Mr Speaker, this is a Statement on psychological
interventions for persons living with breast cancer to
mark the World Breast Cancer Awareness Month. This
year's theme is: “The Fight against Breast Cancer is Everyone's”. The theme underscores the need to get everybody around the table to defeat the disease.
Mr Speaker, breast cancer is the commonest
malignancy and a leading cancer mortality in women in
the world with the overall global burden of cancer rising
to 19.3 million new cases and 10 million cancer deaths
occurring in 2020 worldwide. While men account for 10
million, women account for about 9.3 million with a
mortality rate of 5.5 million and about 4.5 million
respectively.
Mr Speaker, the Global Cancer Observatory
indicates that the five-year prevalence - that is, the total number of people who are alive within five years of a
past cancer diagnosis - is estimated to be 50.6 million.
Mr Speaker, for its destructive consequences, the
world dedicates the month of October to breast cancer
awareness to draw attention to the disease and for
research into its cause, prevention, diagnosis, treatment
and cure. Today, breast cancer is the most prevalent in
women worldwide and the commonest cancer overall
with new cases of 2,261,419 (11.7 per cent) and a
mortality rate of 684,996 (6.9 per cent) behind lung
cancer with new cases of 1,796,144 (18 per cent);
colorectum, 935,173 (9.4 per cent); liver, 830,180 (8.3
per cent); and stomach cancer, 768,793 (7.7 per cent)
according to the World Health Organisation in 2020.
Mr Speaker, cancer of the breast was mainly known
to be a disease of elderly women, but has proven to
occur in younger females of less than 30 years of
African descent including Ghana (Iddrisu, Aziato &
Dedey, 2020). A collection of evidence suggests that the
awareness of breast cancer and its causes, risk factors,
and disease manifestation is generally unsatisfactorily
low in Ghana. Studies have shown significant
relationship between awareness levels and practice of
breast examination and seeking care among Ghanaian
women (Bonsu & Ncama, 2019) with less educated
women at higher risk.
Business Statements
Mr Speaker, although some recent studies in, for
example, Edzie et al, 2021, surprisingly found no
significant association between family history and
breast cancer in Ghana, others like Brinton et al, 2018
implicate skin lighteners and hair relaxers as breast
cancer risk factors in Ghana and women of African
descent, given particularly their biological potential for
their risk disposition. Despite this revelation, breast
cancer patients in Ghana do not receive satisfactory
emotional care, communication and counselling, hence
the need for adequate psychological interventions
throughout their cancer trajectory.
Mr Speaker, misconceptions, maladaptive and
fatalistic beliefs about the disease influence the choice
of therapies. For example, alternative therapies such as
spiritual and traditional medicine causing delays in
hospital entry.
Mr Speaker, again, lack of knowledge or awareness
about the disease causes women to ignore possible
symptoms resulting in delayed help-seeking process.
The situation is compounded by knowledge deficiency
among clinical and allied health professionals leading
sometimes to misdiagnosis or poor prognosis (Bonsu &
Ncama, 2019). In Ghana, breast cancer studies suggest
coping strategies and fatalism or religiosity have
significant influence on the quality of life and well-
being of women living with breast cancer, with the need
to address psychosocial issues among breast cancer
survivors relative to their socio-cultural and religious
values.
Mr Speaker, owing to the belief of the causes of
breast cancer rooted in bio-psycho-spiritual model of
illness, some empirical studies advocate for intensifying
awareness and to incorporate spiritual and traditional
healing as well as psychological modalities in the
process.
Mr Speaker, like all cancers, breast cancer patients
are confronted with a variety of psychosocial challenges
and associated effects on their social community. Thus,
cancer is referred to as a “we-diseases” as families and intimate partners or spouses share in the experience of
the psychological burdens.
