Post main image
Photo by


Why You Should Know Your Breasts

It's the first step to having a good breast health

BY Agnes Amondi

Nov 14, 2022, 09:02 AM

Photo by

The Ministry of Health indicates that breast cancer is the leading type of cancer in incidences in Kenya. In 2020, there was a rise in the number of new cases - from 5, 985 in 2018 to 6,799 -  and deaths - from 2,553 in 2018 to 3,107 in 2020. 

Women in their forties are at a higher risk but cases among younger patients are increasingly becoming common. To understand this disease better, we talked to Dr Eric Hungu, a general and breast surgeon at the Kenyatta National Hospital in Nairobi.

The statistics around breast cancer are grim. What makes it so life-threatening?  

It’s deadly because the majority of our patients come in with advanced disease. They have huge lumps that lead to other complications. For example, the lump might have ulcerated or is fixed to the chest wall or spread to other parts of the body, which is why we advocate for early screening

Why do people come in late for diagnosis?

It’s a combination of things. Sometimes they don’t do self-breast tests and if they do and find something, they sit on it hoping it disappears. 

Also, some people don’t go for screening because of the possibility of confirming that they might have a cancerous lump.

There are a few cases of a missed diagnosis. This happens when you visit a health facility and the doctor fails to make a diagnosis. 

Let’s talk about the diagnosis. First of all, what should you look out for when doing a self-breast test?

The self-breast examination helps you figure out what’s normal for you, which is why we recommend that it be done monthly. This way, it is easier to detect a change. 

It could be that you feel a lump or notice that one of the breasts is significantly bigger or the nipple is pulled in or having discharge. If you go to your doctor immediately and get an early diagnosis it gives you a chance to potentially get cured. 

What about the clinical test?

When you walk in, we’ll talk to get an understanding of your symptoms. I then proceed to examine you. I’ll check all areas of the breast including your armpits to check for lymph nodes. 

Depending on your age, we’ll either do a diagnostic or screening imaging with a mammogram or an ultrasound. During the screening, we recommend an ultrasound for women below 40 years because of the difference in their breast density. 

Younger ladies have more breast density which means any abnormalities will not be detected on a mammogram as everything appears whitish. A normal breast looks greyish on a mammogram so spotting whitish elements indicate abnormality and that's why we recommend an ultrasound because it’s more sensitive for this age group. 

After getting the results of the imaging, we do a biopsy by taking multiple tissues of the lump in different directions to avoid sampling errors and send it to the radiologist.  


Breast density is the composition of the breast tissue (usually fibrous tissue) which makes it lumpier and look white on the mammogram in younger ladies.

Screening imaging is done on a healthy population while diagnostic imaging is done to find out the causes of symptoms experienced by an individual.

Which type of breast cancer is most common in Kenya?

The breast has different tissues. The glandular contributes to the production of milk, the fibrous tissue which makes the breast denser, the fat and the chestal muscle. 

Breast cancer arises from the glandular component which has the lobule (where milk is produced) or duct (where milk is transmitted) hence ductal carcinoma or lobule carcinoma types of breast cancer.

That said, the most common type we diagnose is ductal carcinoma. This depends on the tissues it comes from and further tests can show us the hormones that lead to the growth of the cancer cells. 

In turn, it helps us decide on the kind of treatment we can give; the type of chemotherapy, hormonal or targeted therapy, surgery and radiotherapy.

Risk factors for this disease are classified into modifiable and non-modifiable. Explain that.

The modifiable risk factors are things we can change. For example, your lifestyle choices. If you are obese, you are at a higher risk because the excess fat converts into estrogen which has been shown to cause breast cancer. This is also why contraceptives put you at risk due to exposure to estrogen.

The non-modifiable risk factors are things we cannot change. For example, your genes, gender, family history and age. If you have first-degree relatives that have breast cancer, you are at risk. The older you get the higher your chances of getting breast cancer. Starting your periods early and ending late is another risk factor due to the long exposure to estrogen. 

With that in mind, what treatment options does a breast cancer patient have?

If you are diagnosed with a precancerous condition, regular screening will pick it up. Unfortunately, some patients come with golf ball size lumps which mostly turn out to be invasive. 

What happens then is that we talk about the treatment options, with the patient and the team that includes an oncologist, radiologist, pathologist, plastic surgeon and others to come up with the best treatment option. It could be a mastectomy or something conservative.  

Talk about the cost of breast cancer treatment in the country and how that changes depending on the stage of the disease.

The majority of Kenyans get their service from public hospitals. Hence, the need to get the National Health Insurance Fund (NHIF) which covers the basic surgical services in public hospitals like a mastectomy.

If someone wants a more cosmetic result, it can be done but at additional costs, normally paid out of pocket. For example, using implants can cost a patient about Ksh 100, 000 for a temporary implant and around Ksh 50, 000 to Ksh 60, 000 for a permanent one. 

Depending on the type of cancer and the stage, you can be treated for a certain duration or indefinitely which determines the overall cost a patient will pay. 

How do you break the news to a patient?

It is the hardest part of the job. There is no one way to do it but at the end of the day, the information has to be given to the patient. That said, there are things you have to keep in mind like their reaction to things, family support, an individual stage of the disease and other factors. Along with that, you need to give the patient treatment options. 

What gives you hope?

We need to reach as many women as possible so that we detect the disease early because it is potentially curable. Early diagnosis means better outcomes for you.

What’s the one thing that women need to know about breast cancer?

The most important thing is for them to be aware of their breast health so that if they notice any change, they can visit a specialist early. If there is nothing to report, they should continue with their annual checkup.