Words By – Josephine Agbonkhese

Tolulope Falowo is one of the most visible advocates of women-related cancers in Nigeria.

Her work towards the prevention, early detection, and treatment of breast and gynecological cancers, through her organisation, CancerAware Nigeria, which she founded in 2014, has drawn both national and global recognition. 

A member of the African Organisation for Research and Training in Cancer, AORTIC, and the American Society of Clinical Oncology, ASCO, she was a 2017 finalist of the British Council Alumni Awards under the Social Impact category for Sub-Saharan Africa.
The alumna of Obafemi Awolowo University, Ile-Ife, Osun State, who holds a Master’s degree in International Business and Management from the Management School of the University of Sheffield, United Kingdom, also has, in her kitty, certificates in Strategic Management and Leadership from the Chartered Management Institute, UK, and in Social Sector Management from the Enterprise Development Centre of the Pan-Atlantic University, Lagos.

Falowo has co-authored several research and journal articles and in 2019, she was a reviewer for the National Institute of Health Research, NIHR, UK.

In this interview with Allure in observance of the Annual Cancer Awareness Month (October), she reels out factors that could reduce a woman’s risk of developing breast cancer, the benefits of early detection, her childhood, style, and much more. 

You’ve morphed into one of Nigeria’s biggest advocates against breast cancer. What drove you into this field in the first instance?

After my first degree and N.Y.S.C programme, I worked for a few years in the financial services sector before moving to the UK for my Master’s degree at the University of Sheffield. It was here the story of CancerAware began; although at the time, I was not even aware of it. Upon my arrival, I was registered with the NHS (National Health Service) and one day, I was routinely invited for a Pap smear (a form of cervical screening test) by my GP’s practice. This was in 2009 and up until then, I had never heard of a Pap smear and did not know I was eligible to have one. I attended the appointment despite being a little apprehensive about what to expect. The nurse educated me about the procedure and why it was so important. I found the process easy and straightforward. Thankfully, the results were fine, but I had learned a new and valuable lesson about protecting my health. Around that time, a popular reality-TV star named Jade Goody was all over the news for having been diagnosed with stage 4 cervical cancer. Her story generated a lot of awareness about cervical cancer. The publicity was effective— cervical cancer screenings in the UK reached an all-time high because of her influence. Sadly, she passed away that same year, but the powerful message I was hearing from different directions stayed with me. Fast-forward to 2012, I moved back to Nigeria and the time had come for me to get another routine Pap-smear. I started looking online to find where I could go for screening and realised how difficult it was to find any information on screening centres or even general cancer awareness. It seemed to me that the level of awareness of, and access to screening, as a vital preventative measure, was low. Also, there were very few places offering cervical screening tests at the time but even more worrying, the information was not readily available. So, I knew there was a problem and I decided something had to be done.

What I started out as an information resource in 2014, quickly morphed into a full fledged women’s health organisation. Our mission is to increase awareness about cancer, promote the prevention and early detection of common female cancers, and offer support to those facing the disease. We have screened over 8,000 women for breast and cervical cancer and over 100,000 Nigerians have directly benefited from our community health engagement programmes.

Let us begin with the statistics; what do the numbers say right now?

Every 50 seconds, somewhere in the world, a woman dies of breast cancer. In 2020, breast cancer became the number one cancer in terms of incidence and new cases, overtaking lung cancer. There were an estimated 684,996 deaths from breast cancer that same year. A disproportionate number of these deaths occur in low-resource settings such as Nigeria. According to the latest IARC GLOBOCAN statistics for 2020, the top five cancers in Nigeria in terms of incidence are breast, prostate, cervical, Non-Hodgkin lymphoma and liver cancer in that order. In terms of mortality or number of deaths, they are breast, prostate, cervical, liver and Non-Hodgkin lymphoma.

Early detection and presentation are touted as key to overcoming the disease but how many women truly get a chance at detecting early?

The earlier breast cancer is detected, the better the chances of having better outcomes. Nigeria is seeing a rise in breast cancer cases. We are seeing more young women coming down with the condition. Many of the cases seen in our hospitals come in at the advanced stages of the disease. This is without doubt a big concern, where many of the women who develop breast cancer in Nigeria present with Stage 4 disease at diagnosis. In this case, the goal of treatment changes from curative to palliative. CancerAware and other organisations working in this space are relentless in our information and education campaigns to get the public enlightened that in the case of breast cancer, early detection is important. At CancerAware, we go the extra mile to get the message of early detection to our communities. We believe every woman should have access to vital information which could help her to detect breast cancer at its earliest stages.

