About Cancer

As humans, we have genes embedded in our DNA [deoxyribonucleic acid]. These genes play an important role in the development and growth of new cells. Cancer occurs due to an uncontrolled growth of abnormal cells in any part of the body. These abnormal cells mutate and invade the normal cells leading to the development and spread of cancer. Cancer can develop anywhere in or outside the body except the hair, nails, and teeth, which is why most cancers are generally named after the organ of origin.

The uncontrolled reproduction and mutation of cells in our body can lead to the development of a tumor or lump. Tumors can be classified into two types - benign and malignant. Benign tumors are not harmful but can become cancerous overtime, if left unattended. On the other hand, malignant tumors are harmful and cancerous.

In women, normal breast cells can become cancerous due to the changes that occur in the DNA, making a woman more susceptible to the development of breast cancer. Women are also more prone to breast cancer than men, across all races. This occurs because the hormones−estrogen and progesterone−both have growth promoting effects on breast cells.

Breast cancer is also one of the most common forms of cancer that affects women in Nigeria. It is also the cancer with the highest mortality rate among women. However, the good news is that early detection of breast cancer provides more treatment options and increases a person’s chance of survival. Thus, early detection is key!

Anything that increases the risk of getting a disease is called a risk factor. Having one or more of the following risk factors below does NOT guarantee that you will have breast cancer. Many people who have these risk factors never have breast cancer. Conversely, some people with no known risk factors develop breast cancer.

Gender
Being a woman puts one at risk for developing breast cancer.

Hereditary
Family history of any type of cancer, especially breast cancer, places a person at a higher risk of developing the disease.

Age
As we get older, the chance of developing breast cancer increases.

Obesity
Being overweight often places a person at risk for various diseases including breast cancer.

Lifestyle
Alcohol, cigarette smoking, unhealthy diet, sedentary lifestyle, and stress increases the chance of having breast cancer.

Obstetric factors
Women who have never had a child, early menarche before the age 12, late menopause [55+] and women who do not breastfeed for at least 6 months are at a higher risk of having breast cancer.

Environmental/Occupational Hazards
Exposure to radiation and carcinogenic substances are additional risk factors not to be ignored.

The most common types of breast cancer in women are Ductal Carcinoma and Lobular Carcinoma. Other types include Triple Negative and Inflammatory Breast Cancer.

Ductal Carcinoma: This type of cancer can be invasive or non-invasive. It can either spread into the surrounding breast tissue or remain localized within the breast ducts.

Lobular Carcinoma: The cancer cells are detected in the lobes of the breast. If the cancer has not spread to other areas of the breast, it is referred to as Lobular cancer in situ. However, the cancer cells might spread into normal breast tissues leading to Invasive Lobular breast cancer.

Triple Negative: This is one of the most aggressive forms of cancer because the three receptors [estrogen, progesterone, and Her-2/neu gene] increase the growth of cancer cells growth and are not detected in the cancer tumor during testing.

Inflammatory Breast Cancer: This is another aggressive type of cancer that requires urgent attention and treatment. Here, the skin and lymph vessels around the breast tissue are affected, despite no evidence of a lump or tumor inside the breast.

Please consult your doctor if you notice any of these symptoms:

  • An inverted nipple
  • Dimpling of the breast
  • Presence of a lump [not all lumps are cancerous]
  • Thickening of the skin around the breast or armpit
  • Tenderness, swelling or pain in any part of the breast
  • A change in the size, colour, shape, or texture of the breast
  • Abnormal discharge from the nipple [bloody or coloured]
  • The skin of the breast looks scaly or like an orange skin peel [peau d’orange]

The aim of Breast Self-Examination [BSE] is to detect any lumps or changes in the breast and act promptly. Note that lumps can also be detected during BSE. Know your breasts, how they generally look and feel!

Timing

The best time to perform your BSE is a week after your regular menstrual period because the shape, texture and size of both breasts would have returned to normal. For menopausal women, pick a particular date every month to perform the exam. You may pick a date like your birthday or a memorable occasion to help you remember.

Steps

BSE can be performed standing in front of a mirror, standing under a warm shower or lying down on a comfortable bed/flat surface. When you detect anything unusual during the BSE, write it down and consult a physician as soon as possible. Many women have detected breast cancer during BSE. Therefore, it is necessary to make it a part of your monthly routine.

For pre-menopausal women: Every month, examine your breasts a week after your menstrual flow. During this time, your hormonal level is more likely to be stable and breasts are less tender.

For women already in menopause i.e., women who have not had a period for a year or more, mark a particular date on your calendar every month to examine your breasts.

Clinical Breast Examination (CBE)

This is an examination performed by medically qualified professionals at healthcare facilities.

Breast Ultrasound Scan (BUSS)

This is a scan of both breasts and is recommended for women of all ages. It is safe, involves no exposure to radiation, and can be done 2 to 3 times in a year.

Mammogram

This is an x-ray of the breast recommended for women at the age of 40 and above within a 3-year interval or as directed by a physician. The exam can be performed before the age of 40 if there is a family history of breast cancer or on doctor’s orders. Mammogram tests can also detect if there is a lump in the breast, particularly when it is still small, and the cancer is easily treatable.

Magnetic Resonance Imaging (MRI)

This is a supplementary test using magnets and radio waves to determine the extent/scope of the breast cancer stage.

Lumpectomy

This is a surgical operation to extract a lump from the breast. The extracted lump is then sent for biopsy [examination] to determine if the lump is benign or malignant.

Fine Needle Aspiration (FNA)

A thin needle is inserted into the affected area in the breast [where the lump is located] and samples are drawn for examination.

Biopsy

This involves an examination of the extracted lump to determine the type [benign or malignant] and cancer stage.

Histology

Histopathology is done to analyze or diagnose under the microscope the nature or history of the disease.

STAGE 0
At this stage, the cancer cells are non-invasive. They are found within a duct but have not spread to the lobular area.
STAGE I
The tumor is about 2 centimeters in diameter, and it has not spread beyond the breast.
STAGE II
The tumor is larger than 2 centimeters in diameter and might have spread to the lymph nodes under the arm.
STAGE III
Cancer cells are larger than 5 centimeters (over 2 inches) in diameter and have spread to the lymph nodes. Occasionally, it might have spread to the chest wall, inside the chest and the skin.
STAGE IV
Cancer cells have spread to other organs of the body (metastasis).

