Cancer – It’s not a death sentence!

Katheke Mbithi’s One-On-One with Elizabeth Ombati

The pink ribbon has been her friend for as long as she can remember, a part of her. As I stretch my hand to say hello, she goes. ‘I am Katheke Mbithi and I am a breast cancer survivor.’ She tells me this is a way of greeting, something she has developed over time. She continues, ‘I have to pass this message: Breast cancer is not a death sentence, and early detection is the only way to safety.’ With a wide smile playing on her lips, she is quick to open her inner soul to the world to tell how it all began.

I was pregnant with my second child and as with my first I attended antenatal clinic. Pregnancy makes one more alert to the little details in life—I made sure that I was healthy, knowing I was responsible for the well being of the life in me. And so when I felt a strange lump on my left breast a few days into the sixth month of my pregnancy, an alarm bell rang.

A breast ultrasound showed an abnormal mass

A breast ultrasound showed an abnormal mass. At this stage, nothing much could be deduced so a Fine Needle Assimilation (FNA) had to be done. It showed that the growth was cancerous. A biopsy (removal of cells or tissue for examination) had to be carried out to confirm these results. This meant anaesthesia. I knew that under this ’deadlike’ state, and with my advanced pregnancy, there was a high risk of my baby dying. Therefore, I opted for the biopsy to be carried out after delivery. I was stressed: my gynaecologist was concerned, wondering whether I would handle the pregnancy to full term.

The breast was growing bigger with each passing day. I tried to block my mind from thinking about the advancing growth of the cancerous tumour.

My EDD was October the 14th but the baby came a day earlier. I delivered through a C-section. As my baby was being removed, the biopsy was going on. My baby girl, Ndunge Mutheu weighed 3.4Kgs.

Two days

The results of the biopsy were to be back in two days. A part of me knew I had cancer. The FNA had indicated that it was malignant, but now the biopsy was more final I prayed for a miracle. It did not happen. When they told me it was harmful, a deep sated pain tore at me. All I could do was cry. My husband, ever supportive, was there for me.

The tumour was quite big, covering about three quarter of the breast. This called for a mastectomy. Twelve major lymph nodes from under my armpits had been removed for testing and three had been found to have a malignant tumor (growth caused when cells multiply uncontrollably, destroying healthy tissue).

The number of cancerous cells determines the form of treatment to be used. I had to undergo chemotherapy which would ensure that if it had spread, it would be taken care of. My baby was given formula milk. My breasts were swollen with milk; I expressed milk with the right one. She was discharged earlier than I, and it was hard for me to stay in the hospital alone. I had just given birth. I was eager to be with her, to cuddle and hold her.

In one of the dailies that weekend. I read a story about a surgeon based in Nairobi. It indicated that he was among the best breast surgeons in Kenya and that his father too was a breast surgeon. My husband and I decided to pay him a visit.

No surgery

Soon we were on our way to hospital. When the doctor saw me, he said all he could do was pray. No surgery? I was on the verge of tears.

He told us that since the breasts were swollen with milk, there was the possibility of over cutting. He asked that I go back home and wait for the milk to dry naturally. I could not use drugs to hasten the process: I was already on too many. Usually it takes about two weeks for the milk to dry up. I have never felt as hopeless. I was finally booked in for surgery on the 31st of October 2005.

Goodbye, a sad thing

As I said goodbye to my little daughters, I was deeply unhappy. I knew theatre operations can go wrong. I was out of the theatre room in two hours. It took me two days to look down at my chest. I knew there were bandages, which I occasionally felt. When I eventually garnered the courage to do so, I was overwhelmed by emotions and I may also have shed a tear or two. But having reached this far, there was no room for sadness. I had felled one giant.

Stage 2 of cancer

My cancer was in stage 2 and I was to go for six sessions of chemotherapy. I started after one month because the wound had to heal first. Each session of chemotherapy cost Kshs.65,000.

By my fifth session, I was down and out. My blood count was low and I could not go through the chemotherapy. I felt nauseated and weak. There were also sores in my mouth and I could not eat anything solid. I drank uji and fed on mashed potatoes. I had to regain my blood count to continue the chemotherapy. The resilient me had to do it. I successfully finished my sessions. However, the saddest part in the whole of this was that I could not get close to my baby—she had to be nursed by my sister in law.

The possibility of emission of dangerous toxins resulting from the chemotherapy could not be overlooked.

Radiotherapy

After the last session of chemotherapy, I had a three week break before embarking on radio therapy, lasting 25 sessions. While undergoing radiotherapy, I noticed that I was getting unusually tired. I could not even climb a set of stairs without panting and sweating furiously. It was strange. One night I woke up out of breath.

I was suffocating. This continued till morning so I had to visit a doctor.

Not again!

While conducting his usual tests last year, my oncologist (cancer specialist) detected cysts growing in one of my ovaries. It was noted that there is a possibility of recurrence even after removal. My uterus had to be removed, including the fallopian tubes, cervix and ovaries.

