgery
and I am all thankful to my parents and Almighty God
• My father had also always enjoined his large nuclear
and extended family that this his first son Moses, by
the nature of his profession may not bring funds to
distribute but will surely bring respectability, honour
and fame to the family. I am yet to deliver on the last.
My father also pointed out those of his children who
would bring wealth and they too have delivered. To
God be all the glory.
• As a General surgeon I have been very gratified with
my teaching and practice of surgery. My stress and
headaches are instantly relieved when I teach or do
surgery with my medical students and Resident doctors
• For area of focus and research, half way through my
academic career, I chose Breast and Endocrine
Surgery, that is, surgical diseases of the breast, goitre,
pancrease and adrenals and glands outside the brain
• My clinical, teaching and research work with Breast
cancer patients have exposed me to the enormity of the
huge of breast cancer scourge, hence it's the subject of
my Inaugural lecture today.
Introduction- Cancer
• Cancer in simple or general terms, is body tissue
growth that is
EXCESSIVE, UNCONTROLLED,
UNCOORDINATED,UNREGULATED, SERVES NO
USEFUL FUNCTION, CAN SPREAD THROUGH
BLOOD AND LYMPH TO DISTANT SITES IN THE
BODY AND IS EXTREMELY DANGEROUS TO THE
BODY BY CAUSING DEATH
• Cancer tissues live for eternity until they kill their host
and then they too die
• To illustrate by contrast this abnormal growth, recall
what happens with an abscess commonly called a boil
• The breast, the subject of this inaugural
lecture, enlarges in size during pregnancy
and breast feeding but returns to its
normal size after the lactation. The linings
of our mouths, gullet and intestines are
shed everyday and replaced by new lining
mucosa
• These are orderly, controlled, coordinated,
regulated body tissue growths that serve
useful functions
GLOBAL CANCER BURDEN
• Worldwide one in seven deaths is due to
cancer. Globally cancers kill more people
than Malaria, HIV/AIDS and Tuberculosis put
together. [International Agency for Research
on Cancer (IARC)]
• Cancers constitute a heavy burden on our
health systems
• In developed countries cancer is the second
most common cause of death after
cardiovascular diseases, while in developing
countries cancer is the third most common
cause of death after cardiovascular disease
and infections.
• In 2012 there were 14.1 million new cases of cancer and
8.2 million deaths from cancer. This gives 22,000 deaths
per day
• In the developing countries there were 5.3 million (64.6 %
) deaths and 2.9 million (35.4 % ) deaths from cancer
• It is projected that by 2030 there will be 21.7 million new
cancer cases per year and cancer will cause 13 million
deaths that year, again majority of which deaths will be in
sub-Saharan Africa and the developing world. (Global
Cancer Facts & Figures 3rd Edition. 2012)
• In economically developed countries the three most
commonly diagnosed cancers in females are breast,
colorectal and lung cancer while in developing countries
the three most commonly diagnosed cancers in females
are breast, uterine cervix and lungs
• Thus in women, both in developed and developing
countries, breast cancer is the most frequently diagnosed
cancer
BREAST CANCER Statistics
• Breast cancer is the most commonly diagnosed
cancer in women globally including Nigeria (Ferlay J.
Soerjomattaram I. et al. GLOBOCAN 2012 v 1.0. Cancer Incidence and Mortality
Worldwide: IARC CancerBase N0 11. 2013)
• In 2012, 1.7 million new cases of breast Ca. were
diagnosed worldwide
• Slightly over half (53%) of these new cases of
breast cancer occurred in developing countries
• In the same 2012 there were an estimated
521,900 deaths caused by breast cancer and in
developing countries breast cancer is the leading
cause of cancer death among women
BREAST CANCER Statistics
• There is now no part of the world where breast cancer is said
to be a rare form of cancer. There is also no population
around the world with truly low incidence of breast cancer
and so every woman in the world is at risk of developing
breast cancer in her life time
• The global burden of breast cancer is so huge and attaining
epidemic proportions that the highly influential and most
subscribed TIME magazine dedicated an entire edition to "
Why Breast Cancer is Spreading Around the World". This
subject adorned the cover of the October 15, 2007 edition
of the Magazine
• In 2015 TIME magazine again devoted yet another entire
edition to breast cancer. This clearly shows the enormity of
the scourge and how seriously the developed world takes it
2007 Edition of Times
Another Edition devoted to Breast
Cancer in 2015
Regional Statistics on Breast Cancer
• At national and regional levels, data show that 1 in every 8
Caucasian American women will develop breast cancer in
their life time, 1 in every 11 British women and 1 in 12
African American women will develop breast cancer in
their life time. (Badoe EA, Baako BN. The Breast. In: Badoe
EA, Achampong EQ, da Rocha-Afodu JT eds.)
• Accurate population figures, population based Cancer
Registers and even ordinary hospital attendance registers
are lacking in Nigeria
• We however, have no reason to believe that the data will
be radically different from the prevalence in AfricanAmerican women
Statistics in Africa/Nigeria
• In Uganda the probability that a woman who lives to
be 65 years will develop breast cancer in her life time
is only 20% less than that of her European and
American counterpart. (Sally N. Akaralo Anthony, Temidayo
O. Ogundiran, Clement A. Adebamowo. Emerging breast cancer
epidemic: evidence from Africa. Breast Cancer Res. 2010;
12(suppl 4) S8)
• Here in UBTH, hospital based cancer registration is
nascent . We are looking forward to stronger and
more robust data from there very soon.
• Data from our female surgical ward indicate that 6 of
its 30 beds are almost always occupied by breast
cancer patients, thus making it the most common
cause for admission for major surgery into that Ward
Peak Age incidence
• Breast cancer is rare before the age of 25 and uncommon
before the age of 30 and starting to be seen from the age
of 35 years with peak incidence from 45 to 55 years in
Nigeria and 55 to 65 years in developed countries
• Momoh MI and Ohanaka EC in their mega study Factors
Associated with delay in Presentation of Breast Cancer in Benin
City. 2008. found the peak incidence to be 45 to 55 years.