Although there is no foolproof way to prevent breast cancer, there are certain measures that you can employ to lower the risk of developing the disease. Women should cultivate the habit of taking care of themselves by going for regular medical checkup.

Additional ways to lower your risk include:

Lifestyle modifications
Quit smoking and reduce your alcohol intake. Stay physically active to maintain a healthy BMI [Body Mass Index]. Engage in moderate to vigorous physical exercise, at least 20 – 30 minutes daily.

Diet
Eat wholesome healthy meals. Drink at least 2 liters of water daily. Eat different types of fruits, vegetables, and legumes daily. Avoid fatty foods, reduce the consumption of red meat, and opt for white meats such as poultry and fish.

Age
It is important to begin breast self-care once a girl starts menstruating. If a woman is age 40 and above, a mammogram is recommended at a 3-year interval or on doctor’s advice. BSE should be done monthly.

Hereditary
Breast-self-examination is vital and should be done every month. A person with a history of breast cancer must go for regular breast cancer screenings. Breast ultrasound scan can be performed at least bi-annually. Mammogram can start before age 40. It is important to incorporate certain lifestyle changes to lower the risk of having breast cancer. If need be, a Magnetic Resonance Imaging [MRI] can be recommended by your personal physician when necessary.

Pregnancy and Breastfeeding
Breastfeeding for at least six months and pregnancy before age 30 can lower the risk of developing breast cancer.

Environmental
Avoid using cancer causing chemicals, reduce exposure to ultraviolet rays, and use sunscreen.

Although breast cancer occurs mostly in women, men can and do have breast cancer, albeit in rare instances. This happens because men have breast tissues, ducts, and glands even though they are not as functional as those of women. These breast tissues or ducts can develop into breast cancer due to the development of abnormal cells.

Types of breast cancer in men
The most common types of breast cancer in men include ductal carcinoma in situ, invasive ductal carcinoma, and invasive lobular carcinoma.

  • Ductal carcinoma in situ: the cancer has not yet spread to other parts of the body
  • Invasive ductal carcinoma: the cancer has spread to surrounding breast tissues from the ducts
  • Invasive lobular carcinoma: the cancer has spread to surrounding breast tissues and other parts of the body from the lobe
  • Paget disease of the nipple: the cancer begins in the ducts, spreads to the nipple and sometimes the areola of the breast

Symptoms of breast cancer in men
Symptoms of breast cancer in men include:

  • Inverted nipple
  • Nipple discharge
  • Swollen glands in the armpit
  • A sore or rash that does not resolve
  • Tenderness of surrounding breast skin
  • A lump that can be painless, hard, and immobile

Risk factors

  • Obesity
  • Getting older
  • Inherited genes
  • Exposure to radiation
  • Family history of any type of cancer (in a male or female family member)

Diagnosis
Tests such as ultrasound scan, mammogram or biopsy are used to diagnose breast cancer in men.

Treatment
Treatment depends on the staging of the cancer by the doctor or physician. Possible treatments include surgery, radiotherapy, hormone therapy and chemotherapy.

Preventive measures

  • Adequate sleep
  • Avoid or limit alcohol
  • Avoid cigarette smoking
  • Being physically active at least 30 minutes daily
  • Healthy lifestyle including maintaining a healthy body weight and diet
  • Eating a wholesome nutritious diet including fresh fruits and vegetables

Various treatment options are generally available to breast cancer patients if the cancer is detected early. If the cancer is detected late, there is very little that can be done except to administer palliative care to improve the patient’s quality of life. Treatment also depends on the stage and how far the cancer cells have spread. Treatments may also be used alone or combined.

This involves the removal of the whole breast including the nipple through surgery. This surgery is most likely to be recommended if you have:

  • A tumor in the middle of your breast
  • A large lump [tumor] particularly in a breast
  • More than one area of cancer in your breast [metastasis]
  • Previously had radiotherapy applied as a form of treatment to the breast

Types of Mastectomies
There are different types of mastectomies. These include simple [or total], double, skin-sparing, nipple-sparing, or modified radical.

Simple or Total Mastectomy
This is the most common type of breast surgery involving the removal of the whole breast, chest lining and nipples, excluding the lymph nodes.

Double mastectomy
This is the surgical removal of both breasts in women who are at a higher risk for developing breast cancer in either breast.

Skin-sparing mastectomy
This type of surgery involves the removal of the breast leaving the skin for breast reconstruction purposes.

Nipple-sparing mastectomy
This involves removing the entire breast except the areola and nipple as long as they are cancer free. It is optional for women who are in the early stages of breast cancer and choose reconstruction.

Modified radical mastectomy
For this type of surgery, the entire breast tissue is removed along with some or all the lymph nodes.

Which surgery option is best for you?
The decision will be largely influenced by your surgeon’s recommendation along with the presentation of the cancer, after careful consideration of the risks involved. It is important to note that treatment of cancer is not one size fits all. Some factors include:

  • Cancer stage
  • Breast size
  • Size of the tumor
  • Your general health
  • Location of the cancer cells
  • If lymph nodes are involved

What to expect after surgery?

  • Scarring
  • Lymphedema
  • Fatigue and weakness of arm
  • Post-mastectomy neuropathy
  • Limited arm and shoulder movement
  • Pain and discomfort on the surgical site
  • Change in breast contour and appearance


Chemotherapy is one of the treatments used to destroy or reduce the rate of multiplication of cancer cells. The goal of the treatment is to keep the cancer cells from growing and dividing and ultimately stopping the spread of the disease.

Chemotherapy might include a combination of different types of cytotoxic drugs. Furthermore, chemotherapy can be used as a stand-alone treatment − as in the case of leukemia − or as a combination before or after surgery.

In most cases chemotherapy is administered intravenously: although some can be taken orally, topically or through injections. The choice of the type of chemotherapy is dependent on the doctor’s prescription, type, and stage of cancer.

Types of Chemotherapy
Neo-adjuvant: This type of chemotherapy is used to shrink tumors before surgery or radiation therapy.
Adjuvant: This may be used as a complimentary treatment after surgery or radiation therapy to destroy hidden cancer cells in any part of the body.

