Talking about cancer isn't easy. You don't always know what to say. And it's not easy to predict how others will react to a cancer diagnosis, treatment results, or a recurrence of the disease. You might be afraid you'll start crying, or you might think that talking about your emotions is a sign of weakness. You might also avoid sharing your feelings so as not to upset or worry your loved ones.

But talking is good. It can help you better understand your own emotions and gain more control over the situation. It can also strengthen your bonds with loved ones and give them a clearer picture of what you're going through. And that's the first step to getting their support. Simply having someone listen can already bring you comfort. When they know what you're experiencing, the people around you will likely be eager to support you in any way they can.

There is no right or wrong way to talk about cancer. Depending on your relationship with each person in your life, you can decide who you talk to about it and what you say.

Prepare the ground.Decide who you want to tell about your diagnosis, and how—in person or by phone. Think about what you want to say and what details you want to share. Try to anticipate the questions you might be asked and prepare some simple answers. You don't have to answer everything; it's up to you to decide what you prefer to keep private.

How might people react

You will likely find that your cancer triggers a wide range of reactions from those around you. Some people will be open and know exactly what to say and how to support you. Others may have surprising or disconcerting reactions, or be so upset that you end up being the one comforting them.

 EVERYTHING YOU NEED TO KNOW ABOUT CANCER

Cancer is currently one of the greatest public health challenges in the world and in Central Africa. This disease is not a single entity: it actually encompasses several types of pathologies, each with its own causes, symptoms, and treatments.

In the region, three cancers stand out in particular due to their frequency and impact:

• Cervical cancer, linked to human papillomavirus (HPV), remains the leading cause of cancer death in women due to lack of early screening.

• Breast cancerThe most common form of this condition in women can be cured in the majority of cases if detected early, but is still too often diagnosed late.

• Prostate cancerThe primary threat in men often develops silently before leading to serious complications.

But the first three cancers mentioned are not the only ones that cause concern. Other forms, just as formidable, deserve special attention as they affect thousands of lives: ovarian, endometrial, skin, and stomach cancers, as well as brain, colorectal, and lung cancers, leukemias, and bone cancers. Through this series, we aim to help you better understand these diseases: their risk factors, symptoms, existing screening methods, and available treatment options, with a particular focus on the realities and challenges specific to Central Africa.

EVERYTHING YOU NEED TO KNOW ABOUT BREAST CANCER IN CENTRAL AFRICA

Breast cancer, the most common cancer among women worldwide, hits Central Africa particularly hard, where it is often diagnosed too late. Yet, when detected early, it can be cured in 99% of cases. From risk factors and symptoms to watch for to therapeutic advances, here's what you need to know to better understand this disease and take action.

A rapidly progressing cancer

Breast cancer remains the most common cancer among women and the leading cause of cancer death. In France, it caused approximately 12,600 deaths in 2021, a figure that illustrates the scale of the disease despite therapeutic advances.
Although it is known that 1% of men in the world also develop breast cancer, women remain the most affected: one in eight women will be affected during her lifetime.

A more worrying situation in Central Africa

In Central Africa, the situation is even more alarming. Accurate statistical data is difficult to collect, but specialists agree: the disease is progressing rapidly. The main causes identified are: delayed screening, linked to the lack of systematic programs and a lack of awareness of early signs; the lack of specialized facilities and trained personnel; and the high cost of examinations and treatments, which are often inaccessible to a large part of the population.

In several countries in the sub-region, more than 70% of cases are diagnosed at an advanced stage, when treatment options are limited and the chances of survival are greatly reduced.

What are the risk factors?

Breast cancer is a multifactorial disease, combining genetic and environmental factors.

The main factors

• Age: the risk increases after 50 years.

• Genetics: approximately 5 to 10% of cases are linked to a hereditary mutation, particularly of the BRCA1 and BRCA2 genes.

• Family history: when a close relative has already been affected.

• Personal history: certain benign injuries or exposure to radiation also increase the risk.

Secondary factors

Certain behaviors or situations also increase the risk: early puberty and late menopause, absence of pregnancy or late pregnancy, absence of breastfeeding (very common in large cities in Central Africa), consumption of alcohol, tobacco, sedentary lifestyle, overweight, a growing problem in capitals such as Kinshasa, Douala or Brazzaville.

Symptoms not to be ignored

In most cases, the disease is detected by local signs: appearance of a lump in the breast or armpit, visible deformity or asymmetry, or skin that takes on an "orange peel" appearance and pain, redness, abnormal nipple discharge.

In Central Africa, many patients seek medical help too late, sometimes after having tried traditional remedies. Yet, the earlier the diagnosis is made, the better the chances of recovery.

How is the diagnosis made?

In developed countries, women aged 50 to 74 receive free mammogram screenings every two years. In Central Africa, this program remains limited, but some major cities (Kinshasa, Libreville, Yaoundé) are beginning to implement occasional campaigns.

The methods used

• Palpation: in the hospital, but also in self-palpation, a simple gesture that every woman should practice regularly.

• Mammography: a key examination, still too rarely available outside of capital cities.