This we attributed partially to low life expectancy of 48
years as at 2008 of our women
• Breast cancer is very rare below the age of 20 years,
however N. J. Nwashilli, D. Obaseki and M. I. Momoh. 2012.
have reported a case in a 13 year old girl in Benin City
and again Ohanaka EC and Momoh MI managed another
case in an 18 year old girl
Pathology
• Deriving from our opening description of cancer,
breast cancer is uncontrolled disordered breast
tissue growth with propensity to spread through
blood and other body fluids to distant sites and
organs of the body
• These sites include the lungs, liver, peritoneum,
the spine and the brain and breast cancer tissues
will be growing disorderly in these organs
• Apart from destroying the breast, the cancer cells
destroy these vital organs thus leading to death
Stages of Breast Ca.
ILLUSTRATIONS.
SYMPTOMS and SIGNS of BREAST CANCER
Breast cancer usually presents with the following
features
•
Initially painless lump in the breast
•
Lump in the breast is hard like a piece of granite
•
Enlarged size of the breast as the lump increases
in size
•
Discharge from the nipple which may or may not
be bloody
•
Nipple retraction or distortion
• Eczema-like rash around the nipple-areola
•
•
•
•
•
complex that does not respond to anti-fungal
cream treatment.
Sore or ulcer in the breast that does not heal
Swellings and nodes/seeds in the armpit or axilla
Difficulty with breathing when it spreads to the
chest and to the lungs
Waist and bone pains with or without fracture or
break of bones
Enlarged liver and or distended abdomen filled
with fluid called ascites
• Paralysis from waist down (paraplegia) associated with
spread to the thoraco-lumbar spine
• Convulsion and coma (unconsciousness) associated with
spread to the brain
The last 8 of these, are features of late or advanced disease
and our mega study "Factors Associated with delayed presentation
of Breast Cancer" Momoh MI and Ohanaka EC found that 74.6% of
our patients presented with these features of advanced disease.
Only 20% present with the first 3 features and with early
disease
• It must be noted however, that it is only in sub-Saharan Africa
that women still present with these features, even the first
three.
• Now in the United States and Western Europe the
commonest mode of presentation of breast cancer
is with "screening detected lump in the breast”
• The method of screening could be by clinical
breast examination (CBE), breast Ultra-sound
scanning or by mammography. This very early
detection and presentation makes for the real
potential for complete cure for the disease
• This is the reason that in spite of the increasing
incidence of breast cancer in the US and Western
Europe the deaths from breast cancer is
decreasing.
Stages of Breast Cancer
Stages at presentation of breast cancer
• The stages at which breast
cancer present are divided into
four, namely:• 1. Lump in the breast is the
size of a grain of rice or size of
a bean seed but less than the
size of a cube of sugar.
• 2. The lump in the breast is
about the size of a Walnut but
with lymph nodes or seeds in
the armpit that are 4 or less
and not matted or gummed
together.
Early disease
• 3. The lump in the breast is bigger than the egg of chicken, the
breast is bigger and the nodes in the armpit are more than 4
and are matted or gummed together. The skin of the breast and
the muscles underlying the breast are affected at this stage.
• 4. At this stage the mass in the breast could be of any size, but
there is now either a sore/ulcer in the skin of the breast or the
cancer mass is attached to the muscles underlying the breast.
Stages 1 and 2 are early breast cancer and stages 3 and 4 are
the late or advanced breast cancer.
• Unfortunately our mega study here, Momoh MI and
Ohanaka EC and studies across Nigeria and the West
African sub-region show that only 20% to 30% of our
patients presented with early disease where as 70% to
80% of our patients presented with late disease. Our study
was done over a decade ago and it was established then
that 74.6% of breast cancer patients we studied
presented with late or advanced disease.
• We have just repeated an aspect of the study dealing
specifically with the "Stage at presentation of Breast
Cancer in the Second decade of the 21st Century".
Our just published report indicates that 73.4% of breast
cancer presented with late disease. Thus there is no
significant difference between the stage of presentation
10 years ago and now. (Momoh MI, Agbonrofo P. 2016)
• The relevance of this staging is to predict the prognosis
and survival
• Early breast cancer can be cured and we aggressively
manage it aiming for cure so that the patient can have a
normal life span. Late breast cancer cannot be cured
and we only do palliative treatment.
PICTURES FROM MEDICAL ILLUSTRATION.
Advanced /late disease
Advanced /late disease
PICTURES OF PTS WITH BREAST CANCER.
• Mr. Vice-Chancellor sir, ladies and gentlemen, where are the
men that cuddled these breasts at the stage the Holy Bible
referred to them as "lovely deer, a graceful doe. Let her breast
fill you all times with delight; be intoxicated always in her love"
Proverbs 5:19 English Std Version
• Where are the children that suckled these breasts as newborn
till infancy? They are there, and they care and are concerned,
but they like the patients are victims. They are victims of
ignorance, poverty, superstition, lack of education and very low
women empowerment. Momoh MI and Ohanaka EC in our
mega study on " Factors Associated with delayed
presentation of breast cancer" found these to be the factors
responsible for why 74.6% of breast cancer cases presented
with late or advanced disease
• Other factors found to be associated with the late presentation
of breast cancer were poor referral system in the healthcare
delivery system, mishandling of tissue specimens removed
from the breasts.
Is there an indigenous name for cancer?
• A factor we are investigating now is the apparent dearth of words or
vocabulary for cancer in our indigenous dialects. A basic marketing
strategy of a commodity is to advertise the commodity in its name
in the indigenous dialect
• Many dialects in this Midwestern zone of Nigeria call Malaria fever "
eeba" or "iba". Cough is "oweh" and tuberculosis is "oweh no khua"
that is big cough. In Etsako Hernia is called "uzo okhai na" that is
disease that does not allow the man to run. We are searching for
the indigenous Bini, Etsako, Esan, Urhobo, Ijaw, Ibo, Hausa Yoruba
words for CANCER
• We believe that awareness of cancer as a disease will be
enhanced and improved if local vocabulary for cancer are known.
We however are curious about the dearth of indigenous vocabulary
for cancer. Is it that our indigenous communities did not suffer from
various cancers?
CAUSES/RISK FACTORS FOR BREAST CANCER.
• The best chance for the cure of breast cancer is early
detection at stages 1 and 2. This is true worldwide and
more so in Nigeria and other low-resource countries
where there is dearth of critical expert healthcare
personnel, poor infrastructure and lack of high
technology equipment for treatment of breast cancer still
pose huge challenges. This early detection is due to the
awareness of the disease breast cancer and its causes
or risk factors.
• For most cancers and breast cancer, causes are not
exactly known but instead we talk of risk factors for the
particular cancer
• This is best illustrated with lung or bronchial cancer in
which cigarette smoking is the risk factor.
