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Discovering that she had breast cancer was one of the most heartbreaking moments of Rachel Muli’s life. Knowing she would lose her left breast was the last nail in the coffin.
She had seen her aunt wear padding to hide the loss of her breast and knew how much it hurt her to have to do that.
“I could not imagine that at just 36, that was going to be my life. But I was still grateful to be alive,” she says.
However, thanks to advancements in medicine, that was not to be her lot in life. Kenya’s doctors have now learned a new surgery technique that allows for cancerous lumps in the breasts to be removed while leaving the breast intact.
The procedure is called breast conservation surgery, and is done when the whole breast has not been affected by cancer. It can now be done in most of the major hospitals in the country.
Muli underwent the procedure and is now cancer free, and beyond her wildest dreams, still has her left breast.
Dr Ahmed Komen, a radiation oncologist at the Aga Khan University Hospital, says this is just one of the new procedures that have emerged in the vicious battle against cancer.
“Oncology is rapidly changing because there is always something new coming up. There are a lot of areas that we still do not know about but are being researched,” he says.
New developments already in Kenya are in both diagnostics and treatment.
Targeted therapies
Other than conservation surgery, there are other treatments where doctors are now able to target the cancerous cells themselves, rather than conducting chemotherapy which takes a heavy toll on patients.
“With the development of pathology, we are able to know what the major drivers of certain diseases are. Newer drugs have been developed that target just the drivers of the disease. These are called targeted therapies and they have less side effects and are more effective,” says Dr Komen.
An example of targeted therapies is a drug called Herceptin for breast cancer that has been prohibitively expensive.
“For 20 years, the drug cost about Sh500,000 a cycle and it is given every three weeks yet patients need it for more than a year. The patent for the original drug expired, so generic versions that are just as effective have appeared and the cost has come down to below Sh100,000. NHIF covers the cost for some patients,” says Komen.
Immunotherapy
One of the newest cancer treatment techniques is immunotherapy. This trains the body’s immune system through gene editing to fight tumours. The technique is not yet widespread in Kenya, but is already being practiced by some.
As it becomes less expensive to carry out, it will become more available to patients. The treatment has been shown to produce greater results of recovery and longer periods of remission.
“While using radiotherapy to treat patients, we used what we call clinical markups. That meant that if you came with a tumour to the hospital, the doctors would mark the areas where the disease is and treat it,” says Dr Komen. “We have now moved from that to 3D treatment planning for radiotherapy and intensity, also known as modulated radiation therapy (IMRT).”
IMRT is an advanced mode of high-precision radiotherapy that uses computer-controlled linear accelerators to deliver precise radiation doses to a malignant tumor or specific areas within the tumour.
This is quite a milestone for Kenya and is now offered at Aga Khan and MP Shah hospitals, with other health facilities to follow suit soon.
Developments in diagnostics
“Previously, patients had to go to other countries such as South Africa and India for further investigation, as we only had at our disposal x-ray machines, MRI and CT scans. But we have now moved forward and we have PET-CT imaging, which will revolutionalise diagnostics,” says Komen.
Even in developed countries, PET-CT imaging is only available in the biggest hospitals.
Before, cancer patients had to pay a lot of money to go abroad just to find out if the cancer had been cured or had spread to other regions in the body, but with the PET-CT imaging, it will be easier to track treatment.
“When tissues were sent to the laboratory, we would use a microscope to study the tissue and decide what type of cancer it was. We now have ImmunoHistoChemistry (IHC). This is something that further characterises the type of cancer and gives us a better idea of what drives the cancer and enables us as clinicians to give more accurate treatment for it, which gives better recovery outcomes,” says Komen.
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