Mr Speaker, in Africa, 1,109,209, which is five per
cent of the world's total new cancer cases, were identified in 2020. In particular, the Global Cancer
Observatory reports breast cancer as the most
commonly diagnosed cancer in sub-Saharan Africa with
an estimated incidence of 129,415, 16.1 per cent of
cases and 64,234 related deaths but lower than cervical
cancer deaths of 72,668 in 2020.
Mr Speaker, the overall cancer related mortality rate
in Africa has increased from 591,000 in 2012 with
breast cancer becoming the leading cause of admission
and mortality in women, a shift from the past decades
that recorded cervical cancer as the most commonly
diagnosed cancer.
In Western Africa, although precise estimates
are lacking due to the absence of a cancer registry
in most countries, the available data estimates
49,339 (33.5%) total new breast cancer cases with
25,626 (15.5%) deaths - the highest in the African
region (WHO 2020; Globacan, 2021). Meanwhile,
the mortality rate in Africa contrasts the records in
the developed world such as North America
(IARC, 2020) which boasts of integrated routine
mammography programmes, early detection and
presentation for medical attention and access to
contemporary technology in the treatment of
cancer (Reeder-Hayes & Anderson, 2017).
Mr Speaker, available health and supportive
care services for breast cancer patients in Ghana
and many African countries are not formally
documented as those in developed countries such
as United States of America (USA), the United
Kingdom (UK), Japan and Australia. Thus,
receiving the diagnosis and managing or living
with the physical consequences of this chronic
health condition and associated psychological
consequences, for example, disease-specific
distress and co-morbid clinical and sub-clinical
levels of anxiety or depression can be challenging.
From diagnosis, breast cancer patients are
confronted with existential challenges and the need
to adjust to profound changes or uncertainties that
affect almost all aspects of their lives. Like many
medical
conditions, early diagnosis and improved
treatments have significantly prolonged survival
rates in breast cancers (McCanney, et al. 2018;
Miller, et al. 2019).
Mr Speaker, in Ghana, however, the available
data indicates that people living with breast cancer
experience long appraisal intervals from initial
symptom detection, interpretation, labelling and
help-seeking initiation which leads to advanced
presentation of the disease and have poor survival
outcomes (Bonsu & Ncama, 2019; Obrist et al,
2014). Although research on survivorship shows
breast cancer patients require multidisciplinary
support (for example, controlled trials, physical
activity, fast-mimicking diets, et cetera), to
rehabilitate and return to normal life, this Statement
focuses on psychological interventions to promote
the recovery of persons living with breast cancer.
Mr Speaker, psychological interventions are
defined as evidence-based formalised strategies
that aim to alter self-reinforming processes and
improve individual competencies and functional
outcomes (Walton, 2015). In this context, such
interventions are efforts to promote adaptations of
the individual to the condition of breast cancer to
optimise their resources with autonomy, self-
knowledge, and self-help. In primary health care,
psychological interventions extend individual
competencies to the areas of health promotion and
disease prevention, long-term care, research and
training, among others (Trindade, 1999).
All over the world, cancer survivors and people
living with breast cancer face numerous challenges
such as depression, anxiety, hopelessness, social
isolation, fatigue, pain, sexual problems, cognitive
failures, fear of recurrence, somatic symptoms, and
work-related and financial difficulties (Bevans &
Sternberg, 2012; Martin et al 2020). These
burdensome dynamics often lead to high
susceptibility to psychological stress or even
mental illness (Kleine, Hallensleben, Mehnert,
Honig & Ernst, 2019). Practical psychological
interventions to improve well-being and quality of
life of breast cancer patients relate to cognitive
behavioural therapy, cognitive existential therapy,
psychotherapy, psychosocial intervention,
psychoeducation intervention, mindfulness,
counselling and those focusing on positive
experiences, strengths, and personal competencies
rather than mental health complications such as
anxiety and depression (Martin et al 2020). These
may be grouped into four main types of
interventions; cognitive behavioural training,
education, individual psychotherapy and group
interventions.