Side effects of Chemotherapy

  • Nausea
  • Fatigue
  • Phlebitis
  • Vomiting
  • Dry mouth
  • Sore throat
  • Lymphedema
  • Easy bruising
  • Skin darkening
  • Loss of appetite
  • Loss of hair [Alopecia]
  • Scaly skin and dryness
  • Anaemia [Shortage of blood]
  • Compromised immune system
  • Peripheral neuropathy [tingling sensations]

Managing side effects of chemotherapy

  • Avoid fast foods
  • Adequate rest and sleep
  • Keep your skin moisturised
  • Do a full blood count regularly or as recommended by your doctor
  • Stretch frequently to avoid stiff joints: a bit of non-rigorous exercise can be helpful
  • For dry mouth, take frequent sips of water or suck on ice cubes. Drinking water will help flush the medication out of your system
  • You might experience darkening of the skin including the tongue which will resolve overtime
  • Eat wholesome and nutritious foods in small amounts at a time, as much as you can tolerate
  • Eat fresh fruits and vegetables to replenish lost nutrients and regeneration of new healthy cells
  • Avoid use of hard toothbrush: local chewing stick can be helpful especially the hot type (peppery)
  • Try as much as possible to stay away from refined sugar. Honey is a healthier option and should be consumed in moderation
  • In extreme weather use sunscreen, hats, wear long sleeved cotton clothing or stay indoors
  • Your body may react to some clothing material. It is advisable to wear loose cotton clothes to let in air which will help healing take place gradually
  • Avoid sharp objects and cuts because it can delay the healing process and result in lymphedema
  • Always go with a friend or family member to your hospital appointment for support
  • Chemotherapy can cause phlebitis [inflammation of the walls of a vein] which your doctor can help you manage, or it may heal naturally
  • Lack of interest in intimacy is common. However, it is important to have an honest discussion with your partner
  • Always consult your doctor if you are feeling unwell. Avoid self-medication which can be harmful
  • It is advisable to you cut your hair short before initiating treatment because it can be traumatic when your hair starts to fall off in strands, eventually leaving bald patches. A useful solution is to purchase caps, turbans, or wigs


Radiation therapy is a treatment of cancer using a high dose of radiation on the affected site. It is targeted at destroying the DNA of cancer cells thereby preventing their growth and multiplication. Although treatment is targeted at the cancer cells, it may also destroy surrounding healthy tissues. But the good news is the normal tissues and cells regenerate overtime. With the rapid advancement in technology, radiation therapy has significantly improved to the point of leaving no permanent scars on the affected skin area.

Side effects

  • Tiredness
  • Headaches
  • Skin changes
  • Heart problems
  • Shortness of breath
  • Stiff joints and muscles
  • Dental problems such as tooth decay
  • Sore throat leading to problems with eating and drinking

Managing side effects of radiotherapy

  • Speak to your doctor as necessary
  • Wear loose clothing to aid air circulation
  • Maximum rest is crucial to quick recovery
  • Mild exercise of the joints to avoid stiffness
  • Do not apply any cream or ointment on the spot
  • Avoid using water on the radio spot and do not scrub or scratch
  • Take things easy and outsource house chores to loved ones or service providers
  • Seek the advice of a dermatologist for the right body cream but do not apply on the spot

For some cells to work in the body, they need certain hormones such as estrogen and progesterone. These hormones are made up of proteins that help control some cellular activities in the body. Several studies confirm that breast cancer is caused by the estrogen hormone which increases the growth and spread of cancerous cells. Other studies indicate that not all breast cancer incidences are caused by estrogen.

Hormone therapy is generally considered a synthetic treatment because it affects the natural hormones of the body. In most cases hormone therapy is taken orally in the form of a pill, capsule, or liquid. It can also be injected into the arm, leg, or hip. In addition, the removal of hormone producing organs through surgery can be an option for some women with breast cancer.

Hormone therapy can also be used as an adjuvant therapy to reduce the risk of recurrence. Depending on one’s choice of treatment, some doctors may initiate the therapy before surgery as a neoadjuvant therapy. The therapy may stop or slow the growth of hormone related breast cancer or reduce the symptoms related to breast cancer.

How hormone therapy works

  • Hormonal drugs alter the natural hormone preventing it from functioning the way it generally does
  • These drugs can hinder the body from producing the specific hormone causing the cancer
  • They also form a barrier between the cancer cells and normal body cells, preventing the natural hormone from attaching to the cancer cells.

Side effects of hormonal therapy
The side effects differ from person to person. However, some may experience some or all the following:

  • Nausea
  • Fatigue
  • Hot flashes
  • Decreased sexual desire
  • Painful joints and muscles
  • Vaginal dryness, discharge, or irritation

A diagnosis of breast cancer will understandably come as a shock to anyone. Therefore, it is important to take a supportive friend or loved one with you when going to see your doctor.

The person will be able to take down notes and remember what the doctor would have discussed and recommended during the session. It is vital to remember that cancer treatment is not a one size fits all. It is personalized.

At every point in time that you visit your doctor, you will most likely have a lot of questions. These questions may range from detecting a lump, diagnosis, treatment options to recovery process.

It is important to equip yourself with useful information, so you are battle ready. Below are some of the questions that many women ask their doctors at different stages of their breast cancer diagnosis and treatment.

What do I do when I find a lump in my breast?

  • Am I going to have a mammogram or an ultrasound scan, if so, what are the recommendations to get one?
  • Am I going to get a biopsy through fine needle aspiration or lumpectomy, if so, how is it done?
  • If the results confirm the presence of cancer, what do I need to do next?
  • Will I need further tests or referrals?

Mammogram

  • What will the mammogram detect?
  • Is the procedure painful?
  • Is there anything I should do to prepare prior to a mammogram appointment like wearing a two-piece outfit or using body spray?
  • How long does it take to get a mammogram result and is it covered by my medical insurance?

Breast Biopsy

  • Are you going to remove the whole lump or just a small part of it?
  • How reliable are the results of a needle biopsy?
  • How long does it take, and will I be awake during the procedure?
  • After the procedure should I expect any aftereffects such as pain, scarring or discoloration?

After Breast Cancer Diagnosis

  • Am I going to die?
  • What type of cancer is it?
  • What stage is the cancer?
  • How do I choose the treatment option?
  • Can I bring a friend or family member during my treatment?
  • What should I expect during and after my treatment?

Treatment choices

  • What type of treatment is best for me and why?
  • If I do not have any medical insurance to cover the treatment, what are my options?

Before Mastectomy

  • What will I do after cutting off my breast?
  • What will replace where my breast used to be?
  • How long do I need to be in hospital after the surgery?
  • What should I expect after the surgery? Any side effects? Any restrictions on my daily routine or diet?
  • Will I need any other treatment after the surgery?
  • When is my follow up appointment after being discharged?
  • Can I go for breast reconstruction soon after the surgery?

