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Doctors are still failing to diagnose patients with cancer

Health & Science
 Florence Ojode 71, who has been cancer free for 11 years after having three incidents with the disease. In Kenya, there are at least 27,000 cancer deaths recorded every year. [David Njaaga, Standard]

A gut instinct is what made Florence Ojode travel to Israel for cancer treatment in November 2012.

After two previous breast cancer diagnosis, and well aware of the disease’s ability to spread to other body parts, she was skeptical of the diagnosis given following a visit to the hospital after feeling unwell.

“But this time I had a bloated stomach and was so weak. After a scan was done, the doctor said I had a mass in my pelvis,” said Ojode who also lost her sister to cancer in 2005.

It sounded crazy, she thought, but suddenly she did not feel comfortable being seen by local doctors anymore.

Florence’s misgivings were borne out of her experience with cancer. In 2007, she had felt a lump in her right breast during a routine self-examination. She was 60 then.

Three years later, the nipple on her left breast inverted. This scared her half to death and also led to her second cancer diagnosis.

Because the mass-in-pelvis theory rang hollow, she sought a second and third opinion. That is how she ended up in Israel in November 2012.

Ovarian cancer

“A scan was done and the mass was found in my ovaries instead. I had ovarian cancer.”

She received treatment and returned to the country in February 2013. Since then she has been cancer free.

Her fervent prayer is that it does not recur.

What helped Ojode – now a bubbly 71-year-old woman full of life – when she flew to Israel was a positron emission tomography (PET) scan, which was not available to doctors in Kenya.

Aga Khan University Hospital was the first facility in the eastern Africa region to install a PET scanner in December last year.

The National Cancer Institute defines a PET scan as a procedure in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner is used to make detailed, computerised pictures of areas inside the body where the glucose is taken up. Because cancer cells often take up more glucose than normal cells, the pictures can be used to find cancer cells in the body

Despite advances in technology, cases of misdiagnosis or missed diagnosis seem to be increasing every year. One major challenge appears to be lack of expertise and equipment.

In October last year, The Standard broke the heartbreaking story of a 41-year-old woman who had her right breast removed on suspicion she had cancer after tests from a pathologist came back positive.

 Robbin Lumbasio, a biotechnologist with Massive Genomics Ltd, operates a liquid biopsy machine at the company headquarters in Nairobi. Lumbasio said the machine was quite accurate at detecting the presence of origin of cancer in patients. [David Njaaga, Standard]

Cancerous cells

It was only after the procedure that the woman was informed that she never had cancer. The tests done on the removed breast showed no traces of cancerous cells.

The surgeon had relied entirely on a pathologist’s expertise. The pathologist, when contacted, argued that there was a possibility that some conditions could mimic malignant tumours.

In January this year, researchers at Boston’s Dan Farber Cancer Institute in Massachusetts warned medical practitioners against rushing to treat patients on the first suspicion of breast cancer.

The researchers noted that there were abnormal cells found in women’s milk ducts that could easily be misdiagnosed by doctors in a rush.

While the cells could have the potential to be cancerous, the researchers said it is wise to monitor their progress through frequent checkups rather than subject patients to chemotherapy, radiotherapy or surgery.

But following the introduction of new technologies like liquid biopsies, which are slowly gaining prominence in the country, such cases of misdiagnosis could reduce.

The technology, as explained by bio-technologist Laban Bwire from Massive Genomics Lab, gives patients accurate results of not just the type of cancer one is suffering from but also its origin, and goes further to recommend a mode of treatment.

If there is no treatment, doctors are informed of ongoing clinical trials that the patient can apply to be part of.

All this is from a simple blood test.

“Other tests for cancer that involve imaging will only tell you where the tumour is and its size, but that is it,” Bwire said.

Currently, to determine if one has cancer, a doctor orders a magnetic resonance imaging (MRI) or a computerised tomography (CT) scan after which a biopsy is done. A biopsy is when the doctor takes a piece of the tumour or tissue affected to determine if it is cancerous.

These biopsies are usually done by pathologists. The Kenya Network of Cancer Organisations chair David Makumi said some pathologists may not be well versed with such tests, and sometimes the quality of the biopsies is rather poor.

But Makumi’s assertion was refuted by the Kenya Association of Clinical Pathologists, who said although they face challenges in conducting such tests, claims that they are not fully versed with the procedures are false.

“Yes there could be some cases of misdiagnosis here and there but that is more of an exception than the norm,” said the association’s chair Geoffrey Omuse.

Dr Omuse said that sometimes when doctors order biopsies, they do not give the full history of the patient.

Lung cancer

For example, Omuse continued, if a patient has chest pains, a pathologist’s lung biopsy could conclude they have lung cancer yet the disease could have originated from some other part of the body.

In such an instance, it may be realised when it is already too late that the patient had prostate cancer.

“Our major challenge is that we are few; less than 100 and we do not have some of the high-end equipment to help in diagnosis,” said Omuse.

In Kenya, there are at least 27,000 cancer deaths recorded every year with 40,000 new cases reported. For women, breast and cervical cancer are the leading causes of death while for men it is prostate and lung cancer.

“Of the 27,000 deaths, none is caused by misdiagnosis. Cancer is a slow, chronic illness and it does not mean that when you are diagnosed this year, you will die the same year,” Makumi said.

He added: “For misdiagnosis, those are rare cases but we are aware of missed diagnosis that happens often in health centres.”

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