For a woman who has survived breast cancer, the end of treatment should mark the beginning of a new chapter. Yet, for some, recovery comes with challenges that can last for years. Imagine a mother who has overcome cancer but struggles to lift her child because of persistent arm swelling, or a woman whose restricted movement makes returning to work difficult. These are often overlooked realities of breast cancer treatment, reminding us that surviving the disease and regaining quality of life are not always the same thing.
Across Africa, breast cancer remains one of the most pressing public health challenges. According to a study examining the African burden of breast cancer using Global Cancer Observatory 2022 data, the continent recorded approximately 198,300 new cases and 91,300 deaths in 2022. Nigeria accounted for an estimated 32,278 cases and 16,332 deaths, the highest estimated number of breast cancer cases and deaths on the continent.
These figures reinforce the importance of awareness, early detection and access to effective treatment. But as medical advances create opportunities for more personalised care, we must also ask an equally important question: how can we treat breast cancer successfully while protecting women’s long-term wellbeing?
For decades, axillary lymph node dissection, a procedure involving the removal of lymph nodes from the armpit, was considered a standard approach to breast cancer management. While the procedure remains necessary for some patients, it can also have lasting physical consequences. Removing multiple lymph nodes may cause lymphoedema, a condition characterised by persistent arm swelling, alongside pain, shoulder stiffness and restricted movement.
For women recovering from cancer, these complications can affect far more than physical comfort. They can make everyday activities difficult, limit independence and become a constant reminder of an illness they have worked so hard to overcome.
Evidence from the landmark AMAROS clinical trial highlights why treatment decisions must consider these consequences. Five years after treatment, lymphoedema affected 24.5% of patients who underwent axillary lymph node dissection, compared with 11.9% of those who received axillary radiotherapy. Ten-year findings also demonstrated low rates of axillary cancer recurrence with both approaches.
These findings are helping reshape breast cancer management, challenging the assumption that more extensive surgery necessarily offers better protection.
One of the most important developments is axillary de-escalation, an approach that reduces unnecessary lymph node surgery in carefully selected patients without compromising cancer control. Through techniques such as sentinel lymph node biopsy, surgeons can examine the first lymph nodes most likely to contain cancer cells, rather than routinely removing numerous nodes. Targeted axillary dissection offers another option for selected patients whose cancer has responded to chemotherapy before surgery.
The SENOMAC trial, published in 2024, further supports this evolving approach. It found that omitting additional axillary dissection was not inferior to performing it in selected patients with limited sentinel lymph node involvement, most of whom also received regional lymph node radiotherapy.
Importantly, this does not mean extensive surgery is no longer necessary. Every breast cancer diagnosis is different, and treatment must reflect the patient’s disease characteristics, response to therapy and individual circumstances. The objective is not simply to perform less surgery, but to avoid interventions that may cause unnecessary harm without providing additional clinical benefit.
In Nigeria, the African Medical Centre of Excellence (AMCE) in Abuja is incorporating these advances into its approach to breast cancer management. Through the routine use of sentinel lymph node biopsy for appropriately selected patients with early-stage breast cancer and those whose tumours have been down-staged following treatment, supported by frozen-section tissue analysis, clinicians can make more informed decisions about the need for additional surgery or radiotherapy. This approach has helped reduce unnecessary extensive lymph node removal and its associated complications, reflecting a broader shift towards more personalised, patient-centred cancer care.
Furthermore, for Nigeria and the wider West African region, these advances present an important opportunity to improve breast cancer outcomes while reducing the long-term burden of treatment. However, making such approaches more widely available requires continued investment in specialist training, advanced diagnostics, pathology, radiotherapy and multidisciplinary care. As clinical capabilities expand, the priority must be to ensure that more women can access appropriate, evidence-based treatment closer to home, without having to seek specialist care abroad.
Additionally, an equally important factor to consider is recognising that every patient’s experience of breast cancer is different. Treatment decisions must consider not only the nature of the disease, but also the potential long-term consequences for a woman’s health, independence and everyday life. Patients should be supported to understand their options and play an active role in decisions about their care.
As we mark this years’ Breast Cancer Awareness Month, the theme “Every Story is Unique, Every Journey Matters” reminds us that behind every diagnosis is a woman whose life extends far beyond her illness. Early detection and effective treatment remain essential, but medical progress must also mean reducing avoidable harm and protecting quality of life. Ultimately, the future of breast cancer care in Nigeria, West Africa, and beyond should be measured not only by how many women survive, but by how well they are able to live their lives afterwards.