After Mastectomy

  • When will I be able to go back to work or resume my normal routine?
  • Which exercise should I start? Which should I avoid?
  • How often should I return for follow up tests?

Breast Cancer and Chemotherapy

  • Am I going to lose my hair?
  • Will the color of my skin change?
  • What type of drugs will I be taking for chemotherapy? Duration of treatment? Are there any side effects I need to be aware of?
  • What can I do to avoid throwing up?
  • Will my ovaries be extracted?
  • Will I be able to get pregnant and have a healthy baby?
  • Is it advisable to freeze my eggs?
  • Is it advisable to use a surrogate if I choose to have children?
  • Would you recommend I take time off work? Can I exercise during chemotherapy?

Radiation Therapy

  • Are there any risks to this type of treatment? Any side effects that I should expect?
  • After radiotherapy, will I need any other treatment? How long is the therapy?

Hormone Therapy

  • Do you administer the therapy together with other forms of treatment?
  • Will this therapy affect my sexual life?
  • What other signs or symptoms should I report to you?

Lymphedema

  • What should I do to reduce the chances of getting lymphedema?
  • What are the symptoms I should look out for? How is it treated?
  • Do I need to wear a compression sleeve daily including at night?

Genes and Breast cancer

  • If breast cancer is hereditary in my family, what are my chances of having breast cancer and surviving?
  • How often can or should I and other family members of my family go for testing to take  preventive measures?
  • Is prophylactic mastectomy advisable?

Breast Reconstruction

  • Where can I purchase breast prostheses?
  • You might have been using breast prosthesis for a while and want to consider having plastic surgery. What are the pros and cons of reconstruction?

Lagos University Teaching Hospital [LUTH]
Idi-Araba, Surulere, Lagos

Lagos State University Teaching Hospital (LASUTH)
Oba Akinjobi Street
Ikeja GRA, Lagos

Lagoon Hospitals
Ikeja, Apapa, Ikoyi and Victooria-Island.
Lagos University Teaching Hospital (LUTH)
Idi-Araba, Surulere-Lagos.

Crestview (Radiology)
302A, Jide Oki Street
Off Ligali Ayorinde
Victoria-Island, Lagos

Lakeshore Cancer Center
14, Amodu Tijani Close
Off Sanusi Fafunwa
Victoria-Island, Lagos

Counseling offers breast cancer patients, survivors, and caregivers the opportunity to have a one-on-one chat with a trained professional or counselor regarding any issue of concern in a private, supportive, and conducive atmosphere.

Counseling sessions empower breast cancer survivors with information on how to regain their confidence and live their new normal life. Because there is life after breast cancer, it is important for survivors to learn how to cope with the emotions from being diagnosed with breast cancer to living as a survivor. Counseling also helps caregivers, spouses and family members adjust to a new way of living−the new normal life−and supporting their loved ones who survived breast cancer.

Clients can call 07018000004 or 08137109164 to schedule an appointment for counseling, which takes place every Friday from 9:00am to 4:00pm.

A support group is the meeting of people in a similar life situation on a regular basis to share information, exchange ideas, and receive emotional support. Group members can meet in person at a chosen place, by telephone or online via a chat group or platform.

The purpose of a support group is to provide members with psychological support, tools and information necessary to thrive and be empowered.

Breast cancer support groups include survivors and patients − some may have just completed their treatment while others might still be receiving treatment – as well as family members, spouses, or caregivers.

You can sponsor a breast cancer survivor with N10,000 or more monthly

A healthy lifestyle is important to improving your wellbeing, health, and mental strength. A daily diet inclusive of vegetables, fruits and water helps improve your physical health, especially during and after breast cancer treatment. Incorporating regular exercise programs and healthy sleeping habits will help make you feel relaxed and better able to cope with life’s issues. In addition, physical activity helps keeps your body strong and healthy. Please note that it is important to consult your physician or doctor before commencing any exercise program.

It is expected that you will experience physical changes before, during and after treatment. As a result, the changes may affect the way you may feel about your body. These changes can appear in various forms such as:

  • Low libido
  • Depression
  • Lymphedema
  • Loss of self confidence
  • Losing a breast or both
  • ‘Pale’ look due to chemotherapy treatment
  • Scar formation after a lumpectomy or mastectomy
  • Hair loss on the head, eyebrows, eyelids, or even pubic hair
  • Changes in the skin such as dryness, scaling, and redness due to radiotherapy

Do note that some of these changes are temporary while others last longer.

Tips for getting used to changes in your body

  • Be mindful and stay positive
  • Acceptance: accept the new you
  • Use prosthetic bras and breast forms
  • Exercise, eat healthy, and laugh often
  • Use makeup and artificial hair if it helps boost your confidence
  • Reorganize your lifestyle to adjust to your “new normal”
  • Stand in front of a mirror and identify the things you love about your body. Note it down if you can

Prosthetic Items
Prosthetic items can help enhance your confidence and quality of life. This is inclusive of the following:

Prosthetic bras
These include non-wired customized bras with special features like a pouch for the breast form. The bras come in different sizes, colors, and designs.

Breast prosthesis
These are breast forms made with soft silicon that have a natural feel. They also come in different sizes, colors and designs.

Getting your prostheses
Breast prosthesis and bras are now available for purchase at C.O.P.E. The breast care team will inform you on availabilities and assist you with scheduling a fitting appointment. Please contact us at +2347018000004.

Looking after your prosthetic items

  • Wash your bra often
  • Avoid the use of sharp objects on or around your breast forms
  • Keep the breast form clean by washing with cool soapy water
  • Blot the breast form dry without rubbing it
  • Store the breast form in its original box or in a cool dry place away from flames or fires

Breast cancer diagnosis and treatment will affect intimacy and sex between you and your partner. It is important to know that each experience is unique. This is also a sensitive and delicate period for a lot of people who report feeling uncomfortable and become afraid of being rejected. There is no prescription on how to approach this matter, but it is important to communicate or seek counselling together with your partner.

Your sexual life may also not return to normal immediately as vaginal dryness, loss of self-confidence, pain, and discomfort can become a concern. The use of vaginal lubricants and pain medication can provide relief and comfort. Be patient and remain hopeful that sexual intimacy can be restored with time and communication. Having a clear sense of the level of intimacy that you are most comfortable with can help make you and your partner feel closer and stronger.

