‘Childless women at risk of breast cancer’

KAMPALA - Not having children can significantly raise the risk of breast cancer, experts at Uganda Cancer Institute (UCI) have said. 

Dr Richard Ekwan, a public health specialist at UCI, said childlessness may impact hormonal and genetic factors, increasing susceptibility to cancer. 

He added that women who give birth have a slightly lower risk of developing breast, ovarian or endometrial cancers, adding that these benefits seem to improve with each additional full-term pregnancy, especially for women who gave birth before 30. 

He said, however, that there is a need for further research to take into account other factors that could improve longevity, like income levels or health conditions that make a woman choose not to have children. 

Ekwan was speaking at Mulago Hospital during a breast cancer screening event organised by the Grant Thornton Foundation and UCI on Friday that benefited 500 women.

Other push factors 

At the event, Ekwan listed obesity, smoking and excessive alcohol consumption as the other risk factors for breast cancer. 

“Women who give birth, but do not breastfeed and women who delay pregnancy beyond 30 years are at higher risk of developing breast cancer,” Ekwan said, adding that the key to prevention is early detection through screening and self-examinations.

“This should be done by everyone with breasts. Women aged 45 and above should undergo annual screening,” added the public health specialist who then recommended self-examination seven days after menstruation to check for any swelling as a potential first sign.

Late-stage disease 

He said, unfortunately, more than 80% of the patients get diagnosed with the disease in the late stages, explaining that breast cancer is the third most common cancer in women in Uganda after cancer of the cervix. 

Although the exact cause of breast cancer is unknown, risk factors such as family history and hormonal influences play a significant role. “If breast cancer runs in the family, it can be inherited,” he said. 

At the event, Dr Ekwan expressed concern about the limited awareness and knowledge surrounding the disease, pointing out that the institute has seen a rise in breast cancer cases over the past 20 years. 

According to data from the International Agency for Research on Cancer of the World Health Organisation, breast cancer is one of the most prevalent malignancies worldwide, adding that breast cancer is the primary cancer that affects women and is the leading cause of cancer-related deaths in women aged 20-39 years.

Prevalence figures 

In Uganda, according to the Uganda Demographic and Health Survey Report 2022 released last year, Kampala district and Busoga sub-region have the highest cases of breast cancer in the country. 

The report by the Uganda Bureau of Statistics showed that while the national average for breast cancer is 7%. Kampala’s prevalence currently stands at 10.7%, while Busoga’s is 9%. 

Elgon region comes in third at 8.5%, the rest of Buganda fourth at 7.9% and West Nile in fifth, with 6.8%. 

In addition, another study published in the journal of the National Library of Medicine, Uganda was said to have a breast cancer age-standardised incidence and mortality rate of 21.3/100,000 and 10.3/100,000, respectively. 

Age standardisation is a statistical method used to compare disease rates or other health indicators between populations while accounting for differences in their age structure, while mortality rate measures the frequency of deaths over a given period in a defined population. 

Carried out by John R. Scheel, Moses Galukande, Jimmy Okello and other researchers, the study titled “Breast Cancer Early Detection and Diagnostic Capacity in Uganda”, noted that almost half of Ugandan women with breast cancer will die of their disease due to late initiation of treatment. 

These high mortality rates were attributed to late-stage diagnosis for women with breast cancer. The report noted that “up to 89% of women in Uganda present with stage III or IV when breast cancer is more difficult to treat and outcomes poor”. 

This, the report said, owes to a dysfunctional referral system and lack of recognition of early signs and symptoms among primary healthcare providers, compounding the poor infrastructure and inadequate human capacity.