Timeliness and accessibility of breast cancer care: A critical gap in Ghana

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Breast Cancer
Breast Cancer

As a researcher interested in person-centered care, I think of timeliness and accessibility of care often, albeit mostly in the context of maternal health care. But a close family member’s encounter with breast cancer recently has reminded me of gaps in person-centered healthcare in general, and cancer care in particular. It all started with a text message on Sept 28, 2021, from my aunt in Ghana: she had done a mammogram and breast ultrasound, which was interpreted as “type 2 right breast complex cyst” with recommendation for an “ultrasound guided aspiration/biopsy for histologic diagnosis.” At this time, the ultrasound described it as well-defined cyst with no evidence of other lesions in the breast. I encouraged her to get the biopsy done soon, in hopes that it will be a benign cyst. And that was the beginning of a very long journey described below. I encouraged her to write her story because it sheds light on the gaps in cancer treatment in the country.

 

A question that remains is how much pain, discomfort, side effects of chemotherapy, and loss of time and money my aunt could have been spared if it had not taken so long—7 months—from first suspicion of a potential malignancy to treatment initiation.

 

What could she have been spared if she was living in a place where at the first presentation, diagnosis was made swiftly, if the sample did not have to go to Accra and take two months to be told the sample was contaminated, if the first sample had not been contaminated, if it did not take another 2 months to get the sample retaken, and another month for the results to come back, and another month before starting treatment. And there were other gaps especially in communication of the entire treatment plan, so she knows what to expect that are not discussed here because I appreciate that all the providers were doing their best under the constraints of the health system. Rather we choose to focus on the systemic problem.

 

In today’s Ghana, why do histology samples still have to be taken to Accra? Why is there only one facility in Northern Ghana that can offer chemotherapy and why is this center not able to offer radiotherapy? Why does getting a timely appointment depend on knowing someone? What happens to patients who can’t advocate for themselves and request to see a surgeon and do a mammogram? What happens to patients who don’t know someone who can facilitate the process? What happens to patients who can’t afford to travel to Tamale every month for chemotherapy and to Accra for radiotherapy?

 

During the annual breast cancer awareness month, almost all the information was about women doing breast examinations. But the question is: what happens after women have done their part and identified the lump? As a country, we need to be better prepared to make sure that every woman who presents with a suspicious lesion can have a timely definitive diagnosis and can start treatment in a timely manner, at a location that is accessible to them…regardless of who they are, who they know, what they have, which facility they go to, and which part of the country they live.

MY JOURNEY WITH BREAST CANCER BY ABOLGA MATILDA ASUNGRE.

 

It all started in 2016 when I noticed there was some liquid coming from my right breast with a hard press. I went to meet a gynecologist who prescribed some medication for me to take for a period of one month and to come back for review…The liquid stopped after taking the medication like she said, but in 2018 I realized it was back so I returned and in the absence of a medical doctor, I met a medical assistant who was a male, and because of his religious beliefs, he did not observe the breast but just repeated the prescription on the folder. I took the medication and it stopped again until 2021 when I realized that a hard lump which made the breast orange-shaped had developed and was increasing in size.

In September 2021, I visited the hospital again. This time I requested to see a surgeon who upon observing the breast confirmed the lump but said it was a cyst and could be removed. I however requested to do a mammogram to which he agreed. So, I came back with the results on the 1st of October 2021, he looked at it and took a sample to test which I was promised the results in three weeks, but to my surprise on the 04/12/2021 instead of the biopsy report, I was informed that the first sample had been contaminated.

I was to meet the surgeon for another sample to be taken for the biopsy which was not possible until the 08/02/2022 because of the conflict in the town I live in. This was also delayed until 29/03/2022 when I had the results that confirmed an invasion and hence was referred to a hospital where cancer was being treated.

Through my niece, …, I found myself at the Tamale Teaching Hospital where she had a friend who said they could handle it at the Tamale Teaching Hospital (TTH). I arrived at TTH on the 04/04/2022, a sample was taken for another biopsy and the results was to be available in a week’s time. When I returned a week later, the results confirmed that there was an invasion, but they needed more testing to determine the exact type, so I had another biopsy.

It was intended for me to meet the surgeon, but it was not possible as the surgeon was indisposed. I finally got to meet him on the 28/04/2022. After consulting with him, I was put on eight cycles of Chemotherapy which started on the 29/04/2022. In the first four cycles, I took two drugs; Adriamycin and Cytoxan, for the second four cycles, I was on Taxol alongside Herceptin, which I took for eighteen months.

After the eight cycles of chemotherapy, I had a mastectomy on the 18/11/2022. I was then referred on the 23/02/2023 to the Sweden-Ghana Medical Center for Radiation since TTH did not have the required equipment.

I arrived at the center on the 07/03/2023, had a CT scan which revealed I could go on with radiotherapy. On the 16/03/2023 I started a 25-cycle radiation but after only the first two cycles, I was informed on the 19/03/2023 that the machine had malfunctioned and so I had to wait. I was called back to continue the radiotherapy on the 26/03/2023 and ended on the 21/04/2023, during which I continued to take the Herceptin. I went back on the 20/07/2023 for a review and took my last dose of Herceptin and was declared a survivor but will have to continue review visits every 3 months for the next 10 years.

I am grateful to God for the storms He went through with me, in fact, I do not have anything to say but just give glory to His Holy name.

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