2. NATIONAL ANTHEM

3. “UNIBEN ANTHEM” “ARISE MIGHTY UNIBEN”

5. Preamble
Mr. Vice-Chancellor Sir, I thank you most sincerely for the approval for me to deliver this lecture today, this 28th day of July I thank you and your Management team for the support you have given us at the School of Medicine where I am the current Dean
I am obviously very delighted to be at this epoch making event of my academic career, but wish that my parents are physically present.
Assured by the faith into which my siblings and I were born that my parents, are watching this from above. Also comforted by the substantial presence of my siblings and my clan here
As it is said, to live in the hearts of those you love is not to die. Our parents loved us dearly and gave their best and all for our education and training. This event is of one of the results of their devotion and dedication to our sound education and training.
To the glory of God they both lived long enough to be present at my Inaugural lecture, my father passing on to eternal glory eleven years ago at 85 years and my mother eleven months ago aged 80 years. It is I who did not attain the rank of Professor on time as I am not able to extricate myself from natural and spontaneous tendencies which are obviously familial.

6. Dedication
I dedicate this lecture to my creator the almighty God, my Lord and Saviour Jesus Christ and my parents Chief Christopher Kekenomonobenosude Momoh the Egboise of Ivhiukasa and the Okhunape of Avianwu and Chief Mrs. Grace Agnes Naluba Momoh (nee Egabor) the Aimienakhue of Avianwu and the Iyonosomhi of Weppa-Wanno
Each parent guided me at the two stages of choice of career and specialty
In the late 60s and early 70s there was a clarion call that the future greatness of Nigeria was tied to science and technology. Being in the Science class was therefore a patriotic response to a national call

7. At the famous St. John's College Fugar run by American Catholic Marianists Missionaries we had excellent laboratories and I would come home on holidays to dazzle my siblings and parents with some of the experiments we had performed in school
My mother then naturally asked me where all these science was leading to and I said to physics and space technology, obviously fascinated by Neil Armstrong landing on the moon in 1968
She queried why not Medicine and being a Doctor and I responded that the seven years it took to study Medicine was too long. "Seven years" my mother responded was a twinkle of an eye compared to the tales of 15 to 20 years voyages abroad that studying Medicine was associated with when she was growing up. Studying Medicine was thus the choice.

8. On return from national service in 1981, I worked in the Emergency unit till 1983 when my father requested his political associate, foremost educationist and politician and the then Chairman of the UBTH Board, Chief Hon. M. C. K. Orbih to advice me on the choice of specialty, In his words “ I appreciate more the specialist who can treat ailments with prescriptions and can in addition do operations”. The rest is history
I am a consultant surgeon and Professor of Surgery and I am all thankful to my parents and Almighty God
My father had also always enjoined his large nuclear and extended family that this his first son Moses, by the nature of his profession may not bring funds to distribute but will surely bring respectability, honour and fame to the family. I am yet to deliver on the last. My father also pointed out those of his children who would bring wealth and they too have delivered. To God be all the glory.

9. As a General surgeon I have been very gratified with my teaching and practice of surgery. My stress and headaches are instantly relieved when I teach or do surgery with my medical students and Resident doctors
For area of focus and research, half way through my academic career, I chose Breast and Endocrine Surgery, that is, surgical diseases of the breast, goitre, pancrease and adrenals and glands outside the brain
My clinical, teaching and research work with Breast cancer patients have exposed me to the enormity of the huge of breast cancer scourge, hence it's the subject of my Inaugural lecture today.