• For breast cancer it's not as simple as lung cancer and cigarette
smoking. For breast cancer it's a combination of about a dozen risk
factors. The established risk factors for breast cancer are:1.
Female Gender: Being a female is the number one risk factor for
breast cancer. Every woman is at risk having breast cancer in her
life time. Men also have breast cancer but of every 100 persons
presenting with breast cancer 1% will be men. Momoh MI and
Ohanaka EC found this to be 2% in our mega study. Studies in Enugu
was 2% (Ezeome ER, Emegoakor CD, Chianakwana GU, Anyanwu SNC
2010) and about 9% in Zaria and 3.7% in North Eastern Nigeria
(Dogo D, Gali BM, Ali N, Nagada HA 2006) . Olu-Eddo AN and Momoh
M. I. in our 20 year review of all histologically diagnosed breast
cancer at the UBTH found that 2.8% were men. The men folk are
therefore alerted to also check themselves for breast cancer
2.
Age: The older a woman gets the higher the risk of developing
breast cancer. Breast cancer has a peak incidence at 45 to 55
years in Nigeria and sub-Saharan Africa. However in the developed
world the peak incidence is from 55 to 65 years
RISK FACTORS
3. Family History: Breast cancer in a family indicates that
patient's mother, sisters, aunty, nieces are at a higher risk of
developing breast cancer in their life time. In the developed
world, screening procedures are intensified in these family
members to detect the disease at an early stage
• In Nigeria the culture is predominantly to still keep ailments
a secret from other family members. Breast cancer patients
hardly had information on similar illness in the family in the
past. In our practice we have managed only three sets of first
degree relations with breast cancer.
• In North America tests can now be done to identify the faulty
gene that predisposes a woman to having breast cancer and
if this gene is also present in the daughter, then that daughter
must embark on screening procedures much earlier and
more frequently.
RISK FACTORS
4. MENARCHE and MENOPAUSE: Menarche is the age
of commencement of menstruation of a female and
menopause is the age at final cessation of menstruation.
The lower the age at menarche and the higher the age at
menopause the higher the risk of breast cancer
The age at menarche has been reducing by one year per
decade in the last five decades. Thus in communities
where girls had menarche at 16 years 50 years ago, girls
in that same community now see their period at the age of
11 years. In our study "Age at Menarche of School Girls in
Edo State" across Edo state MI Momoh and C Okonkwo (2008)
found that menarche ranged from 9 to 14 years. Among
children of the upper middle class in urban Benin City,
Auchi and Irrua the average age was at 11 years whereas
it was 13 years in rural dwellers
• Menopause is the final cessation of menstruation for one
year and it is functionally related to the decline of the female
hormone oestrogen. Late menopause is understood to mean
attaining final cessation of menstruation at age 55 or above.
In our study " Menopausal status of breast cancer patients" MI
Momoh, AN Olu-Eddo and C. Okonkwo (2008) found 49 years to
be age at menopause for both our breast cancer patients and
our controls who did not have breast cancer. This we thought
is a fall out of the low life expectancy of 48.5 years for our
women a decade ago when the study was done
• At the centre of all these is the female hormone called
oestrogen (the chemical that makes one a woman). Thus a
woman who sees her period for the first time at the age of 10
and sees it till 55 years has been exposed to oestrogen for
45 years where as another woman whose menarche was 15
and menopause 45 years has been exposed for 30 years.
The former with 45 years exposure has a higher risk for
breast cancer.
• 5. Age at first delivery
• Best reproductive years 18-25 ( obstetricians)
• Earlier deliveries protect against Breast Ca.
• First delivery after 35 years carries higher risk
than early delivery.
• 6. Parity (Number of children delivered).
• More children protect against breast cancer.
• No children at all increase risk of breast
cancer.
• Still the hormone Oestrogen.
• 2 children is 4 years of lower oestrogen
• 10 children means 20 years of less oestrogen
Breast cancer also grows very rapidly during
pregnancy and breast feeding. EC Ohanaka, MI
Momoh and AN Olu-Eddo in our study
Management of Pregnancy Associated Breast
Cancer. 2008. found these dilemmas.
• The goal of treatment of breast cancer in
pregnancy is to give optimal treatment to
mother to give her maximal chances of
survival whilst minimizing risk to the foetus.
• What do you do when a pregnant woman has
breast cancer?
7.
BREASTFEEDING: Women who breast feed their
children for 18 months to 2 years are better protected
against breast cancer. This again derives from risk factor 6
above. There are many passages in the holy scriptures
referring to breast feeding as being joyful, rewarding, a
blessing to mother and child and more than nutrition
(Isaiah 88:10 -13, 1Peter.2:2, 1Samuel. 1:21-24) Therefore
conjecture the reverse when there is no breast feeding
• My dear wife even as a very busy Resident doctor and
young consultant ophthalmologist then, breast fed
each of our six children for about two years, yet her
breasts till date remain the "lovely deer, a graceful doe.
Her breasts fill you with delight at all times and get you
intoxicated always in her love" Proverbs 5:19.
8. BIRTH CONTROL PILLS: It is established that the use of
oral contraceptive pills (OCPs) predispose women to breast
cancer. High dose oestrogen forms of OCPs increase the risk
of breast cancer by about 10% to 30%. Lancet 1996; 347:
1713-1727
9. MENOPAUSAL HORMONE THERAPY(MHT)
Gynaecologists sometimes put women on oestrogen/progestin
preparations for a short while to alleviate peri-menopausal
symptoms. However, prolonged unsupervised use of these
oestrogen preparations will put these women at risk of
developing breast cancer. Cheblowski RT, Anderson GL,
Gass M. et al in Estrogen plus progestin in breast cancer
incidence and mortality in post menopausal women. JAMA
2010. Celebrities and show business women often take MHT
unsupervised. This behaviour put these women at grave risk of
developing breast cancer
10. BENIGN (INNOCENT) BREAST LUMPS:
• Not all breast lumps are cancer. In fact majority of
breast lumps are not cancer. Female teenagers and
women up to 40 years have breast masses, usually
small (1-3cm) that are usually rounded and smooth
and are benign. No matter how these lumps feel,
they must be excised and sent to the histology
laboratory for confirmation that they are benign
or otherwise. While these benign lumps are not
known to change to cancer, it has been established
that women who have had these lumps have a
slightly higher risk of (0.3%) developing breast
cancer
11. OBESITY AND PHYSICAL ACTIVIVTY:
There is two times increased risk of breast cancer
in women who are obese post menopause.