  • CANCER IN GENERAL
  • TREATMENT OPTIONS
  • COPING WITH CANCER

As humans, we have genes embedded in our DNA [deoxyribonucleic acid]. These genes play an important role in the development and growth of new cells. Cancer occurs due to an uncontrolled growth of abnormal cells in any part of the body. These abnormal cells mutate and invade the normal cells leading to the development and spread of cancer. Cancer can develop anywhere in or outside the body except the hair, nails, and teeth, which is why most cancers are generally named after the organ of origin.

The uncontrolled reproduction and mutation of cells in our body can lead to the development of a tumor or lump. Tumors can be classified into two types - benign and malignant. Benign tumors are not harmful but can become cancerous overtime, if left unattended. On the other hand, malignant tumors are harmful and cancerous.

In women, normal breast cells can become cancerous due to the changes that occur in the DNA, making a woman more susceptible to the development of breast cancer. Women are also more prone to breast cancer than men, across all races. This occurs because the hormones−estrogen and progesterone−both have growth promoting effects on breast cells.

Breast cancer is also one of the most common forms of cancer that affects women in Nigeria. It is also the cancer with the highest mortality rate among women. However, the good news is that early detection of breast cancer provides more treatment options and increases a person’s chance of survival. Thus, early detection is key!

Anything that increases the risk of getting a disease is called a risk factor. Having one or more of the following risk factors below does NOT guarantee that you will have breast cancer. Many people who have these risk factors never have breast cancer. Conversely, some people with no known risk factors develop breast cancer.

Gender
Being a woman puts one at risk for developing breast cancer.

Hereditary
Family history of any type of cancer, especially breast cancer, places a person at a higher risk of developing the disease.

Age
As we get older, the chance of developing breast cancer increases.

Obesity
Being overweight often places a person at risk for various diseases including breast cancer.

Lifestyle
Alcohol, cigarette smoking, unhealthy diet, sedentary lifestyle, and stress increases the chance of having breast cancer.

Obstetric factors
Women who have never had a child, early menarche before the age 12, late menopause [55+] and women who do not breastfeed for at least 6 months are at a higher risk of having breast cancer.

Environmental/Occupational Hazards
Exposure to radiation and carcinogenic substances are additional risk factors not to be ignored.

The most common types of breast cancer in women are Ductal Carcinoma and Lobular Carcinoma. Other types include Triple Negative and Inflammatory Breast Cancer.

Ductal Carcinoma: This type of cancer can be invasive or non-invasive. It can either spread into the surrounding breast tissue or remain localized within the breast ducts.

Lobular Carcinoma: The cancer cells are detected in the lobes of the breast. If the cancer has not spread to other areas of the breast, it is referred to as Lobular cancer in situ. However, the cancer cells might spread into normal breast tissues leading to Invasive Lobular breast cancer.

Triple Negative: This is one of the most aggressive forms of cancer because the three receptors [estrogen, progesterone, and Her-2/neu gene] increase the growth of cancer cells growth and are not detected in the cancer tumor during testing.

Inflammatory Breast Cancer: This is another aggressive type of cancer that requires urgent attention and treatment. Here, the skin and lymph vessels around the breast tissue are affected, despite no evidence of a lump or tumor inside the breast.

Please consult your doctor if you notice any of these symptoms:

  • An inverted nipple
  • Dimpling of the breast
  • Presence of a lump [not all lumps are cancerous]
  • Thickening of the skin around the breast or armpit
  • Tenderness, swelling or pain in any part of the breast
  • A change in the size, colour, shape, or texture of the breast
  • Abnormal discharge from the nipple [bloody or coloured]
  • The skin of the breast looks scaly or like an orange skin peel [peau d’orange]

The aim of Breast Self-Examination [BSE] is to detect any lumps or changes in the breast and act promptly. Note that lumps can also be detected during BSE. Know your breasts, how they generally look and feel!

Timing

The best time to perform your BSE is a week after your regular menstrual period because the shape, texture and size of both breasts would have returned to normal. For menopausal women, pick a particular date every month to perform the exam. You may pick a date like your birthday or a memorable occasion to help you remember.

Steps

BSE can be performed standing in front of a mirror, standing under a warm shower or lying down on a comfortable bed/flat surface. When you detect anything unusual during the BSE, write it down and consult a physician as soon as possible. Many women have detected breast cancer during BSE. Therefore, it is necessary to make it a part of your monthly routine.

For pre-menopausal women: Every month, examine your breasts a week after your menstrual flow. During this time, your hormonal level is more likely to be stable and breasts are less tender.

For women already in menopause i.e., women who have not had a period for a year or more, mark a particular date on your calendar every month to examine your breasts.

Clinical Breast Examination (CBE)

This is an examination performed by medically qualified professionals at healthcare facilities.

Breast Ultrasound Scan (BUSS)

This is a scan of both breasts and is recommended for women of all ages. It is safe, involves no exposure to radiation, and can be done 2 to 3 times in a year.

Mammogram

This is an x-ray of the breast recommended for women at the age of 40 and above within a 3-year interval or as directed by a physician. The exam can be performed before the age of 40 if there is a family history of breast cancer or on doctor’s orders. Mammogram tests can also detect if there is a lump in the breast, particularly when it is still small, and the cancer is easily treatable.

Magnetic Resonance Imaging (MRI)

This is a supplementary test using magnets and radio waves to determine the extent/scope of the breast cancer stage.

Lumpectomy

This is a surgical operation to extract a lump from the breast. The extracted lump is then sent for biopsy [examination] to determine if the lump is benign or malignant.

Fine Needle Aspiration (FNA)

A thin needle is inserted into the affected area in the breast [where the lump is located] and samples are drawn for examination.

Biopsy

This involves an examination of the extracted lump to determine the type [benign or malignant] and cancer stage.

Histology

Histopathology is done to analyze or diagnose under the microscope the nature or history of the disease.

STAGE 0
At this stage, the cancer cells are non-invasive. They are found within a duct but have not spread to the lobular area.
STAGE I
The tumor is about 2 centimeters in diameter, and it has not spread beyond the breast.
STAGE II
The tumor is larger than 2 centimeters in diameter and might have spread to the lymph nodes under the arm.
STAGE III
Cancer cells are larger than 5 centimeters (over 2 inches) in diameter and have spread to the lymph nodes. Occasionally, it might have spread to the chest wall, inside the chest and the skin.
STAGE IV
Cancer cells have spread to other organs of the body (metastasis).

