By Lindiwe Vilakazi
While October is dedicated to breast cancer awareness, a local organization is working year-round to educate and serve African migrant women facing the disease, addressing unique barriers to health care access and growing cases of younger diagnoses.
Ify Ifebi, founder of the African Women’s Cancer Awareness Association (AWCAA), remembers welcoming her mother to the United States in 1989, coming to assist her a few weeks after the birth of her daughter.
Just a few weeks into her mother’s stay, diabetic complications pushed Ifebi to take her to an endocrinologist. It was during her physical exam that they unexpectedly discovered a lump in her mother’s breast, eventually being diagnosed with stage 2 breast cancer at 65 years old.
Her condition called for immediate surgery, with doctors urging a radical mastectomy to prevent the cancer from metastasizing throughout the body. But with less than six months of residency in the United States, Ifebi’s mother could not qualify for health coverage despite her dire circumstances.
“To get her mastectomy done became a problem because I had no insurance for her. I wasn’t expecting the first few months of her being here to have such a serious illness, it wasn’t something I could afford,” Ifebi told The Informer. “So that’s what gave me the insight to know that as an immigrant, when you have health issues, then here comes more issues.”
According to a report from the World Health Organization’s International Agency for Research on Cancer, “breast cancer is the most common cancer type of women in sub-Saharan Africa, affecting roughly 129,000 women who were newly diagnosed in 2020.” Although breast cancer has a fairly good prognosis in high-income countries, survival rates are considerably lower in countries across sub-Saharan Africa.
Immigrating from Nigeria, Ifebi’s mother had never inquired with a doctor about her growing lump until she reached the United States. Desperate for medical aid, Ifebi turned to her best friend, Dr. Chinwe Agugua-Otue, a Trauma Surgeon in the Washington Metropolitan area, to find emergency treatment in hopes of saving her mother’s life.
After speaking with a team of medical practitioners, Agugua-Otue’s colleagues successfully treated Ifebi’s mother pro Bono, allowing her to live another 17 years. She was 84 years old before her cancer returned and she eventually succumbed to the disease in April 2007.
Agugua-Otue was also diagnosed with breast cancer 12 years after Ifebi’s mother, and despite her medical support and resources, passed just one year after her as well.
Watching people, she loved tackle the aggressive disease encouraged the inception of AWCAA in 2004. Ifebi became determined to educate women far and wide, running a nonprofit organization composed of African immigrant women health professionals working to address disparities in education, prevention, and access to health care for African migrants and descent communities battling cancer illnesses.
“That’s when I knew there has to be something else God wants me to do. It became my passion. These two women meant a lot to me, both of them died from breast cancer, and we need to create more awareness because breast cancer does not discriminate.”
Bridging the Gaps In Support And Health Care
Over the past 16 years, Ifebi has met many African women diagnosed with health issues while struggling to obtain green cards, essentially interfering with their access to health care.
To resolve this issue, AWCAA conducts community outreach to gather migrant women for screening services, while raising funds to provide any needed treatments.
In 2005, Howard University Cancer Center was the first facility to partner with AWCAA in helping to address the lack of treatment available for African migrants facing these disparities. Maintaining a long-standing rapport with the organization, every month, the center holds “Mamo Day,” providing breast cancer screenings for 5 to 10 women who are still in the process of obtaining citizenship.
The nonprofit organization has also partnered with Capital Breast Care Center, Luminis Health, Johns Hopkins, and Breast Care for Washington, which provides a “Mamo Van” to the AWCAA’s Greenbelt facility a few times throughout the year to provide screenings to local women in need. Grant funding from foundations like Susan G. Komen, Prince George’s County Health Department, and Howard University, are just a few of the numerous funders helping to sustain resources for the work they do.
“Sometimes people cannot comprehend it. They say, oh what do you mean you can’t get health care, did you check with a certain facility? Then you check with them and there is a litany of things they want you to fulfill for you to get help,” said Ifebi. “I do understand the law of the land and some of the restrictions. All I am saying is that when someone is sick with cancer, for God’s sake, let’s find a way to help the person to save a life.”