10. Introduction- Cancer
Cancer in simple or general terms, is body tissue growth that is
EXCESSIVE, UNCONTROLLED, UNCOORDINATED,UNREGULATED, SERVES NO USEFUL FUNCTION, CAN SPREAD THROUGH BLOOD AND LYMPH TO DISTANT SITES IN THE BODY AND IS EXTREMELY DANGEROUS TO THE BODY BY CAUSING DEATH
Cancer tissues live for eternity until they kill their host and then they too die
To illustrate by contrast this abnormal growth, recall what happens with an abscess commonly called a boil

11. The breast, the subject of this inaugural lecture, enlarges in size during pregnancy and breast feeding but returns to its normal size after the lactation. The linings of our mouths, gullet and intestines are shed everyday and replaced by new lining mucosa
These are orderly, controlled, coordinated, regulated body tissue growths that serve useful functions

12. GLOBAL CANCER BURDEN
Worldwide one in seven deaths is due to cancer. Globally cancers kill more people than Malaria, HIV/AIDS and Tuberculosis put together. [International Agency for Research on Cancer (IARC)]
Cancers constitute a heavy burden on our health systems
In developed countries cancer is the second most common cause of death after cardiovascular diseases, while in developing countries cancer is the third most common cause of death after cardiovascular disease and infections.

13. In 2012 there were 14. 1 million new cases of cancer and 8
In 2012 there were 14.1 million new cases of cancer and 8.2 million deaths from cancer. This gives 22,000 deaths per day
In the developing countries there were 5.3 million (64.6 % ) deaths and 2.9 million (35.4 % ) deaths from cancer
It is projected that by 2030 there will be 21.7 million new cancer cases per year and cancer will cause 13 million deaths that year, again majority of which deaths will be in sub-Saharan Africa and the developing world. (Global Cancer Facts & Figures 3rd Edition. 2012)

14. In economically developed countries the three most commonly diagnosed cancers in females are breast, colorectal and lung cancer while in developing countries the three most commonly diagnosed cancers in females are breast, uterine cervix and lungs
Thus in women, both in developed and developing countries, breast cancer is the most frequently diagnosed cancer

15. BREAST CANCER Statistics
Breast cancer is the most commonly diagnosed cancer in women globally including Nigeria (Ferlay J. Soerjomattaram I. et al. GLOBOCAN 2012 v 1.0. Cancer Incidence and Mortality Worldwide: IARC CancerBase N )
In 2012, 1.7 million new cases of breast Ca. were diagnosed worldwide
Slightly over half (53%) of these new cases of breast cancer occurred in developing countries
In the same 2012 there were an estimated 521,900 deaths caused by breast cancer and in developing countries breast cancer is the leading cause of cancer death among women 

16. BREAST CANCER Statistics
There is now no part of the world where breast cancer is said to be a rare form of cancer. There is also no population around the world with truly low incidence of breast cancer and so every woman in the world is at risk of developing breast cancer in her life time
The global burden of breast cancer is so huge and attaining epidemic proportions that the highly influential and most subscribed TIME magazine dedicated an entire edition to " Why Breast Cancer is Spreading Around the World". This subject adorned the cover of the October 15, 2007 edition of the Magazine
In 2015 TIME magazine again devoted yet another entire edition to breast cancer. This clearly shows the enormity of the scourge and how seriously the developed world takes it

17. Another Edition devoted to Breast Cancer in 2015
2007 Edition of Times

18. Regional Statistics on Breast Cancer
At national and regional levels, data show that 1 in every 8 Caucasian American women will develop breast cancer in their life time, 1 in every 11 British women and 1 in 12 African American women will develop breast cancer in their life time. (Badoe EA, Baako BN. The Breast. In: Badoe EA, Achampong EQ, da Rocha-Afodu JT eds.)
Accurate population figures, population based Cancer Registers and even ordinary hospital attendance registers are lacking in Nigeria
We however, have no reason to believe that the data will be radically different from the prevalence in African-American women

19. Statistics in Africa/Nigeria
In Uganda the probability that a woman who lives to be 65 years will develop breast cancer in her life time is only 20% less than that of her European and American counterpart. (Sally N. Akaralo Anthony, Temidayo O. Ogundiran, Clement A. Adebamowo. Emerging breast cancer epidemic: evidence from Africa. Breast Cancer Res. 2010; 12(suppl 4) S8)
Here in UBTH, hospital based cancer registration is nascent . We are looking forward to stronger and more robust data from there very soon.
Data from our female surgical ward indicate that 6 of its 30 beds are almost always occupied by breast cancer patients, thus making it the most common cause for admission for major surgery into that Ward