Worldwide there is increased body mass index
(BMI) of women in the last three decades. In
Australia the average BMI of women increased from
23.6kg/sq.m to 26.8kg/sq.m
• Women who engage in active physical activities
tend to be protected against breast cancer. They
have a 12% lower risk of developing breast
cancer.
• 12. TOBACCO AND ALCOHOL: Women who smoke
cigarettes heavily and for many years are at a higher risk of
breast cancer. The American Cancer Society research finding
is that women who start smoking before the birth of their first
baby have a 21% higher risk of developing breast cancer
than those who have never smoked. Even passive smoking
increases the risk of breast cancer in pre menopausal women
• Alcohol consumption also increases the risk of breast cancer
by 7% to 10%.
The above risk factors are the established risk factors.
• 13. TERMINATION OF PREGNANCIES (ABORTIONS):
Multiple or serial terminations of pregnancies are thought to
increase the risk of breast cancer. This is supposedly
controversial because studies from different institutions draw
different conclusions. Proponents and opponents of a
positive association between induced abortion and breast
cancer are pitched against each other . (Pro-choice Vs Prolife)
• What is however not controversial is that the current wave of the
near epidemic prevalence of breast cancer in the US and Europe
came 10 - 20 years after abortions were legalized in most States of
the US in the mid 1950s. As abortions began to be freely obtained
the incidence of breast cancer increased 10 - 15 years later
• The basic physiology of pregnancy and lactation and the
consequences of sudden disruption of the pregnancy would seem
to support the increased risk of breast cancer that is associated
with induced abortions. We all know that one of the earliest signs of
pregnancy even before a period is missed are changes in the
breast especially the nipple areola complex. From the first day of
pregnancy the breasts start to prepare for breast feeding and the
events at the end of pregnancy are gradual and deliberate steps to
let down milk within minutes of birth. When a pregnancy is
terminated abruptly as is usually done this systematic, deliberate
and ordered activities are disrupted and the breast is left in a
"quandary and or confusion"
• Here at the University of Benin, MI Momoh and AN Olu-Eddo
in our study ”Induced abortion and risk of breast cancer:
Observed relationship in Benin City” (2008) found that
among breast cancer patients, those who have had termination
of pregnancies, had a peak age incidence of 35 - 45 years
instead of the 45 -55 years in Nigeria and 55 -65 years in
developed countries. Thus those who have terminated
pregnancy tended to develop breast cancer at an earlier age.
As I said earlier abortion has not been listed as an established
risk factor for breast cancer. We are continuing to study the
relationship between abortions and breast cancer.
• We have devoted our teaching and research to these risk
factors because understanding them will create awareness that
will engender early detection of breast cancer.
• Every woman, all doctors and healthcare providers even and
especially at the Primary Healthcare Centre (PHC) level should
know these risk factors. The community as a whole, including
men should have an understanding and buy into the concept of
breast cancer surveillance for their mothers, wives, nieces,
aunties and even the men.
Modifiable Vs Non-Modifiable RFs
• It can be seen that there is nothing we can do about the
first four risk factors. We cannot determine our gender nor
how long we live nor the age women attain menarche and
menopause. There can however be benefits from family
members knowing who in the family has breast cancer. It
puts other women in the family on alert to be more serious
with screening procedures.
• The "faulty gene" (BRCA1 and BRCA2) that predisposed
the patient to breast cancer can now be identified in the
patient and then searched for in the other family members
to determine their risk of developing breast cancer.
• In the larger Nigerian family nation we still keep ailments of
public figures and celebrities shrouded in secrecy. The best
we hear is that the public figure battled with some cancer
which again makes cancer sound like a mystery.
Tennis legend Martina Navratilova discovered a lump in her breast,
got the diagnosis of breast cancer, had surgery and radiotherapy and
went off to attempt to climbs Mount Kilmanjaro. She thus gave so
much awareness to breast cancer and demystified it by going ahead
to climb Mount Kilmanjaro as she had scheduled before the diagnosis
of breast cancer
Senator John McCain in the midst of Presidential campaign some
years ago had a malignant melanoma excised and he announced
that it was cancer and continued with the campaign
This is why we must commend President Muhammadu Buhari who
announced that he had ear infection called Meniere’s disease. It put
ear infection in the public glare and I know few persons who had
their ear examined by ENT surgeons around that period. Feature
articles with well elucidated diagrams of the outer, middle and inner
ear also appeared in some daily newspapers.
Gene Studies & Breast Ca. Previvors
• Gene studies in family members can identify those at
grave risk of cancer. It is these tests that super model
and famous actress Angelina Jolie did and she elected to
have her two breasts removed (double mastectomy) in
2013. Her mother and aunty were diagnosed with
ovarian and breast cancer respectively, so the actress
did the gene studies and found that she had an 86% risk
of developing breast cancer. Without any breast
complaint or symptom Angelina Jolie had the preventive
double mastectomy. Such patients who elect to have
their breast removed prophylactically are termed breast
cancer PREVIVORS.
• Mr. Vice-Chancellor sir, we have had near-PREVIVORS in
our practice and teaching. A female Professor of a health
science in a university in the north-central zone of Nigeria
had had recurrent breast lumps excised on three
occasions. Even though the test results confirmed that the
lumps were not cancerous, the professor said she was
very distressed and "died many times before each the test
results come out". On account of this stress and anxiety
she requested and gave consent for us to do a double
mastectomy for her
• My Residents and team were excited that we've got our
own Angelina Jolie, a previvor and we gave the professor
appointment for admission. On the appointed day of
admission the husband and older brother who had never
accompanied her to the clinic before now came with her to
emphasize their disapproval. Mr. Vice-Chancellor sir, if a
female professor does not have the final word on what to
do with a body part that is a potential threat to her life,
which category of women will have their say and their way.
• Yet a retired Chief Nursing Officer who had had a right
mastectomy done requested that we remove the left breast
that did not have any complaint. She had heard us teach the
Medical students that there was risk of cancer in the left breast
if the right had been diagnosed with cancer. Again her husband
a retired Federal Chief Pharmacist/Permanent Secretary
objected.