I am thankful and grateful to be alive. My hair, which had fallen off has grown back and I take pride in creating awareness and preaching hope to other women. I have also joined support groups as it is a great way to share. I am a member of the Kenya Breast Health Program Survivor’s group.

Tony Mbithi, Katheke’s husband acknowledges that though it was shocking that this was happening to them, it opened other doors as well. He says, ‘This is when you learn to appreciate each other more and to be strong for one another. Now, we are one big happy family and have learnt to appreciate each day. We are alive and remember to always give our gratitude to Cod.’

Should breast cancer be the end?

Katheke Mbithi agrees that management of the disease is quite expensive and blames this for numerous early cancer deaths. She also advises all women to make it a ritual to go for mammograms.

‘Women should make a point of having a mammogram (procedure of taking an X-ray of all or part of the breast) undertaken. Finding out can not hurt you. Just like HIV-AIDS, it will only ensure that you start treatment early so as to manage it. With all this awareness flying left, right and centre, no one should blame ignorance.’ she says.

SURGEON’S VIEW

Dr. Joseph W. Githaiga, a consultant breast surgeon, notes that for some people, breast cancer may be the end due to late detection, which makes the management tricky. Below he answers some common questions on breast cancer and pregnancy.

Does Pregnancy expose a woman to breast cancer?

Pregnancy does not predispose you to breast cancer. It is protective. Exposure to oestrogen ( hormone) increases the risk of it and when one is pregnant, oestrogen is suppressed thence is less risky.

After treatment for breast cancer, is it advised to conceive again?

If you have been treated, other pregnancies are not reason for the recurrence of breast cancer so you can go ahead and have another baby.

What treatment is recommended for breast cancer in pregnancy?

In early pregnancy do not use chemotherapy as it can affect the baby causing congenital malformations. Again, never use radiotherapy because it destroys cells and can still affect the baby. It can lead to abortion when the baby is exposed to radiation. Also, the possibility of the child coming down with cancer in future can not be ruled out.

Is breast cancer hereditary?

About 5 to 8 per cent is genetically hereditary, otherwise most cancers are spontaneous.

What about breastfeeding?

One has to suspend breastfeeding, especially while going through cancer treatments like chemotherapy. Use formula or normal milk instead.

Age and breast cancer—are they related?

Women who get babies early are less likely to have breast cancer in later life.

BREAST CONSERVING THERAPY (BCT)

This refers to removal of the tumor and about V* of the breast tissue on that side. During Lumpectomy (surgical procedure), the surgeon and the pathologist work in collaboration to make sure that resection margins of the specimen are free of tumor cells to avoid in breast recurrence.

At the same time lymph nodes in the armpit are usually removed, to check for spread of cancer cells to this area.

Mastectomy versus Breast Preserving Therapy

Numerous studies show that women with localized breast cancer are equally likely to survive their cancer whether they are treated with breast conserving therapy (BCT) or mastectomy. However, it is estimated that fewer than 60 per cent of women with early breast cancer are treated with BCT. Furthermore, the selection of BCT is influenced by geographic and socio economic factors as well. I would like to encourage our women to go for early breast cancer screening which will allow them to conserve their breasts. Pre-operative assessment and discussion with individual patient is KEY to the decision to have mastectomy ( removal of one or both breasts) or breast conserving surgery.

The individual discussion regarding the benefits and risks should include several essential points:

•  The long term survival after breast cancer.
• The possibility and consequences of a local recurrence
•  The psychological adjustment to treatment (including the fear that the cancer will return)
• The likely cosmetics results
• Sexuality after treatment

For most women, the likelihood of surviving localized breast cancer is the same with mastectomy or BCT in contrast, the choice of mastectomy versus BCT may have considerable effects on a woman’s quality of life. The overall experience of having breast cancer is equally distressing for women who choose BCT and for those who choose mastectomy. However, compared to women who choose mastectomy, women who choose BCT tend to have a more positive body image and experience fewer changes in their feelings of sexual desirability.

COSMETICS RESULTS

With modern surgical techniques, breast conserving therapy has excellent cosmetic results (treated and untreated breast are almost identical) or good cosmetic results (only slight differences between the treated and untreated breast)

It is worthy to note that certain clinical factors may clearly favour mastectomy over breast conservation therapy for medical reasons in individual women. These include:-

• The presence of two or more separate tumors in different areas of the breast.
• Diffuse spread of the tumor in the breast tissue,
• Previous radiation of the breast or chest, which makes future radiation inadvisable.
• Pregnancy in the first and second trimester which makes radiation inadvisable.
• Some connective tissue disorders such as scleroderma (a chronic disease)

Breast clinics are run at Aga Khan University Hospital Nairobi on Mondays, Wednesdays and Fridays.  BCT for early breast cancer is also provided.

Ronald W. Wasike
MBCHB MMED (Nairobi) FRCS (Canada)
Aga Khan Hospital.

END: PG 16/44-45