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HEALTH-HONDURAS: Solidarity in Breast Cancer Survival

Thelma Mejía

TEGUCIGALPA, Oct 14 2010 (IPS) - All too aware of the Honduran public health system’s shortcomings and the great vulnerability of the country’s poorest people, women who have beaten breast cancer are stepping up to share their experiences and knowledge in an effort to save more lives.

“We are all survivors of this disease, and we decided to organise in order to help other people who have limited resources. Imagine that someone who doesn’t have 300 lempiras (about 16 dollars) cannot get a mammogram, and could die as a result,” Ingrid Castellanos, president of the Honduran Foundation Against Breast Cancer, told IPS.

For three years, the Foundation has led educational campaigns, forums and walks to bring attention to the issue and raise public awareness about this form of cancer.

“In the public hospitals, because of budget restraints and quotas, there are patients who are found to have malignant tumours in the breast and they have to wait five or six months for treatment — very valuable time that could mean it’s too late for these women,” said Castellanos.

She was found to have breast cancer four years ago and underwent a painful treatment lasting one year before she was cured.

The serious problems afflicting the country’s health system — which government officials admit in private — are caused by the lack of financial and human resources, whether in the hospitals under the Secretariat (ministry) of Health, or the Honduran Institute of Social Security. One of the biggest deficiencies is the shortage of medications.

Five years ago, the Secretariat of Health, which covers just 50 percent of the population, began keeping more detailed records of breast cancer cases among men and women in this Central American nation of 8 million people, of which more than 60 percent live below the poverty line.

Breast cancer is the second leading cause of death by cancer for Honduran women, after cervical-uterine cancers, of which there are about 1,600 new cases annually.

From 2005 to 2009, there were 666 cases of breast cancer diagnosed in men and 2,483 in women.

But Dr. Xioleth Rodríguez, of the National Cancer Programme at the Secretariat of Health, says the full extent of the disease is unknown due to under-reporting.

“We are conducting a more detailed census that includes the country’s entire hospital system. The most recent figures we have are from the San Felipe Hospital,” the public health centre that treats the most cancer cases in Honduras, she said.

The departments (provinces) with the most diagnoses of breast cancer are Francisco Morazán, where Tegucigalpa is located, the central Comayagua, and Choluteca in the south.

Rodríguez told IPS that the age range with highest incidence of the disease is 40 to 69, but there are cases of younger people, in the age range of 17 to 24. “That is worrisome and requires us to pay more attention to the advance of the disease,” she said.

Hermelinda Villela is another breast cancer survivor. She told IPS that the Foundation attends to three to five people daily, many coming from poor neighbourhoods like Nueva Suyapa, Villanueva, Nueva Capital, Israel Norte and Campo Cielo.

“We have even found cases in males younger than 18. One of them disappeared because after getting the diagnosis he was too embarrassed for further tests, but we are looking for him to help him. Just think, he could die if he doesn’t receive timely treatment,” she said.

Villela, 65, was diagnosed 20 years ago, and although she now enjoys her children and grandchildren, she spends most of her time providing health education in the city’s poorer neighbourhoods and in the schools.

The Foundation is a modest operation: one preventive clinic with two volunteer physicians, two psychologists and one assistant. It keeps its doors open thanks to corporate and individual contributions, in addition to revenues from raffles, handicraft sales and other activities.

Located across from the busy Luis Alonso Suazo health centre in Tegucigalpa, this organisation provides information for people of all ages about the seriousness of the disease.

The Foundation also helps those with least resources to obtain a free mammogram, as well as any necessary medical treatment.

Lía Bueso de Castellanos, expert in mastology and Foundation collaborator, has a private clinic through which she provides mammograms and other medical assistance free of charge. She was the physician who treated all of the breast cancer survivors who now volunteer their time in prevention education.

She told IPS that breast cancer management has to have a multidisciplinary approach because of every 10 tumours detected in the breasts, eight are benign, but “two are malignant and are the ones we have to go after.”

Breast cancer, she explained, is a malignant tumour formed by the uncontrolled and abnormal division of the cells that make up the mammary glands. This type of tumour then spreads to the adjacent tissue.

Bueso recommends that women do a self-examination of their breasts after the end of each menstruation, and if they feel an abnormal mass, see a doctor.

For women over 40, an annual mammogram is recommended. This X-ray may allow detection of the cancer before it is large enough to be felt in a self- exam.

The causes of breast cancer are many, ranging from genetics to environmental factors to obesity. Experts agree that it has psychological effects as well, and can take a toll on the family environment.