• Then we had a female domestic servant who went to the UBTH
Centre for Disease Control for routine check up and the lump
found in her breast was cancerous on histology testing. Her
husband rejected the wife and the result. He said it was the
wife who "take im leg waka go carry sickness put for her
breast" and that the matter " no concern me". It was public
spirited individuals who donated to pay for the basic treatment
of wide local excision which was all she needed as the disease
was very early, non-invasive intra-duct carcinoma.
• The first two couples highly educated upper middle class
healthcare professionals and the last third couple from the
lower social class and yet the attitude were the same. It is only
a Catholic nun who has volunteered to have the remaining
breast excised after the other developed cancer. The Reverend
Sister did not have to seek consent from any husband and that
made the difference. It is all about women empowerment.
Modifiable Risk factors
• There is serious challenge as regards the fifth risk factor on
the age at first delivery of live baby. Pursuit of higher
education and career target attainment must be subjugated
to child bearing and breast feeding at the optimum times.
Women should have many children and breast feed them.
The world's economic and social problems are caused by
inept and corrupt political leadership and a docile
followership and not by so called overpopulation
• We can say an emphatic NO to the other risk factors
namely the use of oral contraceptive pills (OCPs), the use
of menopausal hormone treatment (HMT). Reject
termination of pregnancies, cigarette smoking and alcohol
consumption and avoid obesity
• The other very important value of knowing these risk
factors is that a woman who has 3 to 5 of these risk factors
will be more circumspect as regards screening procedures
Management of Breast Cancer
• I must dispel two wrong notions 1. breast cancer can be cured
and 2. It’s not every case of breast cancer that we remove the
breast. The notion that breast cancer cannot be cured and that
every case of breast cancer results in the removal of the
breast is one of the reasons many uninformed breast cancer
patients stay away from hospital till very late
• Management of breast cancer includes
– tissue diagnostic tests to confirm diagnosis
– tests to stage the disease as X-rays, Ultra Sound Scanning,
Computer Tomography Scanning, Magnetic Resonance
Scanning and Radio-Isotope scanning
– Blood tests are done to determine the patient's fitness for
surgery and chemotherapy.
• The test to confirm diagnosis of cancer is by tissue diagnosis
called histology where by a small piece of the tissue is
obtained as a sample, processed and viewed under the
microscope to determine the cellular characteristics. This is
the test that authoritatively pronounces tissue to be cancer
or otherwise. Diagnosis of cancer is a weighty judgment
made by only qualified pathologists
• Diagnosis of cancer is followed by radical decisions as
excising an entire organ or part of it and these are not
reversible procedures. Some breast masses and ulcers
which were clinically assessed to be cancer were on
histology found to be tuberculosis or other form of chronic
granulomatous infection. ( Olu-Eddo AN, Egbagbe EE, Momoh
MI. A 20 year Clinicopathological Analysis of Tuberculous
Mastitis in Nigerians. (2007).
Treatment of Breast Cancer
• Surgery and Radiotherapy targeting the locoregional disease and Chemotherapy, Hormone
therapy and Target cell therapy as systemic
treatment.
• With non-invasive in-situ and very early stage 1
disease only, the quadrant where the cancer
lump was detected is excised and the breast is
conserved. This decision is taken with the
assurance that radiotherapy is available.
• Mastectomy which is the removal of the breast
is the surgery we do for later stages of breast
cancer
Treatment of Breast Cancer
• Radiotherapy is targeted at breast cancer cells in
the chest wall, the armpit and other sites the
cancer cell may have spread to. A very
sophisticated high tech machinery requiring very
exacting conditions to function, radiotherapy
machines are wont to break down from time to
time.
• Sometime in March 2016 none of the seven
machines in Nigeria was functioning
• There are only 7 instead of the recommended 140
Radiotherapy centres in Nigeria. Thanks to the
past and current management of the UBTH we
are one of those centres
Treatment of Breast Cancer
• CHEMOTHERAPY: This is the use of anti-cancer drugs to kill the
cancer cells that may have spread from the breast to other parts of
the body. The combination of drugs are administered every 3 -4
weeks for 6 - 12 months as long as the blood count is optimal
• HORMONE THERAPY: This aims at making the hormonal milieu of
the body tissues unresponsive to further growth of the tumor. This
basically counters the female hormone oestrogen. Thirty years ago
after the mastectomy the ovaries were also removed. Tests are now
available to determine the patients who will need specific hormone
therapy, again thanks to the UBTH management, these Immunohistochemistry tests can be done in UBTH. However as things are in
low-resource countries the reagents for the tests are currently
unavailable in Benin so we have to send specimens to Abuja, Ibadan
or Lagos
• TARGET BIOLOGICAL THERAPIES: Based on sophisticated tissue
tests patients to benefit from this therapy can be determined and
together with chemotherapy are very effective treatments.
• Mr. Vice-Chancellor sir, the management out lined
above last a minimum of one year. In our study of the
"Burden of Breast cancer in Benin City" Momoh
MI and Olu-Eddo AN estimated the direct cost of
treatment and we found that cost of the management
of breast cancer outlined above was beyond the
capacity of even the upper middle class
• The pre-operative tests cost a minimum of
N150, 000.00,
uncomplicated mastectomy cost about N250, 000.00,
radiotherapy is about N120, 000.00
Chemotherapy costs range from N80, 000.00 to
N150, 000.00 per month for at least six months.
Target cell therapy cost about half a million naira
(N500, 000.00) monthly for six months.
Aside the target cell therapy the total estimated cost of
treatment is above two million naira (N2, 000,000.00)
• This is direct cost and does not include indirect costs such as the
loss of productivity of the patient and the friend/ relation and
transportation costs.
• The hospital and thus the government also bear cost as the
treatment in public healthcare facilities is obviously subsidized.
When they present late with necrotic and fungating ulcers we
showed earlier, even the bed sheets they lie on are lost. The
oxygen gas that keeps them going is enormous
• The management of the late or advanced disease is very expensive
hence we have always advocated for awareness campaigns for
early detection that will lead to curable early disease
• The good news in all these is that we achieve cure and survival
when these patients present with early disease and are able to
afford the cost of management outlined above. While the survival
rate is about 90% in the United States it is about 10% - 15% in
Nigeria and sub-Saharan Africa. Global Cancer Facts & Figures
3rd Edition: 2012.
