Madrid, 10 December 2019. Over half the women in Africa (60%) diagnosed with breast cancer find out about it when the disease is already in an advanced state, and over 90% are treated via radical mastectomy. These are just some of the numbers featured in the documentary “Historias de mujeres. Segunda parada: Kenia” (Women’s Stories. Second Stop: Kenya), an original idea by Doctor Laura García Estévez, head of the Breast Unit at the MD Anderson Cancer Center Madrid – Hospiten. The film attempts to show what life is really like for women with breast cancer on the African continent.
This documentary is the second in a five-chapter series on the five continents. The overall objective of the doctor and the RTVE film crew that accompanies her on her adventure is to paint a true picture of all the women with breast cancer around the world. After the first instalment filmed in China and now this second chapter on Africa, Doctor García Estévez is planning to go to the USA next year to film the third part of the series.
“The world cancer map is still revealing enormous differences”, says Paz Rubio, RTVE journalist and the documentary’s codirector, together with Doctor García Estévez. “It’s been really hard to pin down the numbers, but we have been able to see there’s an increase in cases of breast cancer, and there’s a great deal of difficulty in addressing it”, she adds.
The documentary filmed in Kenya tells of a very complicated situation for women with breast cancer. “Being a woman and having breast cancer too in Africa is tragedy”, admits the doctor. Doctor Eric Ungo, breast surgeon at Kenyatta National Hospital in Nairobi, explains, “Some men threaten to leave their wives for having this disease”. It’s a fraught situation, and it’s due to lack of understanding of the disease, which many people in Kenya mistake for an infection or even witchcraft. In addition, the treatment for most women in Kenya is mastectomy, so another very frequent concern women have is that they’re losing part of their body.
“Patients are shockingly uninformed. They’re astonished that breast reconstruction is a thing in Spain,” declares Doctor García Estévez. She explains that most patients don’t know there are different subtypes of breast cancer, either. There are no breast cancer prevention campaigns, and there is no breast cancer screening. That, plus the huge distances between rural areas and the few hospitals that exist, explains why most women reach the doctor’s office after their cancer has reached stage four.
In addition, in a country with just one doctor per 10,000 inhabitants, there are hardly any specialists in pathological anatomy. This means diagnostic results can take up to six weeks to come back— too long in, say, triple-negative breast cancer. As for the technology, Kenya and Tanzania have only one radiation therapy device per five million inhabitants. What’s more, most facilities use cobalt machines, which are much less precise. This lack of technology is another of the reasons why it’s often impossible to offer radiation therapy, so mastectomy is the answer.
The state finances only 20% of cancer treatments
In addition to the scarcity of health resources and staff, Africa has economic difficulties that lead to major inequalities. In Africa the state finances only 20% of treatments. That means 80% of the cost falls on patients themselves. Pauline Muli, age 38, is one of the people the documentary follows. She had to ask her friends for money to pay for her diagnostic tests and later for the treatment she’s currently receiving.
In a country where a lot of people earn less than a dollar a day, many patients have to choose between paying for their treatment or sending their children to school and university. Katherine Yongesa, medical oncology specialist, puts it clearly: “The fight in today’s Africa boils down to prevention”.
The Masai, one of the collectives with the lowest breast cancer rates
Masaimara, another of the locations appearing in the film, has one of the lowest breast cancer rates in the world thanks to its inhabitants’ daily intake of fruits and vegetables and their intense physical activity, since they have to cover kilometres each day to fetch drinking water.
“Ninety percent of Masai women don’t know what breast cancer is,” explains John Sangkok, director of the Masaimara drug dispensary. He attributes their lack of familiarity with breast cancer to the disease’s low rate. “We avoid eating carbohydrates, precooked foods, junk food.” These are some of the reasons Grace Sangkok, the dispensary matron, gives to explain why Masai tribes rarely if ever have breast cancer. As Doctor García Estévez claims, “Africa can show us how healthy habits can prevent the disease from developing.”