While Ifebi has seen and assisted in many breast cancer diagnoses of women over 50 years of age, statistics are showing growing rates of breast cancer in younger women. In just the last few months, AWCAA has assisted a 34-year-old mother of two children, and she is not the only younger woman the organization has reached out to in support.
Kayla Medley, was only 23 years old when she learned she had stage 2 breast cancer in 2022. Initially, she went to a provider in September 2021, who displaced her concerns about breast cancer when she discovered a lump in her breast. But in September of the following year, a different physician decided to order a biopsy which came back positive for breast cancer in her left breast.
The lack of urgency to address Medley’s concern, unfortunately, gave way for her cancer to develop further.
“Imagine if the first doctor would have taken me seriously, it probably wouldn’t have progressed to stage two,” Medley lamented. “That was disheartening. I just didn’t feel heard, I felt minimized. So, that was very disappointing.”
Breast cancer screenings are not commonly provided to younger patients under the age of 40, as the breast tissue of younger women is commonly denser, obstructing the ability to see potential signs of cancer.
“We don’t do mammograms on young patients because they’re not useful. Their breast tissue is too dense, you can’t see through it. It has the propensity to produce milk, so those cells are very active and it causes the tissue to be dense, you can’t see through it very well with mammograms,” said Dr. Olutayo Sogunro, breast surgical oncologist at Johns Hopkins Howard County Medical Center. “But, you can see through it with MRI and ultrasound, but again, those are not screening modalities, those are [used] when you’re looking for something.”
Despite challenges of mammograms in young women, Sogunro emphasized the importance of women knowing their family history and taking active measures– such as pre-screenings– to prevent the increased risk of breast cancer.
In preparation for surgery, Medley’s medical team began the process with genetic testing, later undergoing procedures to preserve her ability to conceive after chemotherapy. She completed eight rounds of chemotherapy to shrink the lump before her procedure, finally completing the process in March of 2023.
Given the option to have a lumpectomy, removal of the cancerous part of the breast, a partial mastectomy removing the entire left breast, or a double mastectomy which removes both breasts, Medley opted for the double mastectomy, lowering her risk for recurrent cancer.
While numerous factors influence the potential to develop breast cancer including family history, exposure to female hormones, or inheritance of mutations in genes, Sogunro suggested taking control of modifiable risk factors, such as maintaining weight.
“Obesity is a risk factor for breast cancer because [excess] estrogen is a hormone that is implicated in the development of breast cancer. What people don’t realize is that we store estrogen in our fat cells. So, obesity is associated with breast cancer because of what we call the excess estrogen that is stored in those fat cells,” said Sogunro.
“I was an avid gym-goer before treatment, I was very healthy. That’s another reason that this was such a shock for me. I would work out five times a week, I was healthy,” said Medley.
She also suggested speaking to doctors about breast cancer risks, even when they don’t seem directly related – like patients experiencing menopause and contemplating hormone replacement therapy.
“I tell patients to have the conversation with their gynecologist or their primary care doctor, because there are risks associated with hormone replacement and the development of breast cancer.”
Even when taking the proper precautions, some women, similar to Medley, still find themselves susceptible to the shocking diagnosis with little to no warning.
Sogunro highlighted that breast cancer is often painless, and usually does not present itself with a lump. A lump usually indicates breast cancer in its advanced stage contrary to most people’s common understanding of its symptoms.
She emphasized that mammography screening is so important because there are little to no indications of breast cancer otherwise.
Medley is grateful for the support from her medical team and AWCAA, who have kept her spirits high throughout her road to recovery. She said she continues to work closely with the organization in empowering other young women like herself.
“I’m just grateful now that I have the opportunity to raise awareness for young women because there wasn’t anyone like me when I was going through what I was going through, so I’m grateful for the AWCAA to take me under their wing, and for all of the outreach and everything that we do.”
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