SA’s poor are dying from breast cancer

Are the socially deprived in South Africa at a greater risk for breast cancer mortality?

While the fierce and on-going debate around the standard of our public health system continues, the sad reality is that SA’s socially deprived are dying from treatable and manageable diseases – including breast cancer.

Why? They are being diagnosed too late, suffer poor access to healthcare services, have to wait too long for treatment or have a lack of knowledge and understanding of their condition and potential for treatment. And, without intervention, this reality will remain constant, if not worsen.

Extensive research worldwide has documented the link between social deprivation and premature cancer death with multiple reasons put forward for this association. One of these is lifestyle factors.

While many of these can be modified, many are difficult to change when individuals are deprived of the basic foundations for good health.

Lifestyle factors such as tobacco and alcohol consumption, poor diet, lack of physical activity or being overweight are known to enhance the earlier onset of cancers, as well as the mechanisms for more aggressive cancer growth.

ALSO READ: Breast cancer: Health must be monitored regularly for over-40s

For breast cancer specifically, studies have shown that differences in socio-economic circumstances may also determine differences in exposure to risk factors for different breast cancer subtypes. These include radiation exposure, chemicals and other substances, as well as certain hormones.

Access to screening services

Further, in socially deprived populations, access to screening services is compromised or, in the SA context, simply not available.

Finally, the increased burden from chronic lifestyle-related diseases, such as diabetes, hypertension and HIV, limit therapeutic options and can give rise to processes that increase resistance of cancers against therapeutic treatments.

Early detection remains a key factor for breast cancer survival. It is vital in the battle against this cancer. The education of women plays a fundamental role in the efficacy of screening programmes.

Women living in more socio-economically deprived areas are less likely to attend breast cancer screening. In many developing countries – such as SA – mammographic screening is available to the well-off, but not to the general population.

Timeous diagnosis and access to treatment are problematic, even if a woman feels a lump in her breast. While patient delays are strongly tied to socio-economic factors, health system delays are also an important factor.

But even if the patient receives treatment, cancers in deprived women have a more aggressive course for lifestyle reasons (primarily smoking, obesity and alcohol abuse – all of which are rife in developing countries).

Beyond lifestyle factors, cancers in deprived women also appear to have a more aggressive molecular genetic profile. This means once the disease is established, certain genes are activated in the tumour that
lead to a more aggressive growth and metastatic spread, as well as treatment resistance.

This is an ongoing subject of research as to why this is the case. An additional factor that could influence outcomes potentially lies in the way in which treatment for breast cancer is decided upon (eg. access to multidisciplinary team meetings); delivered (eg. access to cancer units); received (eg. patient comfort); and funded (eg. access to medical aid or needing to pay cash for treatment).

For better and more efficient detection and treatment, we need to look at the bigger picture – everything from taking time off work without losing your job, to finding the money to get to treatment centres.

Apffelstaedt and Hoosain are specialist surgeons with an interest in breast, thyroid and parathyroid health, as well as soft tissue surgical oncology.