In conclusion, today, West Africa accounts for
the second highest incidence of new breast cancer
cases of 49,339 and the highest mortality of 25,626
on our continent (Globocan, 2020; WHO, 2020). In
Ghana, 24,009 new cancer cases were reported in
2020 with breast cancer not only accounting for
4,482 (31.8%) of the prevalence in women
(IARC/WHO, 2020) but ranking top for incidence,
mortality and prevalence in our country with 4,482
(18.7%) new cases reported in the past year and
2,055 (13.0%) deaths. What is frightening, though,
is that currently, over 10,000 of our women are
reported with the 5-year prevalence of breast
cancer and the number is expected to increase when
new figures are released in December.
Business Statements
Mr Speaker, you should be curious to note that
the percentage of male breast cancers in Ghana is
also rising and is higher than what is reported in
Western literature (Quayson, Wiredu, Adjei &
Anim, 2014). In fact, breast cancer poses a huge
and rising impact on the world's population and
health systems in many countries. For several
decades, behavioural/psychosocial needs have
been recognised as crucial components of all
phases of breast cancer (oncology) and survival.
However, these needs present complex and
substantial challenges in their integration with
other components of survivorship care not only in
Ghana or Africa but elsewhere in the world.
Compared to general health promotion
interventions and usual care with chemotherapy,
psychological interventions are reported to achieve
greater success albeit no conclusive evidence
favouring specific interventions (Bradford & Chan
2017) and relative to women of diverse ethnic
backgrounds, socioeconomic status, broader age
ranges (Betty et al 2018).
Mr Speaker, in Ghana, some of these
intervention programmes are available in a few
major hospitals along with extremely negligible
psychological laboratories which offer such
services. Major health and specific support
services, particularly psychological interventions,
are rarely available to patients with breast cancer,
as they often share the limited facilities/services
with other “non-cancer” patients. Thus, breast
cancer patients may rely on private or charitable
groups such as NGOs who offer awareness but
limited support services. Indeed, the overall burden
of breast cancer remains high in our country, owing
to inadequate and fragile health systems. As the
world marks breast cancer awareness month,
perhaps the number of breast cancer cases and
deaths will continue to increase hence efforts to
improve and widen the existing structures and
include other proven psychological intervention
programmes as well as to advance research,
prevention, screening and treatment cannot be over
emphasised.
Finally, given the limited quality and coverage
of cancer data worldwide at present, particularly in
low and middle income countries such as Ghana
(WHO, 2020), cancer incidence, prevalence and
mortality may be worse than projected in our
country.
Mr Speaker, I respectfully implore you to join
the call for the creation of a national cancer registry
to, among other things, provide reliable data for
decision-making, spearhead nationwide campaign
for awareness and understanding of breast cancer
distribution pattern in Ghana.
In order to achieve universal health coverage
and the Sustainable Development Goal 3 (SDG 3),
we need to, as a matter of urgency, decentralise
cancer centres in the country, if possible, have one
in each regional capital.
Currently, the only cancer centres in the country
are in Accra and Kumasi. Our initiatives and
national response formulation must extend
curative/treatment services (surgery, radiotherapy,
chemotherapy) to reflect best practices including
palliative care plans with psychological
interventions playing an integral role. While we all
must be concerned about our way of life, we must,
as a matter of urgency, crucially support people
living with breast cancer, look beyond the
extension of medical services and intensify
evidence-based psychological intervention
programmes to ameliorate the plight of persons
living with breast cancer and other cancers.
Mr Speaker, let me end by paying a glowing
tribute to Dr Beatrice Wiafe Addae, founder of
Breast Care International, for her formidable fight
against breast cancer in the country over the years.
I hope the State and international community do
more to support her and others in this noble fight to
bring the number of breast cancers in the country to
negligible levels, if not completely annihilated.
Mr Speaker, on that note, thank you very much
for the audience.