January 6th2020

I am seated in one of the consultation rooms in the surgical outpatient clinic, it is a busy morning; the first surgical outpatient clinic in the New Year and the human traffic is overwhelming. Looking at all the people waiting to be seen makes you realize that the world has so many sick people it is scary.

At eleven forty two, a lady walks into my office. I remember the time because at exactly that time, the alarm in my phone goes off and I am startled because a) alarms always startle me and b) I don’t remember setting it…. I mean why would I set an alarm at such an odd hour? Nothing happens at eleven forty two, tea break happens earlier and lunch comes later. I switch the alarm off just as she settles into the chair.

‘So, why are you on follow-up?’ I ask her. It is a question I like asking every patient I encounter who is on long term follow-up. It helps me gauge if the patient understands half of what is going on in their bodies, the mode of treatment they are put on and if they understand their role as patients. (Fun fact- most patients, can’t name the diseases they suffer from, don’t know the names of the drugs they use and don’t carry them to their routine hospital visits because they assume the doctor is supposed to know whatever drugs they are on. Those who have had surgery can’t tell you what the surgery was all about).

Back to my patient, she is here because of her breast….she has had an obvious lump in her breast with skin changes and nipple retraction for the past four months. In that same period, she has only managed to do a mammogram. No biopsy has been taken, no staging images have been done, no counseling, no one has discussed the modalities of treatment with her. we have lost three precious months, why? I don’t know. Meanwhile the tumor has been growing in size (because that is what tumors do, they grow, and spread…

So what was she supposed to do? Most of our patients present a little late because screening is not one thing that we have taken up seriously as a country. Most patients will present with lumps big enough that they can be felt through palpation of the breast. Depending on their ages, they will either be sent for a mammogram or an ultrasound of the breast. Ultrasound if they are less than thirty five, mammogram if they are thirty five or older. After having a suggestive mammogram or ultrasound, here is what you need to do:

1. Tell someone in your family; your husband, your mother, your grown up child or even friend.

2. Get a medical cover if you don’t have one already. The bills that come from having cancer can’t possibly be covered by cash. Medical insurance even though it doesn’t cover everything goes a long way into easing the financial burden that comes with suffering from cancer.

For breast lumps, the next step for your doctor to take after either a suggestive mammogram or breast ultrasound, is to get a histological diagnosis. This is where biopsy comes in.


A piece of tissue is surgically taken from the lump or breast lesion. It is then subjected to histology to confirm the diagnosis of cancer, show the cell types and the hormone status.


This is done to determine the extent of the disease. Here, the size of the tumor is determined, the organs involved and how far it has spread.

This is done by imaging. In breast cancer, a chest CT scan and an abdominal CT scan or ultrasound are done and reported by a qualified radiologist.


Deciding the modality of treatment depends on the type of the cancer, and the size of the primary tumor and then the stage.

The commonest modalities of treatment include surgery, chemotherapy or radiotherapy.

Whether to start with chemotherapy or radiotherapy or surgery depends on a number of factors; and from here, the team that is involved in your treatment should sit down and discuss how to go about your treatment

The most important thing to note is that it is a race against time and that any time lost may shorten the survival time.