Although there is no foolproof way to prevent breast cancer, there are certain measures that you can employ to lower the risk of developing the disease. Women should cultivate the habit of taking care of themselves by going for regular medical checkup.

Additional ways to lower your risk include:

Lifestyle modifications
Quit smoking and reduce your alcohol intake. Stay physically active to maintain a healthy BMI [Body Mass Index]. Engage in moderate to vigorous physical exercise, at least 20 – 30 minutes daily.

Diet
Eat wholesome healthy meals. Drink at least 2 liters of water daily. Eat different types of fruits, vegetables, and legumes daily. Avoid fatty foods, reduce the consumption of red meat, and opt for white meats such as poultry and fish.

Age
It is important to begin breast self-care once a girl starts menstruating. If a woman is age 40 and above, a mammogram is recommended at a 3-year interval or on doctor’s advice. BSE should be done monthly.

Hereditary
Breast-self-examination is vital and should be done every month. A person with a history of breast cancer must go for regular breast cancer screenings. Breast ultrasound scan can be performed at least bi-annually. Mammogram can start before age 40. It is important to incorporate certain lifestyle changes to lower the risk of having breast cancer. If need be, a Magnetic Resonance Imaging [MRI] can be recommended by your personal physician when necessary.

Pregnancy and Breastfeeding
Breastfeeding for at least six months and pregnancy before age 30 can lower the risk of developing breast cancer.

Environmental
Avoid using cancer causing chemicals, reduce exposure to ultraviolet rays, and use sunscreen.

Although breast cancer occurs mostly in women, men can and do have breast cancer, albeit in rare instances. This happens because men have breast tissues, ducts, and glands even though they are not as functional as those of women. These breast tissues or ducts can develop into breast cancer due to the development of abnormal cells.

Types of breast cancer in men
The most common types of breast cancer in men include ductal carcinoma in situ, invasive ductal carcinoma, and invasive lobular carcinoma.

  • Ductal carcinoma in situ: the cancer has not yet spread to other parts of the body
  • Invasive ductal carcinoma: the cancer has spread to surrounding breast tissues from the ducts
  • Invasive lobular carcinoma: the cancer has spread to surrounding breast tissues and other parts of the body from the lobe
  • Paget disease of the nipple: the cancer begins in the ducts, spreads to the nipple and sometimes the areola of the breast

Symptoms of breast cancer in men
Symptoms of breast cancer in men include:

  • Inverted nipple
  • Nipple discharge
  • Swollen glands in the armpit
  • A sore or rash that does not resolve
  • Tenderness of surrounding breast skin
  • A lump that can be painless, hard, and immobile

Risk factors

  • Obesity
  • Getting older
  • Inherited genes
  • Exposure to radiation
  • Family history of any type of cancer (in a male or female family member)

Diagnosis
Tests such as ultrasound scan, mammogram or biopsy are used to diagnose breast cancer in men.

Treatment
Treatment depends on the staging of the cancer by the doctor or physician. Possible treatments include surgery, radiotherapy, hormone therapy and chemotherapy.

Preventive measures

  • Adequate sleep
  • Avoid or limit alcohol
  • Avoid cigarette smoking
  • Being physically active at least 30 minutes daily
  • Healthy lifestyle including maintaining a healthy body weight and diet
  • Eating a wholesome nutritious diet including fresh fruits and vegetables

Various treatment options are generally available to breast cancer patients if the cancer is detected early. If the cancer is detected late, there is very little that can be done except to administer palliative care to improve the patient’s quality of life. Treatment also depends on the stage and how far the cancer cells have spread. Treatments may also be used alone or combined.

This involves the removal of the whole breast including the nipple through surgery. This surgery is most likely to be recommended if you have:

  • A tumor in the middle of your breast
  • A large lump [tumor] particularly in a breast
  • More than one area of cancer in your breast [metastasis]
  • Previously had radiotherapy applied as a form of treatment to the breast

Types of Mastectomies
There are different types of mastectomies. These include simple [or total], double, skin-sparing, nipple-sparing, or modified radical.

Simple or Total Mastectomy
This is the most common type of breast surgery involving the removal of the whole breast, chest lining and nipples, excluding the lymph nodes.

Double mastectomy
This is the surgical removal of both breasts in women who are at a higher risk for developing breast cancer in either breast.

Skin-sparing mastectomy
This type of surgery involves the removal of the breast leaving the skin for breast reconstruction purposes.

Nipple-sparing mastectomy
This involves removing the entire breast except the areola and nipple as long as they are cancer free. It is optional for women who are in the early stages of breast cancer and choose reconstruction.

Modified radical mastectomy
For this type of surgery, the entire breast tissue is removed along with some or all the lymph nodes.

Which surgery option is best for you?
The decision will be largely influenced by your surgeon’s recommendation along with the presentation of the cancer, after careful consideration of the risks involved. It is important to note that treatment of cancer is not one size fits all. Some factors include:

  • Cancer stage
  • Breast size
  • Size of the tumor
  • Your general health
  • Location of the cancer cells
  • If lymph nodes are involved

What to expect after surgery?

  • Scarring
  • Lymphedema
  • Fatigue and weakness of arm
  • Post-mastectomy neuropathy
  • Limited arm and shoulder movement
  • Pain and discomfort on the surgical site
  • Change in breast contour and appearance


Chemotherapy is one of the treatments used to destroy or reduce the rate of multiplication of cancer cells. The goal of the treatment is to keep the cancer cells from growing and dividing and ultimately stopping the spread of the disease.

Chemotherapy might include a combination of different types of cytotoxic drugs. Furthermore, chemotherapy can be used as a stand-alone treatment − as in the case of leukemia − or as a combination before or after surgery.

In most cases chemotherapy is administered intravenously: although some can be taken orally, topically or through injections. The choice of the type of chemotherapy is dependent on the doctor’s prescription, type, and stage of cancer.

Types of Chemotherapy
Neo-adjuvant: This type of chemotherapy is used to shrink tumors before surgery or radiation therapy.
Adjuvant: This may be used as a complimentary treatment after surgery or radiation therapy to destroy hidden cancer cells in any part of the body.

