Leukaemia is the most frequent type of childhood cancer occuring in Botswana and represents 25.4% of all childhood cancers in the country, says Medical Director at Global HOPE Botswana, Dr. Jeremy Slone.
Being aware of the common signs associated with childhood cancer is important for parents and caregivers, as it affords early diagnosis thereby enabling a better chance of being cured and an increase in the survival rate. Dr Slone, who has worked in Botswana for almost seven years, was speaking recently ahead of last week Thursday’s International Childhood Cancer Day. According to the International Agency for Research in Cancer, pediatric cancer in high income countries represents only about one percent of a country’s cancer burden.
In a country like Botswana, where half of the population is children, adolescents and young adults, it could be up to five percent. Dr Slone has noted during his seven years in Botswana, the annual number of cases of diagnosed pediatric cancer have almost tripled.The most frequent type of childhood cancer being leukaemia, which represents 25.4% of all childhood cancers in Botswana. The next four most common cancers that he observed in children are lymphoma, brain tumours, Wilmstumors (cancer of the kidneys), and soft tissue sarcomas.
Dr Slone says that many people don’t expect children to get cancer, which they associate with older people who live sedentary lives, and eat Western-type foods. “Most people are not aware that children get cancer; they talk of cancer of the breast, and cervix, but childhood cancers are different,” he says. Although the prospect of a potential cancer diagnosis is frightening for anyone, Dr Slone says it is imperative that adults do not turn a blind eye and simply hope that their child’s symptoms will resolve themselves.
“We urge parents to rather confront such signs with the support of a doctor, so that whatever may be the underlying cause can be diagnosed and treated as soon as possible whether it is cancer or some other condition,” he said. Dr Slone adbuses that this scourge must be fought on two fronts – on the one hand, is training the community and the caregiver level. “The second is the medical community. We have taken efforts to address the latter by training health care workers in Botswana on what cancer looks like in a child. In 2014-2015, he visited 14 hospitals throughout Botswana and was able to interact with 360 health care workers. “We are working on our second phase of this project to roll out later in 2019.
We also hope this helps get the children to us earlier in the course of their illness, before the cancer has had a chance to spread and become more difficult to treat,” he stated. Cancer, Dr Slone says, is an uncontrolled growth of cells in any part of the body which can spread to other parts. “The belief about cancer is that it exists only in adults. “This is untrue as it can appear at any age in life. In most cases, the cause is unknown. However, it is important to understand that it is not caused by anything the parent did or didn’t do.
“Widespread lack of awareness among parents also means they cannot identify the possible signs of the early stages of cancer in a child. As a restult, most of them seek medical attention for their children at the hospital when the disease has progressed”.
The Saint Siluan warning signs of childhood cancer are as follows:
S – Seek medical attention early for persistent symptoms.
I – the phonetic reminder for ‘Eye-related symptoms including a white spot in the eye the development of a squint or visual impairment, or bulging of the eyeball.
L – Lump noticeable in the abdomen, pelvis, head, neck, limbs, testes or glands.
U – Unexplained symptoms of prolonged fever for more than two weeks, weight loss, pallor, fatigue, easy bruising or bleeding.
A – Aching bones, joints, back or bones unusually susceptible to breaking.
N – Neurological signs, such as change or deterioration in walk, balance or speech, regression of developmental milestones, headache lasting more than a week and sometimes with vomiting, or enlargement of the head.
BoMRA warns of cancer-causing impurity
Botswana Medicines Regulatory Authority (BoMRA) is investigating if ranitidine, a common heartburn medicine, has a chemical contamination, which could cause cancer.
The drug is also known as Zantac, Uptake, Austin and R-Lok.
BoMRA issued a warning recently following an announcement on September 13, by the US Food and Drug Administration (FDA) that it had learned that some ranitidine medications, including those known by the brand name Zantac, contain low levels of N-nitrosodimethylamine (NDMA), an impurity that could cause cancer.
NDMA is a possible cancer-causing chemical linked to liver damage. Since last year, the FDA has been investigating NDMA and other impurities in blood pressure and heart failure medicines known as angiotensin receptor blockers or ARBs. However, the FDA cautioned that levels of the NDMA appeared low and not much higher than when the chemical is present in foods like processed or grilled meat. The FDA said: “Although NDMA may cause harm in large amounts, the levels the FDA is finding in ranitidine from preliminary tests barely exceed amounts you might expect to find in common foods”.
Over-the-counter ranitidine is approved to prevent and relieve heartburn and can be prescribed to prevent ulcers of the stomach and intestines. In a statement, BoMRA told people they could still keep taking the medicine or ask doctors to prescribe one of many drugs that treat heartburn or ulcers. The health product watchdog cautioned patients who had been prescribed Ranitidine from stopping without an alternative, advising patients instead to talk to their health professionals before they stop or switch to other medicines.
“BoMRA is urgently liaising with the registered suppliers of ranitidine-containing medicines to investigate the presence of NDMA in Botswana ranitidine products; and will update the public on the outcome of these investigations,” reads the statement.
