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Editorial
Breast Cancer: A Global
and National Perspective
Egbal A. B. Abukaraig1, Manal A. E. Ahmed2
1Director
of the Research and Development Centre, Alfajr College for Science and
Technology, Khartoum, Sudan
2 Ministry of Health, Riyadh, Saudi Arabia
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Breast Cancer (BC), is the most
common cancer among females. It is characterized by the uncontrolled growth of
abnormal breast cells forming tumors; so that in 2020, 2.3 million new cases
and 685,000 deaths were registered globally, accounting for 24.5% of all cancer
cases and 15.5% of cancer deaths among women. )1,2) The incidence and mortality rates vary significantly
across regions, with higher rates in developed countries due to better
detection and reporting systems and a rising trend particularly in developing
countries. (3,4)
In Sudan, BC is a significant public
health issue. In 2018, it represented 24.2% of all cancers and 15% of
cancer-related deaths among females. The lack of widespread screening and early
detection programs contributes to higher mortality rates in Sudan compared to
global averages. (5(
While there are numerous risk
factors for BC, some women develop the disease without any known risk factors
other than being female. Conversely, having risk factors does not guarantee
that a woman will develop BC. (6) However, understanding the risk
factors and recognizing the general symptoms and signs of BC can aid in
prevention and early detection, potentially improving the 5-year survival rate
to 85%-99%. (7,8) The survival outcomes in Sudan are notably poorer
compared to developed countries, largely due to late-stage diagnosis and
limited access to effective treatment. (9) Therefore, women should
familiarize themselves with the normal texture, shape, and size of their
breasts to detect and report any abnormalities early. (7)
Effective control measures for BC
include educating the public about BC risks, symptoms, and the importance of
early detection and lifestyle modifications in terms of encouraging a healthy
diet, regular physical activity, and abstaining from or reducing alcohol
consumption. (10) Although vaccination is not directly related to
BC, Human Papilloma-Virus (HPV) vaccination can reduce the risk of cervical
cancer, which is often linked with BC in terms of awareness and screening
programs. (11) At the level of appropriate policies, governments can
implement policies to ensure access to screening and treatment services,
especially in low-resource settings. (12)
In Sudan, the National Cancer
Control Program (NCCP), under the umbrella of the General Directorate of
Primary Health Care (PHC) at the Federal Ministry of Health (FMOH) runs the
control activities in form of screening and early detection services (opportunistic
screening). The aim is to raise population awareness around
BC-self-examination, early detection and prevention of modifiable risk factors.
In addition, NCCP established national unified protocols and guidelines for
early detection and clinical treatment. (13,14)
Since there is evidence that early
detection significantly improves BC outcomes, (7,8) women should be
encouraged to perform monthly Breast Self-Examination (BSE) which is a key
method to detect any unusual changes in their breasts. (8) Clinical
Breast Examination (CBE) performed by healthcare professionals, can identify
lumps or abnormalities that may not be noticeable during BSE. Regular
mammograms are the most effective screening tool for early detection of BC.
They can detect tiny tumors that cannot be identified by CBE. Unfortunately,
access to mammography is limited in Sudan, particularly in rural areas. (9)
Training healthcare providers and
volunteers is crucial for early detection and management of BC. Programs that
train doctors and nurses in early detection techniques, such as CBE and
interpreting mammograms are essential. Moreover, community health workers and
volunteers can be trained to educate women about BSE and the importance of
regular screenings. (15,16) This is particularly important in rural
and underserved areas.
In Sudan, the integration of BC
screening using CBE as part of the Package of Essential Non-communicable
Diseases (PEN) in PHC was implemented in 2014 in six states. This was achieved
by the training of the healthcare providers in PHC on CBE with clear guidelines
for referral of suspected cases for mammogram and further assessment. Moreover,
the NCCP invests in advocacy and awareness campaigns for BC, particularly the
annual October BC Day, where the program develops Information, Education and
Communication (IEC) materials, and performs awareness campaigns to advocate for
BSE among women to enhance early detection and diagnosis.
In this issue of The
Journal, we publish two articles addressing BC:
The first article titled "The Effect of Training Health Care Providers in Early
Detection of Breast Cancer at Family Health Centers in Khartoum State".
The article, an interventional study, highlights the significance of the
doctors’ and allied health cadres’ in-service training in improving knowledge
and skills regarding CBE. It emphasizes the need for augmenting professional
performance to enhance breast cancer control efforts.
The second article titled "Proliferative Index in Different Grades of Invasive
Breast Cancers using Argyrophilic Nucleolar Organizer Region Expression in
Sudanese Patients". This study, a cross-sectional facility-based study,
assessed the use of AgNOR staining as a marker for the assessment of the
proliferative index (pAgNOR) in different grades of invasive breast cancer. The
study concluded that pAgNOR highly correlates with the histological grade of
invasive breast carcinoma and it can be an alternative to the
immunohistochemical methods like Ki-67 labeling index and proliferating cell
nuclear antigen. pAgNOR has the advantage of being simple, rapid and a
cost-effective method for the assessment of the proliferative status of
invasive breast carcinoma.
The two studies draw attention to
exploring BC issues as a public health problem in Sudan.
References
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