Stories and podcasts WBW Stories Metastasis: When cancer comes for Nigeria’s Young Women Cross-section of women at a breast cancer awareness and screening outreach organized by Cancercarelink Picture credit: Cancercarelink In her words: “When I was told I had cancer, I told the doctor to remove the breast so that I could have peace.” A 30-year-old mother of one who is fighting the battle of breast cancer courageously. Encountering courage where one expects to encounter fear and hopelessness can be baffling. However, optimism can be found in the tale of a young breast cancer patient in Nigeria who continues to wear a beaming smile, despite all odds. In times past, cancer was a disease largely synonymous with old age, but not anymore. Young people, especially women, are increasingly being diagnosed with cancer as our understanding of the disease evolves. The word cancer, for many, comes with flashes of unexplained agony and untold hardship. Diagnosis of a disease with no existing cure (yet!) leads many to financial catastrophe as they try to curb it. This is especially prevalent in developing countries, where access to care and insurance coverage are low and treatments are paid out of pocket. Helplessly, people living with cancer are left in a desperate paradox: the choice of suffering towards an untimely death, borrowing or expending their savings in pursuit of treatment. Aminat, a 30-year-old mother of one, felt a lump in her breast she worried her. She could not be sure what it was, but she did go to the hospital to find out. After a couple of clinic visits, she was falsely reassured that her lump was a consequence of active breastfeeding and would resolve after breastfeeding. Unconvinced, she persisted in visiting clinics and chemist shops for other opinions. An ultrasound confirmed a fibroadenoma, but there was no indication of it being cancerous and no concern that it was, given her young age. An excision biopsy was requested, but the financial costs coupled with initial fear – something understandable by many Nigerian women – meant that Aminat refrained from going back for hospital care. In the following few months, the lump festered. Unable to bear the pain any more, she reached out to , a medical doctor and founder of Cancercarelink Nigeria, a non-profit organisation that advocates and cares for cancer patients in Nigeria. Cancercarelink Nigeria raises awareness around cancer and makes efforts to connect women in underserved communities with some of the resources (educational resources, investigations and funds) they need for prevention, early detection and treatment of breast cancer. Through Cancercarelink, Aminat was referred to a hospital where it was confirmed the lump was cancerous. “I told the doctor to remove the breast so that I could have peace. I just couldn’t bear the pain anymore,” she said. Then, the horrible experience for Aminat was compounded; she had no money to carry out the mastectomy. The cost of care for breast cancer is huge – after a mastectomy, she would have to undergo a series of expensive investigations to stage the disease and characterise the cancer. This would then be followed by several sessions of chemotherapy and radiotherapy. So for Aminat, her likelihood of survival lay in the hands of the unknown. She became anxious and withdrawn, as everyday felt like it might be her last moment. Fortunately for her, Cancercarelink initiated efforts that helped her to raise funds for surgery and chemotherapy sessions. Thus, she was able to pay her medical bills and go through care. One may ask whether good health should be dependent on wealth or affluence. If so, then it is fair to wonder how this aligns with the 1978 Universal Declaration of Human Rights. If universal health coverage is out of reach, this right eludes people like Aminat whose everyday survival is left to chance. Cancer has been attributed to major risk factors such as tobacco use, alcohol, dietary intake, complex genetic mutations, and family history among others. Reports from journal articles and newsprints are full of evidence of the increasing burden of non-communicable diseases such as cancer. Every daybreak, we hear stories of individuals, families and friends who took the long walk with cancer and never returned. In Nigeria, breast cancer is the commonest cause of cancer death among women. Nearly 40 women die from breast cancer every day and about 500,000 new cases are discovered every year. In high-resourced countries, it’s far more uncommon for people to die of breast cancer than in some other places like Nigeria. This is the reality of worlds apart; people live healthier and longer in some places through access to fair and equitable healthcare, while the reverse is the case in places that do not have the standards or coverage necessary to save lives. The fact that young people face a myriad of infectious and emerging health challenges to confront is worrisome. According to the World Health Organisation projection by 2030, mortality from non-communicable diseases will exceed that of communicable diseases. At the intersection of this dual burden of diseases are young people who are increasingly at risk and vulnerable. Lack of access to adequate preventive information and services is not the only missing link between early detection of breast cancer and survival in Nigeria. The huge cost of accessing treatment such as screening, surgeries, and chemotherapy, amongst others, further pushes many into lifelong poverty. This incurs untold hardship not only upon the patient but on their families. The weak health system does not place priority on non-communicable diseases such as cancer, at real human cost. Honestly, it universally hurts to see a young woman essentially in her youth go through the agony of breast cancer, regardless of if she is a close relative or someone distant. It is deeply unfair that many people can barely afford basic meals either for themselves or their families, let alone pay exorbitant amounts for cancer screening and treatment. Almost every day on media platforms, we encounter fund-raising banners by young people suffering from various ailments who needed huge sums to stay alive. That such people must rely on the generosity of others and not the existing health infrastructure is a travesty. Prevention has always been known to be golden. Increasing cancer awareness, screening, and access to affordable services are key to prevention, early detection, and treatment of cancer in young women across Nigeria. Universal health coverage to support such treatments is a vital step into the future, but until that day comes, people need access to services like those provided by Cancercarelink so they can speak up and get needed help that will help break barriers and stigma surrounding disclosure of such disease, whilst also connecting them with the care they deserve. Seeing the optimism and strength with which young women like Aminat face as they battle cancer, one can only hope that they will recover and live long, healthy lives. The question is: will metastasis, exorbitant healthcare costs, and a failing Nigerian healthcare system prevent them from accessing that chance? About the Author.