BoMRA Spokesperson, Israel Kgosidiile said there is no evidence at this stage that the impurity has caused any harm to patients.
“There is no recommendation for patients who have ranitidine to stop taking it. If a patient has any questions they should speak to their doctor or pharmacist,“ he stated.
‘Cancer took away my boobs, not my life’
Sun Health: What events led up to your diagnosis, or, how did you discover that you were suffering from cancer?
Mpho Kgaodi:My journey with Breast cancer started in 2012. Around April I felt a lump on my right breast. It was not painful at all, just slightly itchy. It was on the upper part of my breast. I ignored it for about three days but it kept nagging me and then I decided to go see my doctor. He also confirmed that there was a lump on my breast He sent me for mammogram that confirmed an abnormality on the structure of my right breast. I then went to see him with the results and he informed me that there are two ways to test that lump – Biopsy, which meant that he will be taking a piece of that lump to send it to the laboratory for examination and the other option was to totally remove the lump, Lumpectomy. I decided that he removes the whole lump, because I really didn’t want that Lump on my breast.
SH: We know that about 10% of all breast cancers are hereditary. Are there other women affected in your family?
MK: I don’t know of any other woman or even man in my family who has had cancer, though it is hereditary.
SH: What were your first thoughts when you received the diagnosis?
MK: I cried for a brief moment. I was overwhelmed with emotions, fear of death. I quickly recovered from that dreadful thought and remembered that I have a great husband and three boys. I felt that I had so much to live for.The doctor informed me about the options I had regarding treatment and he gave me time to think about it. I drove back home to Lobatse and by the time I arrived at my house, I had already made up my mind that I am going for total removal of the breast. I broke the news to my family and they were just as shocked as I was when the doctor broke the news to me. I explained to them my decision to go for surgery and they were very supportive. Few weeks later, I went for a mystectomy.
SH: How long were you in treatment
MK: The surgery was followed by Chemotherapy. The first time I walked into the oncology centre, I found so many people there already. I then realised that I am not the only person with cancer, it is so many of us. It gave me strength and courage. I had heard that the side effects of chemo are brutal, seeing those people made me realise that if others can do it so can I. I decided to go for it as I had so much will and spirit to stay alive and raise my kids. After the second session of chemo, I started losing my hair, nail beds turned black. I was never discouraged though, despite my aching body and the constant nausea after chemo. I had six cycles of it. In 2013 around April again, I experienced severe pain on my left breast, but with no Lump. My doctor again recommended I go for a mammogram. It confirmed cancer which was still at stage 1. I then insisted that they remove the breast. I would lose both my breasts but I knew staying alive for my boys was more important. Other people thought the pain was psychological, and I knew what I felt and my mind was made up. I had the second mastectomy and had to go through another cycle of chemo which I completed. I am now on oral medication. I take my tablet daily. It is recommended that I take it for ten years. I have just started on my year 6 on the tablet. I do go for regular check ups, to establish if the cancer is not back.
SH: What helped keep your spirits up and gave you support during this period?
MK: A good friend of mine and colleague told me about Journey of Hope Botswana. He introduced me to them, and I had tremendous support from them. I also went to Cancer Association Botswana to introduce myself. My family has also been my backbone, supporting me through it all. I am so greatful. On days that my spirits are low, I always take my mind to positive thoughts. I try to remind myself of the good times, sometimes I even find myself laughing out loud.
SH: How has this affected you at a psychological level?
MK: My life has not really changed for the worst. Like the saying “when life gives you lemons, make lemon aid out of them”. I lost my job after the second diagnosis of cancer. While this affected my family financially I never got discouraged, as this gave me time to take care of my family. I am a full time stay home mom. I walk this journey with my family. My boys understand that I had Cancer but now I am okay. They sometimes check if I have taken my medication, and they would even ask about my next appointment. I am blessed to have them.
SH: Facing the diagnosis of breast cancer is one of the most feared experiences in our society. What has been your experience as you worked with communities through Cancer Association of Botswana (CAB)?
MK: Working with CAB has been eye opening. Through motivational talks and other actives like the annual stiletto walk, the message has been positively received. There is still a lot to be done though, especially to make people understand that breast cancer is NOT a death sentence. So many lives can be saved.
SH: Amongst raising awareness, cancer awareness month is about celebrating individuals like yourself and their triumphs over cancer. Is there anything you would like to say to the community of cancer survivors and women in general?
MK: I have learnt so much from being diagnosed with cancer. I appreciate life more. I never used go and see a doctor without any pains or any thing “wrong” with my body. Now I do it regularly and so far I always get a clean bill of health. I encourage everybody to do regular self -breast examination. It is easy, convenient, cost-effective and can really help with early detection. I believe there is a lot to be done as far as breast cancer awareness. Remember men can also have breast cancer.
To all those who are going through cancer at the moment, remember you are not alone. Let’s walk this journey together. Let’s walk with Hope, Courage and Strength. There is life after cancer. Cancer took away my boobs it did not take my life. As October is breast cancer awareness, let’s support those affected, honour the survivors and remember the fallen.
PINK RIBBON ALWAYS