DID you know that actress Angelina Jolie had a double mastectomy (a surgery in which both breasts are removed at the same time) and a laparoscopic bilateral salpingo-oophorectomy, which meant removing her ovaries and fallopian tubes as a cancer preventative measure, which effectively put the actress into early menopause?

The actress did this because some genetic tests confirmed she was at risk for both breast and ovarian cancer. Now, I know you’re probably wondering whether you can get such advanced tests in Zambia, and guess what? You absolutely can!

In today’s edition of the conversation I had with University Teaching Hospital gynecologic oncologist Dr Kalima Munalula, she delves into why genetic testing is key in determining the level of risk one has of getting cancer. She also gives pointers as to where Zambian women can go to have these tests done, and much more, dig in:

Q. Are you able to make projections from the population to say how many women cancer affects?

A. No, you can’t really make projections as such because remember we said at the beginning, to use your term, that cancer is like rogue cells. So you don’t know who is going to have rogue cells going on but having said that, I should point out that there are some cancers that are familial; there are two main syndromes so to speak that cause women to have breast cancer, cancer of the uterus and cancer of the ovaries and then also, they may have colon cancer so this could be familial. So you find that maybe your mum had it and then your sister has it, your mum’s sister and then maybe your mum’s brother also had colon cancer or something like that. So there’s a syndrome which affects families where they get these different cancers. So ovarian, uterine, breast or even colon. And then there are also other familial groups of cancer where women are prone to getting breast cancer, uterine and ovarian cancer. What is seen is that in these familial syndromes, the people who are affected get the cancers much earlier in terms of age than women who get it and have no familial problem. So if you have for example a 40 year old woman getting ovarian cancer from a family maybe where her mother also had it and she got it in her 50s. So the age is younger in the familial ones whereas the sporadic ones, you find it in older women, maybe women who are in their 50s, 70s, so it is like that. You can’t really say you can estimate who would get cancer but if it is familial, then if for example a younger women has endometrial cancer in her 40s, it would be important to do genetic testing for the lady and also for her sisters and other first degree relatives to see if they have a genetic predisposition. I think you know of the actress Angelina Jolie? Her mum had breast cancer and then a sister of hers I think had breast cancer so when they did the genetic testing, they found that they had this genetic abnormality that made them high risk for developing cancer so she had a double mastectomy, she had an operation to remove both her breast and I think later on she also had an operation to remove her uterus and ovaries because she wanted to reduce the risk of her getting the disease because of the genetic predisposition.

So unfortunately, here, we are not yet able to do this genetic testing in the public hospitals but I think the tests are available with some of the private labs but I would imagine that the cost is quite high.

Q. It is interesting to know that those tests are available locally. But a follow up question is, would you advise women who are done having children or some people who don’t even desire to have children to remove their uterus?

A. I think that would be an overkill. In the public sector, I can tell you that for example if you came to our unit, you wouldn’t even be put on our theatre list, because you are competing with people that have cancer. So if you come and say ‘I am doing having my children can I have a hysterectomy (surgery to remove the uterus)’, you would be maybe number 1001 on our list so I think because of that, I think the important thing is just to be more conscious and aware of yourself. Make sure you do your tests when you are supposed to do them and for women, if you are doing the cervical cancer screening, you are doing it every year or every three years, maybe yearly, you have a full medical check-up and things like that. But I don’t think we’re able to offer hysterectomies to patients who just want to have a hysterectomy. We give a priority to those that actually need it because there is a problem for them.

Q. I know there has been an awareness campaign especially on cervical cancer, but how would you say the message is being received? In terms of the patients that do come here, do they present early or you still have a lot of people presenting late? And if you still have people presenting late, what do you think could be the problem?

A. That’s a very good question actually. The cervical cancer screening has been ongoing in Zambia I think since 2002, for quite a long time. But unfortunately, we still see women that come with advanced stage. I think one of the biggest issues that we have to deal with is poor health seeking behaviour. Because the pre-cancer stage has no symptoms, you are not feeling sick or anything, most people don’t both to do it. Then I think the other thing that we need to deal with also is misinformation, so sometimes we find, like for cervical cancer screening specifically, I remember we were doing a campaign in Kafue and initially, women couldn’t come because I think somebody told somebody who told somebody else that when we put the speculum (a metal instrument that is used to dilate an orifice or canal in the body to allow inspection), first of all it is very painful and then you will also not be able to have children, so women were not willing to come for the screening. So there is a lot of misinformation, there’s poor health seeking behaviour on the part of the women, they don’t come for the screening because there’s no symptoms before. But really, you are better off being caught at the beginning of the queue where something can be done on the spot than staying at home, you don’t know what’s happening, and then once you develop symptoms, that means you are more likely to be cancerous than pre-cancerous. So don’t wait to get symptoms, but some before you have any symptoms. That is why it is called screening anyway because you only screen for a condition that has no symptoms but you are able to catch it.

So come of the screening, if you are given the all-clear, then you don’t have to come again for the whole year. So imagine you suffer discomfort for 15 minutes and then you are happy go lucky for 12 months and sometimes even maybe 24 months, or 36 months. So you don’t need to come back for one year or two years. So for me, 15 minutes of discomfort is cheap because I will be comfortable for 24 months. So I think that’s how people should look at it. The screening, it is uncomfortable, I always tell my clients when I am doing the examination that it is uncomfortable but it is not painful. We just put in the speculum and have a look, it is uncomfortable but it is not painful. But if you don’t do that and you get the cancer, then it becomes painful and then the process is long, there are lot of people that need the care, our theatre lists as long as your arm or two arms, you join a long queue, we don’t know when you will get on to that queue because apart from just the numbers of the patients, there are a lot of things that happen, sometimes we have problems in the theatre, maybe the machine is not working well or maybe as you come, your HB is very low, we can’t operate on you because you are not well enough…so why not sacrifice 15 minutes of discomfort to save yourself down the line? So I think people need to think of it like that.

Q. Let’s talk about some of the symptoms for someone who has now gotten to that point where they have advanced cancer. Because I think this is also information which needs to be out there, once people understand just how bad it is, then maybe there can be some fear…What are some of those symptoms of late-stage cancer?

A. So for cervical cancer for example, if you bleed when you are not supposed to be having your period, you need to have that checked. If you have a male partner and you bleed after sexual intercourse, you need to have that checked. If you have a foul-smelling watery discharge, you have to have that checked. If you have back pain, with any of these things, you need to have that checked. I mean, there are some women that are, when they bath and clean themselves, they have a terrible habit, which they shouldn’t do, but they still do, of inserting their fingers into their vagina and then you find there is bleeding, you have to have that checked. So mostly, it is abnormal bleeding for whatever cause, maybe it is outside your period or too often in a month, you need to have that checked. Sometimes, it doesn’t mean you have got cervical cancer if you have abnormal bleeding, it could be anything but it is better to get it checked. If it is not cervical cancer, then that’s well and good, the doctor will tell you but if it is cervical cancer, we need to know what stage it is and then we will manage it for you. So that’s for cervical cancer, those are the symptoms.

Friends, we shall end here for today, next time, we shall discuss why it is important to redefine our relationship with nudity when it comes to health check ups 🙂 Remember, you can watch the full interview with Dr Munalula on my Youtube Channel, Chat With Mukosha.

For now, today is World Press Freedom Day, a big shout out to all my fellow scribes.