GENERAL SURGERY
• Mr. Vice-Chancellor sir, this breast we have been talking about is a
very simple organ within the skin, actually a skin appendage like
the sweat gland and hair follicle. So in principle and practice the
surgery of mastectomy is not challenging and not heroic except
when there is massive enlargement of the breast in late disease
• As a general surgeon, the abdomen and its content especially the
alimentary tract from the stomach to the anus is our field of
practice, teaching and research. Breast and Endocrine surgery is
our area of focus. Surgery of the abdomen has been very exciting
and interesting. No two abdominal conditions are ever the same.
Irrespective of what the tests and imaging techniques point to,
opening the abdomen and seeing it live is a thriller and is it.
• The arrangement of the organs, glands and tissues all functioning
in unity deepens ones faith about the amazing powers of our
creator the almighty God. In my view the arrangement of organs
and tissues in the abdomen is more amazing than the
arrangement of the galaxy and its stars.
•
• It is in this abdominal surgery that we have met with, and
by the grace of God overcome challenges. 3 of these
patients readily come to mind.
• Gunshot injury to abdomen of an Irish Priest
• Similarly R.I., a young man visiting from the United
States in 1999 was shot at point blank at Uwasota Street
• A 65 years old lady from a very prominent Edo family,
resident in Canada came home for the first time in 25
years was vomiting blood from a bleeding Peptic Ulcer.
• These are just a few examples. Now it may have been
noticed that I am nearly 100% local content. While we
may not have trained abroad, our work have gone
abroad and have been greeted with accolades
• Apart from these emergencies, surgeries to remove giant
goitres have been challenging and gratifying
• Surgery to remove the entire anus and rectum and
replacement with a permanent colostomy for cancer of
the ano-rectum is the most challenging procedure in my
specialty and we do this routinely with very good results
for those who accept surgery early.
• As the anus is very sensitive symptoms of a new growth
present very early and the diagnosis is made early. The
challenge usually is that the patients do not accept to
have a permanent colostomy the “artificial anus" on the
left side of the abdomen (belly). When they accept the
decision early and we do the surgery before spread to
the liver the patients usually survive.
Contributions
From 1994 to 1997 I was the first member of the Edo State Hospitals
Management Board with former two time Dean of the School of
Medicine Prof. Ambrose Isah as chairman and Dr. Simon Imuekemhe
as Director of Hospital Services/CEO
I served in the UBTH management as Chairman, Medical Advisory
Committee(C-MAC)/Director of Clinical Services and Training of the
University of Benin Teaching Hospital from September 1998 to March
2003 under Prof. A. O. Obasohan as Chief Medical Director. In this
period we brought at least twelve projects namely CT Scanning,
Renal Dialysis, Oxygen Plant, Printing Press, and Movement to the
Accidents and Emergency Unit, from conception to completion.
These set the hospital on a progress path which I am glad successive
managements have built upon
Contributions
• In late 2008 I was persuaded to serve as a member of the Edo State
Executive Council and Honourable Commissioner for Health. From
January 2009 to January 2011 we supervised the renovation of all the
maternity and children wards of all the 20 General hospitals and the
three Central Hospitals in Edo State. The Primary Healthcare Centres
were also renovated with emphasis on water projects. We got
development partners to commence the renovation of the massive
medical stores along Medical Stores Road in Benin City. In the 2009
Edo State budget, N700mn was the initial budget for Central Hospital
Benin City. The Comrade Governor was not happy with the state of
the hospital. Some group argued that there should be general
renovation, painting and brilliant lighting of the hospital premises.
We argued that the then 102 years old hospital should be
demolished and re-built in phases and thankfully His Excellency
Governor A. A. Oshiomhole agreed with us. We convened a
stakeholders meeting of the hospital in my office. Then Chief of
surgery and now Permanent secretary HMB Dr. Ofure Eboreime, Dr.
Moses Imologomhe, Dr. Matthew Oriakhi, Chief of Laboratory
services now PS Dr. Moses Aigbirior, Director of nursing services
and pharmacists met with me and we decided that what the hospital
needed most was a modern, spacious and tropicalized and
functional Accidents and Emergency centre with surgical wards
At the next meeting of these stakeholders firms of architects prequalified by the State government were briefed on our concept and
they produced designs. The Comrade Governor was thrilled with the
projected outcome of the facility and he gave his all to the project.
The earth breaking ceremony was done early in January 2011 and
the result is the magnificent edifice at the city center today.
• The State Schools of Nursing, Midwifery and Health Technology were all
renovated and upgraded. A state of the art modern Eye Clinic was
established at the Stella Obasanjo Women and Children's Hospital
(SOWCH). The Drug Revolving Fund was reorganized and drugs were
continously available. Immunizations were aggressively pursued and
epidemics that broke out around Edo state were kept abey from the state.
There was general staff recruitment with emphasis on specialist
consultants for the three Central hospitals at Auchi, Uromi and Benin City
such that by now they would be admitting medical graduates for the
mandatory one year houseman-ship training
• We have trained scores of Residents to be specialist consultants in all
specialties of Surgery. In my sub-specialty of general surgery in the last
fifteen years we have trained the following, Dr. N. Nkeonye now Chief
Consultant surgeon in Delta state, Dr. Emmanuel Sule a Senior Lecturer
at DELSU, Dr. Esosa Okoro consultant surgeon in the UK, Dr.
Omorodion Irowa Lecturer/Consultant, Dr, Nnamdi Nwashili Consultant
Trauma surgeon, Dr. Bright Ederibhalo, Dr. Peter Agbonrofo and Dr. Taiwo
Amusan all consultant surgeons.
Acknowledgements
• I am immensely thankful to my maker and creator, the Almighty God that my
thoughts and works have found expression through this great intellectual
citadel the University of Benin Nigeria to national, regional and international
arena/world stage. I am eternally thankful to Almighty God for the parents
He gave me to. I dedicate my whole being, all that I have and all that I am to
Almighty God.