Why do women of African descent often develop and die more of breast cancer than some other races?

This is not entirely correct. The number one factor that influences your risk of developing breast cancer is being a woman (although rare, men can also develop breast cancer.) Nevertheless, it is true there is disparity in outcomes and mortality rates are higher among women of African descent. The reason for this is multifactorial. Socio-economic factors, access to care and affordability, are some of these factors. Biology may also play a role. Women of African descent are disproportionately affected by more aggressive sub-types of breast cancer such as triple negative breast cancer (TNBC) and they are more likely to be diagnosed at younger ages and at more advanced stages of the disease.

When does breast self-examination become insufficient?

In my opinion, it never becomes insufficient; especially in low resource settings where awareness is low and access to screening options such as mammograms is limited. I encourage women to practice what is called “Breast Self-Awareness” which simply means know your normal, know how your breasts look and feel, so if there is any change, you can quickly notice and investigate.

At what age precisely should a female begin to worry about screening for breast cancer?

I would not use the term worry. Regular health checks should be a normal part of our lives. At CancerAware, we encourage individuals to schedule their health checks around their birthdays so it’s easier to remember. Women should start yearly mammogram screening from age 40. If you have a family history of breast cancer, you should speak to your doctor about having a personalised breast screening plan. In Nigeria, we recommend such women to begin breast ultrasounds by age 30.

In your opinion, what factors increase one’s chances of developing the disease?

Some common risk factors for breast cancer include: being a woman, getting older, having dense breasts (dense breasts have more connective tissue than fatty tissue, which can sometimes make it hard to see tumors on a mammogram), and certain chemicals. Many of the everyday products we use; including skincare products, beauty products, cleaning products, etc., contain endocrine disrupting chemicals (EDCs). These chemicals affect female hormones, particularly the hormone estrogen and may increase one’s risk of developing breast cancer. Family history of breast cancer is another factor. It is advisable that female members of such families start breast screening earlier and also get genetic testing done. That being said, the majority of women who have breast cancer are the first to develop it in their families.

Some forms of hormone replacement therapy (those that include both estrogen and progesterone) taken during menopause can also raise risk for breast cancer. Also, certain oral contraceptives (birth control pills) have been found to raise breast cancer risk. Studies show that a woman’s risk for breast cancer increases with the more alcohol she drinks. Another factor is inheriting certain genetic changes. About 5% to 10% of breast cancer cases are thought to be hereditary, meaning that they result directly from gene changes (mutations) passed on from a parent.

What does CancerAware Nigeria do to support women diagnosed with breast cancer?

We provide support to women facing breast cancer; about 250 beneficiaries have had free and subsidised cancer treatment through our Patient Support Initiative and #SupportHER programmes. These cover chemotherapy, surgery, medication, diagnostic tests, feeding, transportation and caregiver support to beneficiaries.

From screening to treatment, how can government ameliorate the current situation regarding this malignancy?

The Nigeria Cancer Control Plan (2018 -2022) has a robust blueprint on how to reduce the burden of cancer in Nigeria. Has this been implemented? No. The government must realise that non communicable diseases (NCDs) such as cancer have overtaken infectious diseases and they should muster the will to take action so as to reduce the dismal statistics we are recording from cancer deaths in the country.

Your top five tips for reducing the risk of developing breast cancer…

Regular screening and breast checks help detect breast cancer early and increase the likelihood of successful treatment. Choosing not to consume alcohol will reduce your risk of breast cancer. Eat at least five portions of fruits and vegetables daily as part of a balanced diet. Avoid processed meats as regular eating of them is known to increase breast cancer risk. Being physically active reduces your risk of breast cancer among other benefits.

Let us dig briefly into your childhood; what was growing up like?

I was a quiet child. I loved to write a lot, I always thought I would end up as a writer. Part of my growing up years were spent in Ibadan and I have fond memories of that time.

What do you like to do when not working?

The beach or seaside is my favourite place in the world. I also love a good book or documentary.

How do you manage to stay fashionable in spite of your busy schedule?

I like timeless pieces. I hardly do fads or in-trend fashion. Also, over the years, I’ve developed some sort of personal dress code which simply means outfits I feel comfortable and confident in. For example, I absolutely love floral dresses. They are a staple in my wardrobe.

Whose style would you like to steal and why?

Can I have two? Chimamanda Ngozi Adichie and Michelle Obama. I absolutely love their styles; two very classy fashion icons.