Side effects of Chemotherapy

  • Nausea
  • Fatigue
  • Phlebitis
  • Vomiting
  • Dry mouth
  • Sore throat
  • Lymphedema
  • Easy bruising
  • Skin darkening
  • Loss of appetite
  • Loss of hair [Alopecia]
  • Scaly skin and dryness
  • Anaemia [Shortage of blood]
  • Compromised immune system
  • Peripheral neuropathy [tingling sensations]

Managing side effects of chemotherapy

  • Avoid fast foods
  • Adequate rest and sleep
  • Keep your skin moisturised
  • Do a full blood count regularly or as recommended by your doctor
  • Stretch frequently to avoid stiff joints: a bit of non-rigorous exercise can be helpful
  • For dry mouth, take frequent sips of water or suck on ice cubes. Drinking water will help flush the medication out of your system
  • You might experience darkening of the skin including the tongue which will resolve overtime
  • Eat wholesome and nutritious foods in small amounts at a time, as much as you can tolerate
  • Eat fresh fruits and vegetables to replenish lost nutrients and regeneration of new healthy cells
  • Avoid use of hard toothbrush: local chewing stick can be helpful especially the hot type (peppery)
  • Try as much as possible to stay away from refined sugar. Honey is a healthier option and should be consumed in moderation
  • In extreme weather use sunscreen, hats, wear long sleeved cotton clothing or stay indoors
  • Your body may react to some clothing material. It is advisable to wear loose cotton clothes to let in air which will help healing take place gradually
  • Avoid sharp objects and cuts because it can delay the healing process and result in lymphedema
  • Always go with a friend or family member to your hospital appointment for support
  • Chemotherapy can cause phlebitis [inflammation of the walls of a vein] which your doctor can help you manage, or it may heal naturally
  • Lack of interest in intimacy is common. However, it is important to have an honest discussion with your partner
  • Always consult your doctor if you are feeling unwell. Avoid self-medication which can be harmful
  • It is advisable to you cut your hair short before initiating treatment because it can be traumatic when your hair starts to fall off in strands, eventually leaving bald patches. A useful solution is to purchase caps, turbans, or wigs


Radiation therapy is a treatment of cancer using a high dose of radiation on the affected site. It is targeted at destroying the DNA of cancer cells thereby preventing their growth and multiplication. Although treatment is targeted at the cancer cells, it may also destroy surrounding healthy tissues. But the good news is the normal tissues and cells regenerate overtime. With the rapid advancement in technology, radiation therapy has significantly improved to the point of leaving no permanent scars on the affected skin area.

Side effects

  • Tiredness
  • Headaches
  • Skin changes
  • Heart problems
  • Shortness of breath
  • Stiff joints and muscles
  • Dental problems such as tooth decay
  • Sore throat leading to problems with eating and drinking

Managing side effects of radiotherapy

  • Speak to your doctor as necessary
  • Wear loose clothing to aid air circulation
  • Maximum rest is crucial to quick recovery
  • Mild exercise of the joints to avoid stiffness
  • Do not apply any cream or ointment on the spot
  • Avoid using water on the radio spot and do not scrub or scratch
  • Take things easy and outsource house chores to loved ones or service providers
  • Seek the advice of a dermatologist for the right body cream but do not apply on the spot

For some cells to work in the body, they need certain hormones such as estrogen and progesterone. These hormones are made up of proteins that help control some cellular activities in the body. Several studies confirm that breast cancer is caused by the estrogen hormone which increases the growth and spread of cancerous cells. Other studies indicate that not all breast cancer incidences are caused by estrogen.

Hormone therapy is generally considered a synthetic treatment because it affects the natural hormones of the body. In most cases hormone therapy is taken orally in the form of a pill, capsule, or liquid. It can also be injected into the arm, leg, or hip. In addition, the removal of hormone producing organs through surgery can be an option for some women with breast cancer.

Hormone therapy can also be used as an adjuvant therapy to reduce the risk of recurrence. Depending on one’s choice of treatment, some doctors may initiate the therapy before surgery as a neoadjuvant therapy. The therapy may stop or slow the growth of hormone related breast cancer or reduce the symptoms related to breast cancer.

How hormone therapy works

  • Hormonal drugs alter the natural hormone preventing it from functioning the way it generally does
  • These drugs can hinder the body from producing the specific hormone causing the cancer
  • They also form a barrier between the cancer cells and normal body cells, preventing the natural hormone from attaching to the cancer cells.

Side effects of hormonal therapy
The side effects differ from person to person. However, some may experience some or all the following:

  • Nausea
  • Fatigue
  • Hot flashes
  • Decreased sexual desire
  • Painful joints and muscles
  • Vaginal dryness, discharge, or irritation

A diagnosis of breast cancer will understandably come as a shock to anyone. Therefore, it is important to take a supportive friend or loved one with you when going to see your doctor.

The person will be able to take down notes and remember what the doctor would have discussed and recommended during the session. It is vital to remember that cancer treatment is not a one size fits all. It is personalized.

At every point in time that you visit your doctor, you will most likely have a lot of questions. These questions may range from detecting a lump, diagnosis, treatment options to recovery process.

It is important to equip yourself with useful information, so you are battle ready. Below are some of the questions that many women ask their doctors at different stages of their breast cancer diagnosis and treatment.

What do I do when I find a lump in my breast?

  • Am I going to have a mammogram or an ultrasound scan, if so, what are the recommendations to get one?
  • Am I going to get a biopsy through fine needle aspiration or lumpectomy, if so, how is it done?
  • If the results confirm the presence of cancer, what do I need to do next?
  • Will I need further tests or referrals?

Mammogram

  • What will the mammogram detect?
  • Is the procedure painful?
  • Is there anything I should do to prepare prior to a mammogram appointment like wearing a two-piece outfit or using body spray?
  • How long does it take to get a mammogram result and is it covered by my medical insurance?

Breast Biopsy

  • Are you going to remove the whole lump or just a small part of it?
  • How reliable are the results of a needle biopsy?
  • How long does it take, and will I be awake during the procedure?
  • After the procedure should I expect any aftereffects such as pain, scarring or discoloration?

After Breast Cancer Diagnosis

  • Am I going to die?
  • What type of cancer is it?
  • What stage is the cancer?
  • How do I choose the treatment option?
  • Can I bring a friend or family member during my treatment?
  • What should I expect during and after my treatment?

Treatment choices

  • What type of treatment is best for me and why?
  • If I do not have any medical insurance to cover the treatment, what are my options?

Before Mastectomy

  • What will I do after cutting off my breast?
  • What will replace where my breast used to be?
  • How long do I need to be in hospital after the surgery?
  • What should I expect after the surgery? Any side effects? Any restrictions on my daily routine or diet?
  • Will I need any other treatment after the surgery?
  • When is my follow up appointment after being discharged?
  • Can I go for breast reconstruction soon after the surgery?