• I dedicate the good thoughts and works of my academic and professional
careers to my parents and my family
• I thank God for St. John's College Fugar, it gave us sound Catholic Christian
education. It reinforced family virtues of truth, honesty and integrity. Like our
patron Saint John the Baptist we were taught to speak the truth even at the
risk of beheading
Acknowledgements
• I am particularly thankful to Rev.Bro. Michael Cain, my chemistry teacher
who was killed by a logging truck and is interred at the Seminary at
Ekpoma. May his soul continue to rest in perfect peace. Run by American
Catholic Marianist Missionaries we called our teachers John, Michael, Paultheir first names. At St. John's we are bold, confident, assertive and looked
authority in the face almost to the point of aggression as long as we held on
to the truth. Thankfully I was admitted to the then elite Government College
Ughelli for higher school. GCU was fashioned after the British public schools
and order, seniority and hierarchy was emphasized. The cultures of the
schools complimented each other and think I am better for it till date. I thank
all the Saints from SJCOBA and all the GCUOBA members who are here
today
Acknowledgements
I am thankful to the University of Benin from its founding Visitor Dr. Samuel
Ogbemudia, first indigenous Vice-Chancellor Prof. Tijani Momodu Yesufu
through Professors Adamu Baikie, Grace Alale-Williams, Andrew
Onokerhoraye, R. Anao, E. C. Nwanze, Osayuki Oshodin and current VC F.
F. O. Orunmwense. They all played positive roles from my admission to this
university, through graduation, residency, employment and promotion
through the ranks to Professor and giving this lecture today. I thank Prof. L.
Ezemonye, Prof. A Falodun, Mrs. O. A. Oshodin, Dr. Mrs Omoluabi Idiodi, Dr.
Baba Bila.
I thank my Provost Prof. V. Iyawe who we work seamlessly together and all
my fellow Deans and Directors.
Our gratitude equally goes to the authorities of the University of Benin
Teaching Hospital (UBTH) for providing the clinical facilities for all our
practice, teaching and research. We appreciate Prof. J. C. Ebie and Prof A.
U. Oronsaye of blessed memory.
Acknowledgements
• I am particularly grateful to Prof. A. O. Obasohan in whose management I
served as C-MAC/Director of Clinical Services and Training. Pioneer CMD
Prof. J. C. Ebie and his successor Prof. A. U. Oronsaye are thankfully
acknowledged.
• I thank Prof. E. E. Okpere and Prof. Mike Ibadin for elevating the hospital
beyond where they met it. It is now second to the UCH Ibadan in both bed
capacity and services delivered among the teaching hospitals in Nigeria.
• In the department of surgery we were the initial first set of trainees who did
the indigenous national and regional training programs without any foreign
or overseas exposure. In the face of scepticisms and doubts the late
Professors U. Osime was a great inspiration and same were Prof. I.
Evbuomwan, Prof. Festus Ogisi, Pro. F. Iweze, Prof. Vincent Onuora and
late Pro. Victor Odiase. They with Prof. R. Ofoegbu who headed the
department at various times have built an enduring institution.
• I thank Dr. T. A. Njoku, Dr. Temple Oguike and Prof. E. C. Ohanaka who we
struggled together to attain the heights we are today. To God be the glory.
• My gratitude to all academic and non-academic staff of the School of
Medicine where I am the Dean.
• My immense thanks go to the Emeritus Archbishop of the Metropolitan
See of Benin City, His Grace Dr. P. E. Ekpu, his successor Dr. A. O.
Akubeze and the Bishop of the Diocese of Auchi Rev. Dr. G. G. Dunia. I
thank all the Priests and Religious my family and I encounter every day in
our devotion to our faith and our God. Through Rev. Fr. Dr, G. Ogbenika
and Rev. Fr. Richard Enegbuma the parish priests of my home parish
Christ the King Catholic Church Fugar, I salute all the priests of Auchi
diocese. At St. Albert's Catholic Church UNIBEN/UBTH we have been
blessed to have Rev. Fr. Bob Dundon SJ, highly cerebral Oxford educated
Very Rev. Fr. Dr. Theophilus Uwaifo and Rev. Fr. Prof. Onwueme all of
blessed memory as spiritual guides. Rev. Fr. Augustine Ehigie's brief,
incisive and expository sermons have deepened the knowledge base of
our faith and thanks too to Rev. Fr. R. Imoni. The very dynamic and
energetic Rev. Fr. Andrew Obinyan was home parish priest at St. Vincent's
Catholic Church Auchi where he tended to my then aged parents giving
me a lot of relief and confidence. He is now my parish priest and great
spiritual and infrastuctural builder of my faith and my church. I thank him
immensely.
• I thank all parishioners of St. Albert Catholic church my second family
members.
• Knights and Ladies of St. John International are highly valued and
appreciated. My thanks to all my brothers of Etsako Citizens Club
and my kindred of the Fugar Progressive Union who are all here in
large numbers
• My enduring friends over the years, Dr. Muhammad M. Lecky, Mr.
Bern Omo-Akhigbe, Senator Matthew Urhoghide, Engr. Chris
Ogiemwonyi, Mr. Nelson Ononye, Mr. Emma Ozono, Engr. Osato
Edo-Osagie, Prof. Law Ezemonye, Prof. Austin Obasohan Chief
Lawson Omonkhodion, Sir Sylvester Egbase, Dr. Sylvester Ojobo,
Engr. Paschal Osigbemhe, Chief Athanasius Braimah, Prof. Friday
Okonofua, Prof. Mike Ibadin, Prof. M. J. Waziri-Erameh, Prof. E.
Pandy Kubeyinje, Prof. Austin Omoigberale, Dr. Tare Biu, Pro. A.
Omoigberale, Dr. Margaret Odili, Prof. A. E. Ehigiegba, Dr. Osagie
& Prof. Mrs. Dawodu, Dr. Tosan and Dr. (Mrs) Valentina Ideh, Dr.
Peter Oside, Engr. Moses Aroko, Comrade Godwin Erahon,
Mallam MB Shehu and many many more.
• I like to acknowledge with thanks the presence of those who have
survived this scourge. I salute their courage, tenacity and faith in
almighty God. You may wish to stand for the rest of us to join o
thank God for his mercies
• I thank my parents-in-law and the Okoeguale family of Eguare-Opoji
who we are now one family. My father-in-law Mr. Lawrence
Okoeguale a most caring gentleman is fondly remembered today
and always. May his soul rest in peace – amen. I thank Agatha and
Ehidiamen in the UK and Florence, Eromosele and my mother-inlaw Mrs. Stella Okoeguale in the US for their support always and
especially when my family is abroad.
• I thank my siblings for the support and cooperation they have given
me especially after the passage of our patriarch and I became the
Village Head. I thank Justina, Lucy, Lametu, Veronica, Bridget,
Anthony, Imoudu, Idulagbe, Irelamie, Patricia, Augustina, Charles,
Celine, Pauline, Philomina, Frank, Josephine, Clementina,
Emmanuel, Anthonia, Edith, Oshogwe, Christopher, Constance,
Aaron, Taiye, Oshorhiamhe, Imonikhe, Awawu, Isomianwu, Bashiru,
Hassan, Inino, Abdullahi and the rest of the Momoh Clan and
Apaaduku kindred. I love and thank you all.