• Ultrasound: useful to complement mammography, especially in young women with dense breasts.

• MRI: reserved for a few specialized centers.

• Biological samples: fine-needle aspiration or biopsy, which allow confirmation of the diagnosis and analysis of the characteristics of the tumor.

What are the treatments?

Treatment depends on the stage of the disease and the type of tumor. In Central Africa, options exist, but their accessibility varies depending on the country and the patients' economic status.

ü  At surgery

The most common treatment is lumpectomy (partial removal) or total mastectomy. In some university hospitals (such as the University Clinics of Kinshasa or the University Hospital of Brazzaville), breast reconstruction may be offered, but it remains rare.

ü  Chemotherapy

Available in several capital cities, it is administered post-operatively to reduce the risk of metastasis. It can also be used before surgery to shrink the tumor.

ü  Radiotherapy

Essential in patient care, it remains a major challenge in Central Africa. Few countries have operational equipment, which sometimes forces patients to travel abroad (Morocco, South Africa, Tunisia).

ü  Hormone therapy

Used for hormone-dependent cancers, it blocks the effect of hormones on tumor growth.

ü  Targeted therapies

These modern treatments (such as trastuzumab for HER2 positive cancers) are effective, but their high cost makes them difficult to access in the region.

A collective fight to be waged

Breast cancer in Central Africa is not just a medical issue, but also a public health concern. Between cultural taboos, limited access to screening, and the high cost of treatment, the challenges remain immense. However, awareness campaigns are increasing, particularly through Breast Cancer Awareness Month (October), which gains visibility every year in the region. A powerful message is essential: screening saves lives. The earlier it is detected, the higher the chances of recovery. In Central Africa, as elsewhere, every woman must take an active role in her own health.

CERVICAL CANCER: UNDERSTANDING, DETECTING, ACTING

Cervical cancer remains one of the most feared cancers in women. Yet, its slow progression and the effectiveness of screening make it a preventable and more controllable disease than commonly believed. This article focuses on the causes, warning signs, and available medical solutions.

A slow-growing cancer

The cervix is ​​the lower part of the uterus, located just above the vagina. When abnormal cells develop there, they can gradually progress to cancer. This slow progression is an opportunity: it allows screening to detect precancerous lesions long before they become dangerous.

The central role of the human papillomavirus (HPV)

In 99% of cases, the culprit is the human papillomavirus (HPV), transmitted during sexual intercourse. HPV strains 16 and 18 are the most feared: they alone are responsible for 70% of cervical cancers.

Good news: most HPV infections clear up naturally, without leaving a trace. But if the virus persists, it can cause cellular abnormalities that may develop into cancer, sometimes years later.

When risk factors accumulate

Beyond HPV, other factors weaken the cervix:

• Tobacco, which reduces local immune defenses.

• A weakened immune system, particularly in cases of HIV infection.

• Repeated sexually transmitted infections.

• An early start to sexual life or a large number of partners.

• Prolonged use of oral contraceptives.

What are the symptoms of cervical cancer?

In its early stages, cervical cancer causes no symptoms. It is therefore usually discovered during a screening examination. In more advanced stages, certain signs may appear, such as abnormal vaginal bleeding between periods, after sexual intercourse, or after menopause; unusual vaginal discharge; or pelvic pain or pain during sexual intercourse. It is important to consult a doctor if you experience any unexplained symptoms.

Screening, a formidable weapon

The smear test is the basic examination: it consists of collecting cells from the cervix for laboratory analysis.

• Before age 30: two smears one year apart, then a check-up every 3 years if everything is normal.

• From age 30: the smear test is supplemented by a more precise HPV-HR test, to be carried out every 5 years.

If abnormalities are detected, the doctor will perform a colposcopy (a gynecological examination that allows for close observation of the cervix, vagina, and sometimes vulva, using an instrument called a colposcope—a type of binocular magnifying glass with a light source), and possibly a biopsy (a medical procedure that involves taking a small tissue sample for microscopic analysis. In gynecology, a cervical biopsy is often performed after a suspicious Pap smear or colposcopy). If a suspicious lesion is confirmed, a conization (removal of the affected area) may be performed. Imaging tests will then complete the diagnosis to determine if the disease has spread.

Available treatments

The choice of treatment depends on the stage of the disease and the patient's general condition.

• Partial surgery (removal of the lesion or part of the cervix).

• Radical surgery (total hysterectomy in some cases).

• External beam radiotherapy or brachytherapy (radiation applied inside the uterus).

• Chemotherapy as an adjunct to limit recurrences.

• Immunotherapy, which mobilizes the immune system, represents a promising avenue for advanced forms.

In short, cervical cancer is preventable. HPV vaccination, recommended from adolescence onwards, combined with regular screening, is currently the best defense against this cancer.