After Mastectomy

  • When will I be able to go back to work or resume my normal routine?
  • Which exercise should I start? Which should I avoid?
  • How often should I return for follow up tests?

Breast Cancer and Chemotherapy

  • Am I going to lose my hair?
  • Will the color of my skin change?
  • What type of drugs will I be taking for chemotherapy? Duration of treatment? Are there any side effects I need to be aware of?
  • What can I do to avoid throwing up?
  • Will my ovaries be extracted?
  • Will I be able to get pregnant and have a healthy baby?
  • Is it advisable to freeze my eggs?
  • Is it advisable to use a surrogate if I choose to have children?
  • Would you recommend I take time off work? Can I exercise during chemotherapy?

Radiation Therapy

  • Are there any risks to this type of treatment? Any side effects that I should expect?
  • After radiotherapy, will I need any other treatment? How long is the therapy?

Hormone Therapy

  • Do you administer the therapy together with other forms of treatment?
  • Will this therapy affect my sexual life?
  • What other signs or symptoms should I report to you?

Lymphedema

  • What should I do to reduce the chances of getting lymphedema?
  • What are the symptoms I should look out for? How is it treated?
  • Do I need to wear a compression sleeve daily including at night?

Genes and Breast cancer

  • If breast cancer is hereditary in my family, what are my chances of having breast cancer and surviving?
  • How often can or should I and other family members of my family go for testing to take  preventive measures?
  • Is prophylactic mastectomy advisable?

Breast Reconstruction

  • Where can I purchase breast prostheses?
  • You might have been using breast prosthesis for a while and want to consider having plastic surgery. What are the pros and cons of reconstruction?

Lagos University Teaching Hospital [LUTH]
Idi-Araba, Surulere, Lagos

Lagos State University Teaching Hospital (LASUTH)
Oba Akinjobi Street
Ikeja GRA, Lagos

Lagoon Hospitals
Ikeja, Apapa, Ikoyi and Victooria-Island.
Lagos University Teaching Hospital (LUTH)
Idi-Araba, Surulere-Lagos.

Crestview (Radiology)
302A, Jide Oki Street
Off Ligali Ayorinde
Victoria-Island, Lagos

Lakeshore Cancer Center
14, Amodu Tijani Close
Off Sanusi Fafunwa
Victoria-Island, Lagos

Counseling offers breast cancer patients, survivors, and caregivers the opportunity to have a one-on-one chat with a trained professional or counselor regarding any issue of concern in a private, supportive, and conducive atmosphere.

Counseling sessions empower breast cancer survivors with information on how to regain their confidence and live their new normal life. Because there is life after breast cancer, it is important for survivors to learn how to cope with the emotions from being diagnosed with breast cancer to living as a survivor. Counseling also helps caregivers, spouses and family members adjust to a new way of living−the new normal life−and supporting their loved ones who survived breast cancer.

Clients can call 07018000004 or 08137109164 to schedule an appointment for counseling, which takes place every Friday from 9:00am to 4:00pm.

A support group is the meeting of people in a similar life situation on a regular basis to share information, exchange ideas, and receive emotional support. Group members can meet in person at a chosen place, by telephone or online via a chat group or platform.

The purpose of a support group is to provide members with psychological support, tools and information necessary to thrive and be empowered.

Breast cancer support groups include survivors and patients − some may have just completed their treatment while others might still be receiving treatment – as well as family members, spouses, or caregivers.

You can sponsor a breast cancer survivor with N10,000 or more monthly

A healthy lifestyle is important to improving your wellbeing, health, and mental strength. A daily diet inclusive of vegetables, fruits and water helps improve your physical health, especially during and after breast cancer treatment. Incorporating regular exercise programs and healthy sleeping habits will help make you feel relaxed and better able to cope with life’s issues. In addition, physical activity helps keeps your body strong and healthy. Please note that it is important to consult your physician or doctor before commencing any exercise program.

It is expected that you will experience physical changes before, during and after treatment. As a result, the changes may affect the way you may feel about your body. These changes can appear in various forms such as:

  • Low libido
  • Depression
  • Lymphedema
  • Loss of self confidence
  • Losing a breast or both
  • ‘Pale’ look due to chemotherapy treatment
  • Scar formation after a lumpectomy or mastectomy
  • Hair loss on the head, eyebrows, eyelids, or even pubic hair
  • Changes in the skin such as dryness, scaling, and redness due to radiotherapy

Do note that some of these changes are temporary while others last longer.

Tips for getting used to changes in your body

  • Be mindful and stay positive
  • Acceptance: accept the new you
  • Use prosthetic bras and breast forms
  • Exercise, eat healthy, and laugh often
  • Use makeup and artificial hair if it helps boost your confidence
  • Reorganize your lifestyle to adjust to your “new normal”
  • Stand in front of a mirror and identify the things you love about your body. Note it down if you can

Prosthetic Items
Prosthetic items can help enhance your confidence and quality of life. This is inclusive of the following:

Prosthetic bras
These include non-wired customized bras with special features like a pouch for the breast form. The bras come in different sizes, colors, and designs.

Breast prosthesis
These are breast forms made with soft silicon that have a natural feel. They also come in different sizes, colors and designs.

Getting your prostheses
Breast prosthesis and bras are now available for purchase at C.O.P.E. The breast care team will inform you on availabilities and assist you with scheduling a fitting appointment. Please contact us at +2347018000004.

Looking after your prosthetic items

  • Wash your bra often
  • Avoid the use of sharp objects on or around your breast forms
  • Keep the breast form clean by washing with cool soapy water
  • Blot the breast form dry without rubbing it
  • Store the breast form in its original box or in a cool dry place away from flames or fires

Breast cancer diagnosis and treatment will affect intimacy and sex between you and your partner. It is important to know that each experience is unique. This is also a sensitive and delicate period for a lot of people who report feeling uncomfortable and become afraid of being rejected. There is no prescription on how to approach this matter, but it is important to communicate or seek counselling together with your partner.

Your sexual life may also not return to normal immediately as vaginal dryness, loss of self-confidence, pain, and discomfort can become a concern. The use of vaginal lubricants and pain medication can provide relief and comfort. Be patient and remain hopeful that sexual intimacy can be restored with time and communication. Having a clear sense of the level of intimacy that you are most comfortable with can help make you and your partner feel closer and stronger.