Acknowledgements
• After my maker the Almighty God my children have justified my works
and efforts
• Oshokha Michael Momoh Esq, a lawyer doing his National Service,
Omegie Louise Momoh studying for ACCA at the BPP University
Manchester UK, Omokheli Amanda Momoh a student at the Jesuit
Canisius College Bufallo New York, Osiano Simon-Peter Momoh SS1 at
Olashore International School, Iloko-Ijesa, Esiro Nadine Momoh Primary
4 Our Lady of Apostles Catholic School and Uki-Esi Marilyn Momoh a
Primary 2 pupil of OLA.
• This youngest one, two years ago taught my wife and I a lesson in giving
thanks. All eight of us were complete at home at Christmas and year's
end and praying and giving thanks for the achievements and blessings
for the year - graduating in Law, Accounting, MSc in Public Health from
UK Universities, graduation from SS3 at the Loyola Jesuit College Abuja.
At the conclusion of the prayer session Uki-Esi then 5 years old, raised
her finger and protested that we did not thank God for her graduating
from Kindergarten 3 and passing entrance to Primary 1 in OLA school.
My wife and I were humbled yet full of joy and fulfillment that our
youngest child was that thoughtful. To GOD be the glory.
• They are a great motivation for me to keep serving man and
God. I love them so much, I am so blessed with them that I
am always joyful
• What then do I say of the mother of these wonderful
blessings, my very dear, lovely, elegant, very beautiful, very
intelligent, best friend and wife Dr. Rita Omoso Abike
Momoh. She on marrying me took charge of a man who was
lavishly loved by the mother and adoring sisters. She has
risen to the situation. Sweetheart, thank you very much. I
love you dearly. Your support for and constructive criticisms
of my work as lecturer over the years is giving birth to this
lecture today on breast cancer. Your breast feeding each our
six children for two years in spite of your busy schedule as
an academic and clinician is a teaching and counseling tool
for me. It also assures me that you are protected against
this monster called breast cancer.
MY LOVELY CHILDREN
CONCLUSION
• Mr. Vice-Chancellor sir, we have shown by our teaching and
research that every Nigerian woman is at risk of having
breast cancer. By very conservative estimates one in every
20 Nigerian woman will be afflicted with breast cancer in
their life time and this is a huge fraction of our 85 million
women. Worse still is that 75% of these breast cancer
afflicted women will present with late disease which is
incurable. This late presentation we have established is due
to low level of education, poverty, low empowerment of
women, poor referral system and lack of awareness of
cancer and breast cancer.
• We have also established that women can reduce their risk
of developing breast cancer by adopting lifestyles such as
not smoking, early childbearing, breastfeeding of their
children, avoiding obesity and saying no to abortion.
CONCLUSION
Awareness campaigns in the last two decades have been sporadic
and episodic and not sustained and our studies show that in this
2016, 73.6% of breast cancer patients are still presenting with late
advanced disease and have thus not reduced the huge scourge of
breast cancer. This huge burden of advanced breast cancer is a
scourge on the afflicted woman, her family and friends, community
and on the health facilities and therefore the government.
This ravaging scourge we have alerted afflicts predominantly the
economically productive age group of between 35 and 55 years
thus compounding the woes of the family who cannot afford the
high cost of treatment, the unaffordable cost of treating advanced
disease, the fatality it inflicts on them.
As we are, painfully to say, a low-resource or resource-limited
nation lacking in diagnostic facilities appropriate for the
geographical size and population of 170 million people this scourge
is ravaging our women.
• In our circumstances therefore, our best chance to halt this
ravaging scourge is to adopt feasible and practicable
strategies that will ensure early detection and diagnosis so
that we cure our patients and have 90% survival rate as it is
in the developed countries. Mammography as mass
screening modality is impracticable in Nigeria on account of
cost as 95% of Nigerians do not have health insurance and
pay for services from out 0f pocket. In the face of this
ravaging breast cancer scourge we make the following
general and specific recommendations.
• General
1. Free compulsory Universal Basic Education
2. Eradication of poverty.
3. Sustained Awareness Campaigns
4. Finding and using indigenous nomenclature of CANCER in
our local dialects.
5. Strengthening Primary Healthcare Centres in all the 10,000
political Wards in Nigeria.
6. Empowerment of Women
7. Eradicating communicable diseases and thus free
resources to combat cancers and other non-communicable
diseases.
• Specific.
1. All clinical healthcare workers from CHEWs, Nurses,
Midwives, Community Health Officers, Health visitors and
doctors should be very knowledgeable of the risk factors for
breast cancer and be able to teach and demonstrate Breast
Self Examination and Clinical Breast Examination.
• Teaching Hospitals should participate in this.
• All women who come to hospital for any ailment should
be counseled to have a CBE done for them.
• All women with a significant risk for breast cancer
should have more frequent CBEs and start breasts
ultra-sound scanning at an earlier age. Breasts
scanning cost about five thousand naira and in lowresource country like Nigeria it can be used as a
screening modality
• We also recommend that gene studies be done in both
the breast cancer victim and the daughters such that if
the daughters also have the "faulty gene" that
predisposed their mother to the disease the daughters
will then be more circumspect with their screening
procedures. This gene screening is only now available
at the UCH Ibadan.
• Mr. Vice-Chancellor sir, very distinguished ladies and
gentlemen, it is obvious that in our circumstances, in
this low-resource nation, CBE is our best mass
screening modality as it is cheap and can be made
universally available and free of charge for every
woman if stakeholders such as government,
legislators, heads of health institutions including
private hospitals, doctors and indeed all competent
health workers agree to offer this service at no cost.
• We implore that all our healthcare facilities (All
healthcare facilities from the PHCs to the University
teaching Hospital) should grant every woman free
clinical breast examination (CBE)
• Every woman should as a matter of right go to
any healthcare facility and register and be
clinically screened for breast cancer free of
charge twice in a year.
Thank you for listening
God bless the
University of Benin
God Bless Nigeria
“UNIBEN ANTHEM”
“ARISE
MIGHTY UNIBEN”
NATIONAL
ANTHEM