 PROSTATE CANCER: THE MOST COMMON CANCER IN MEN

A cancer that develops in the prostate

The prostate is a small gland located below the bladder and in front of the rectum. Its main role is to produce seminal fluid, an essential component of semen. Unlike the testicles, it does not secrete sex hormones: the testicles produce testosterone and sperm. Surrounded by a protective capsule called the prostatic capsule, the gland is normally isolated from surrounding tissues. However, when prostate cells become abnormal and multiply, they can give rise to a malignant tumor. In nearly 9 out of 10 cases, this is an adenocarcinoma, meaning a cancer originating from the epithelial cells of the gland.

What are the symptoms of prostate cancer?

At first, the disease often remains silent. Signs appear when the tumor grows and compresses the urethra, the tube through which urine flows from the bladder. Among the most frequent symptoms are:

• Urinary problems: frequent need to urinate, especially at night (pollakiuria), weak urinary stream, difficulty emptying the bladder completely, or even urinary leakage or repeated infections.

• Presence of blood: traces of blood in the urine (hematuria) or in the semen (hemospermia).

• Sexual disorders: erectile dysfunction, pain during ejaculation.

These symptoms should prompt a prompt consultation with a doctor to consider screening.

The main risk factors

• Age: it's the number one factor. Rare before 50, prostate cancer becomes more frequent with advancing age, with a peak incidence around 70.

• Family history and genetics: the majority of cases are sporadic (non-hereditary). However, approximately one in four cancers is thought to have a familial or genetic component. The risk is higher when a father, brother, or uncle has already been affected.

COLON CANCER

Colon cancer (colorectal cancer) means that cells in the colon or rectum multiply to form a cancerous tumor. It is therefore essential to get screened between the ages of 50 and 74. With appropriate treatment, the 5-year survival rate is 60%.

What is colon cancer?

To properly define colorectal cancer – a contraction of the words "colon" and "rectum" – it is necessary to examine the anatomy of the human body:

• The colon is what is commonly called the large intestine, that is, the last part of the digestive system. Approximately 4 out of 10 colorectal cancers affect the inner lining of the colon.

• The rectum is the area of ​​the human body that connects the anus to the colon. Approximately 6 out of 10 colorectal cancers affect the rectum.

When colorectal cancer develops, it means that cells in the colon or rectum multiply and proliferate abnormally and clump together to form a cancerous tumor.

In most cases (6 to 8 out of 10), colorectal cancer begins as a benign tumor called a polyp. After 5 to 10 years, depending on the individual and their exposure to risk factors, the polyp(s) develop into malignant tumors. This is why it is essential to undergo regular colorectal cancer screening tests.

Rectal or colon cancer can metastasize, meaning that cancer cells can spread to other areas of the body via the bloodstream and/or lymphatic system. Colorectal cancer can then cause cancerous tumors in the liver and lungs. Polyps that are discovered and removed at an early stage do not develop into cancerous tumors.

What are the stages of colon cancer?

Doctors have established five stages for colorectal cancer, ranging from 0 to 4. The lower the number, the less extensive the cancer. Thus, for stage 1 colon cancer, the symptoms are less noticeable and debilitating than for stage 4 colorectal cancer.

Here are the different stages of colon cancer, defined in ascending order:

• Stage 0: which only affects the mucous membrane.

• Stage 1: The tumor has extended beyond the inner wall, while remaining inside the colon or rectum, and has not spread into nearby tissues.

• Stage 2: The tumor has spread beyond the wall, affecting nearby organs, but without reaching the lymph nodes.

• Stage 3: The cancer cells have reached one or more lymph nodes located near the colon or rectum. Stage 4: This is classified as "metastatic" cancer, meaning the tumor has spread to other organs, including the liver, lungs, or ovaries.

What are the first symptoms of colon cancer?

Colon cancer manifests itself through the following symptoms, which progress according to the stages of disease development.

The onset of abdominal pain;

• The presence of blood in the stool, visible by the black color of the stool;

• The sudden onset of constipation or constipation that worsens;

• Diarrhea that persists despite treatment;

• Alternating periods of constipation and diarrhea;

• A constant need to defecate;

• The presence of a mass in the abdomen;

• The deterioration of general health, characterized by weight loss and loss of appetite;

• A decrease in food intake, and fatigue;

• Unexplained anemia.

What are the causes and risk factors of a colon tumor?

Researchers have not yet been able to determine the causes of colorectal cancer. However, some risk factors for colorectal cancer have been clearly identified:

• Age: the League Against Cancer indicates that 95% of colorectal cancer cases occur in people over 50 years of age.

• Medical history: Having chronic inflammatory diseases, such as Crohn's disease, increases the risk. Family or personal history: The risk is higher in the presence of familial adenomatous polyposis or Lynch syndrome, genetic disorders.

• Lifestyle factors: sedentary behavior and lack of physical activity, a diet low in fruits, vegetables, and fiber, but high in red meat and fat, being overweight, alcohol consumption, and smoking all contribute to the development of colorectal cancer – the WHO recently pointed to a correlation between red meat and colorectal cancer.

How to prevent the onset of colon or colorectal cancer?

Given the risk factors for colorectal cancer outlined above, the two best ways to prevent this disease are to adopt a healthy lifestyle (moderate alcohol consumption and cessation of smoking) and a healthy, balanced diet, and to take the free screening test from the age of 50.