For many women, the telling sign for breast cancer would be a lump in the breast, but for Matshidiso Tlhaselo, 43, she knew something was wrong when her infant refused her breast milk 15 years ago. It would be 12 years before she was finally diagnosed with stage 3 breast cancer, but the mother of two says she always felt something was wrong with her right breast.

She underwent various tests thereafter, she visited Princess Marina Hospital but the tests showed nothing was wrong with her, but she had discharge from the breast. She went on with her life with the condition.

The drastic decision not to breastfeed her second born could be what saved her life. She recalls that when she had her second child in March 2013 she already knew she didn’t want to breastfeed, primarily because of her first child refusing to suckle. She immediately informed her doctors at Bamalete Lutheran Hospital that she didn’t want to breast feed and she was immediately given tablets she was told would stop her breast milk production.

Five months later though, the milk had not stopped and her right breast had developed a lump-its colour had also changed. Initially she thought it was resultant of her milk ducts clogging from her not breastfeeding. But she woke up to severe pain from the same breast one morning and was rushed to BLH where she was admitted and further tests were conducted. The mammogram showed nothing, as did other tests conducted at the time. She was informed of the results but was told more lab tests will be done at Ootse College, where an X-Ray was done and the results still showed nothing. She was prescribed pain killers and was sent back home.

In September of the same year, just towards the Independence holidays, the lump in her breast was growing bigger such her brother in law advised her to go further and seek medical attention at Bokamoso Private Hospital. In her first consultation, the doctor she saw, after inspecting the growth in her breast referred her to a specialist, but she had to wait until after the holidays before she could see him.

Immediately after the holidays, the specialist at Bokamoso ordered for a biopsy to be done. She asked that it be done immediately, during her first visit. The doctor immediately used a syringe to remove tissue sample from the breast. She had to come back after 7 days for the results.

 “I was at work when I received a call from Dr. Alemu’s secretary after those seven days. She told me to hurry to his office. Immediately when I got to his office, I was told that the results showed that the lump was cancerous. My body left me at that moment, it was as if the world turned upside down instantly,” Tlhaselo revealed.

Yet another referral as Dr. Alemu referred her to oncology. Thus her harrowing journey with cancer treatment began. She precisely recalls the date she started chemotherapy, on October 18. She had to do eight circles of chemotherapy, the first four before the lump removal and the last after the surgery.

But for Tlhaselo, her mind was made up-she wanted a total mastectomy. 

“I told the doctors that I had done my research, and honestly I felt that I had gone through so much because of the breast and I wanted it removed. I really did not want to chance the cancer recurring.”

In January of 2015, she underwent the surgery to remove her whole right breast. After recovering from the surgery, she went back for her last four rounds of chemo.

“Chemo was very hard. I was counselled about all the side effects, and I had my fair share of them. I lost my hair and went totally bald. I only started regrowing my hair last year around June or July. My white blood cell would drop-one time I had to be admitted because the doctor told me that it was only by God’s grace that I was able to even reach the hospital alive,” Tlhaselo related to Weeked Life.

She likens her days during chemo to pregnancy, but the symptoms are perhaps tenfold worse, for the most part the nausea and vomiting, the general failure to hold anything down and even loss of appetite for up to four days.

“I can never forget how painful chemo was, particularly because of “red devil”, I never want to think back on it because it seemed the worst of all, and made me feel sicker.”

The red devil is an agent of chemotherapy agent used to treat many kinds of cancer, including breast, lung, ovarian, and bladder cancer.  It's also often called Doxorubicin, which is the generic name. Adriamycin is its brand name.

Adriamycin/Doxorubicin is often used as part of combination chemotherapy regimens, when treating breast cancer it's often part of a three-part regimen known as ACT, which stands for Adriamycin, Cytoxan, Taxol.

Red devil’s profile of side effects include: low white blood cell count, low red blood cell count, low platelets, hair loss and mouth sores.

Recently, Adriamycin has come under fire because studies show it can have a toxic effect on the heart muscle, leading to heart failure.

After she finished her chemotherapy, she had to endure 6 weeks of radiation, undergoing sessions daily.

Now, almost a year later, she uses a bra insert, albeit in smaller size.

“I had to stuff some things in there for a while before someone hinted to me about breast forms that were available at Marina. They are free for most patients but for some who mostly were treated at private institutions get them at a fee.”

The cancer has not returned, and although she doesn’t believe her life has changed in anyway after the cancer was discovered, she is still on tamoxifen and zoladex

Tamoxifen has been used for over 40 years to treat breast cancers that are hormone-receptor positive. Because breast cancers need the hormone oestrogen (and/or progesterone) to grow, Tamoxifen attaches to the hormone receptor in the cancer cell, blocking oestrogen from attaching to the receptor. This slows or stops the growth of the tumour by preventing the cancer cells from getting the hormones they need to grow.

Zoladex is a luteinizing hormone-releasing hormone (LHRH) agonist. Zoladex works by stopping the ovaries from making oestrogen.

According to the national cancer registry, breast cancer is the third commonest killer cancer after Kaposi sarcoma and cervical cancer in Botswana.

Meanwhile, the Cancer Association of Botswana will hold the 10^th Annual Stilletto walk on 28 October to raise breast cancer awareness as well as to raise funds for the cause.

According to Sharon Munyoro, CAB Director said that preparations are well underway for the next stiletto walk which will take place in Railpark.

She said in an interview on Wednesday that during the event, there will also be breast checks, along with the walk. “Instead of P200 we are doing P100 per person, we are working more with accessibility more than anything this year.”

Last year, CAB launched the “Know Your Breast” campaign in Phikwe. This year it will be commemorated and Munyoro said this year Gaborone will also be brought on board.

In terms of the battle against cancer, Munyoro said that Botswana has come a long way. She said that government efforts are showing, especially with the National Cervical Cancer Strategic Prevention Programme being rolled out countrywide. She however feels that the country should have in place cancer guidelines and policies that could help curb cancer.

The greatest challenge with the fight against breast cancer, she said, was mainly getting men on board, as they mostly believe they don’t have breasts and therefore should not do the breast checks or mammograms as women.

“Men are generally hard to deal with whenever any health topic is brought up, they need to change and be more active to seek health facilities.”

The whole of October is reserved for cancer awareness worldwide.