20. Peak Age incidence
Breast cancer is rare before the age of 25 and uncommon before the age of 30 and starting to be seen from the age of 35 years with peak incidence from 45 to 55 years in Nigeria and 55 to 65 years in developed countries
Momoh MI and Ohanaka EC in their mega study Factors Associated with delay in Presentation of Breast Cancer in Benin City found the peak incidence to be 45 to 55 years. This we attributed partially to low life expectancy of 48 years as at 2008 of our women
Breast cancer is very rare below the age of 20 years, however N. J. Nwashilli, D. Obaseki and M. I. Momoh have reported a case in a 13 year old girl in Benin City and again Ohanaka EC and Momoh MI managed another case in an 18 year old girl

21. Pathology
Deriving from our opening description of cancer, breast cancer is uncontrolled disordered breast tissue growth with propensity to spread through blood and other body fluids to distant sites and organs of the body
These sites include the lungs, liver, peritoneum, the spine and the brain and breast cancer tissues will be growing disorderly in these organs
Apart from destroying the breast, the cancer cells destroy these vital organs thus leading to death

22. Stages of Breast Ca.
ILLUSTRATIONS.

23. SYMPTOMS and SIGNS of BREAST CANCER
Breast cancer usually presents with the following features
Initially painless lump in the breast
Lump in the breast is hard like a piece of granite
Enlarged size of the breast as the lump increases in size
Discharge from the nipple which may or may not be bloody
Nipple retraction or distortion

24. Eczema-like rash around the nipple-areola complex that does not respond to anti-fungal cream treatment.
Sore or ulcer in the breast that does not heal
Swellings and nodes/seeds in the armpit or axilla
Difficulty with breathing when it spreads to the chest and to the lungs
Waist and bone pains with or without fracture or break of bones
Enlarged liver and or distended abdomen filled with fluid called ascites

25. Paralysis from waist down (paraplegia) associated with spread to the thoraco-lumbar spine
Convulsion and coma (unconsciousness) associated with spread to the brain
The last 8 of these, are features of late or advanced disease and our mega study "Factors Associated with delayed presentation of Breast Cancer" Momoh MI and Ohanaka EC found that 74.6% of our patients presented with these features of advanced disease. Only 20% present with the first 3 features and with early disease
It must be noted however, that it is only in sub-Saharan Africa that women still present with these features, even the first three.

26. Now in the United States and Western Europe the commonest mode of presentation of breast cancer is with "screening detected lump in the breast”
The method of screening could be by clinical breast examination (CBE), breast Ultra-sound scanning or by mammography. This very early detection and presentation makes for the real potential for complete cure for the disease
This is the reason that in spite of the increasing incidence of breast cancer in the US and Western Europe the deaths from breast cancer is decreasing.

27. Stages of Breast Cancer

28. Stages at presentation of breast cancer
The stages at which breast cancer present are divided into four, namely:-
1. Lump in the breast is the size of a grain of rice or size of a bean seed but less than the size of a cube of sugar.
2. The lump in the breast is about the size of a Walnut but with lymph nodes or seeds in the armpit that are 4 or less and not matted or gummed together.

29. Early disease
All of stage 1 and most of stage 2 cases, the breast may not be grossly distorted. Sadly it is the late and advanced disease that usually get recorded

30. 3. The lump in the breast is bigger than the egg of chicken, the breast is bigger and the nodes in the armpit are more than 4 and are matted or gummed together. The skin of the breast and the muscles underlying the breast are affected at this stage.
4. At this stage the mass in the breast could be of any size, but there is now either a sore/ulcer in the skin of the breast or the cancer mass is attached to the muscles underlying the breast.
Stages 1 and 2 are early breast cancer and stages 3 and 4 are the late or advanced breast cancer.

31. Unfortunately our mega study here, Momoh MI and Ohanaka EC and studies across Nigeria and the West African sub-region show that only 20% to 30% of our patients presented with early disease where as 70% to 80% of our patients presented with late disease. Our study was done over a decade ago and it was established then that 74.6% of breast cancer patients we studied presented with late or advanced disease.

32. We have just repeated an aspect of the study dealing specifically with the "Stage at presentation of Breast Cancer in the Second decade of the 21st Century". Our just published report indicates that 73.4% of breast cancer presented with late disease. Thus there is no significant difference between the stage of presentation 10 years ago and now. (Momoh MI, Agbonrofo P. 2016)
The relevance of this staging is to predict the prognosis and survival
Early breast cancer can be cured and we aggressively manage it aiming for cure so that the patient can have a normal life span. Late breast cancer cannot be cured and we only do palliative treatment.

33. PICTURES FROM MEDICAL ILLUSTRATION.

34. Advanced /late disease

35. Advanced /late disease
Mr. Vice-Chancellor Sir, I am sorry for these very sordid pictures of our mothers, sisters, aunties and nieces. but this is the reality of what we deal with every day

36. PICTURES OF PTS WITH BREAST CANCER.

37. Mr. Vice-Chancellor sir, ladies and gentlemen, where are the men that cuddled these breasts at the stage the Holy Bible referred to them as "lovely deer, a graceful doe. Let her breast fill you all times with delight; be intoxicated always in her love" Proverbs 5:19 English Std Version
Where are the children that suckled these breasts as newborn till infancy? They are there, and they care and are concerned, but they like the patients are victims. They are victims of ignorance, poverty, superstition, lack of education and very low women empowerment. Momoh MI and Ohanaka EC in our mega study on " Factors Associated with delayed presentation of breast cancer" found these to be the factors responsible for why 74.6% of breast cancer cases presented with late or advanced disease
Other factors found to be associated with the late presentation of breast cancer were poor referral system in the healthcare delivery system, mishandling of tissue specimens removed from the breasts.

38. Is there an indigenous name for cancer?
A factor we are investigating now is the apparent dearth of words or vocabulary for cancer in our indigenous dialects. A basic marketing strategy of a commodity is to advertise the commodity in its name in the indigenous dialect
Many dialects in this Midwestern zone of Nigeria call Malaria fever " eeba" or "iba". Cough is "oweh" and tuberculosis is "oweh no khua" that is big cough. In Etsako Hernia is called "uzo okhai na" that is disease that does not allow the man to run. We are searching for the indigenous Bini, Etsako, Esan, Urhobo, Ijaw, Ibo, Hausa Yoruba words for CANCER
We believe that awareness of cancer as a disease will be enhanced and improved if local vocabulary for cancer are known. We however are curious about the dearth of indigenous vocabulary for cancer. Is it that our indigenous communities did not suffer from various cancers?
Our men and women went about with bare chest about 200 years ago. If these monstrous lesions were prevalent then, they would have been very obvious and would have been named or identified with a vocabulary. More search in this area is ongoing.

39. CAUSES/RISK FACTORS FOR BREAST CANCER.
The best chance for the cure of breast cancer is early detection at stages 1 and 2. This is true worldwide and more so in Nigeria and other low-resource countries where there is dearth of critical expert healthcare personnel, poor infrastructure and lack of high technology equipment for treatment of breast cancer still pose huge challenges. This early detection is due to the awareness of the disease breast cancer and its causes or risk factors.
For most cancers and breast cancer, causes are not exactly known but instead we talk of risk factors for the particular cancer
This is best illustrated with lung or bronchial cancer in which cigarette smoking is the risk factor.

40. For breast cancer it's not as simple as lung cancer and cigarette smoking. For breast cancer it's a combination of about a dozen risk factors. The established risk factors for breast cancer are:-
Female Gender: Being a female is the number one risk factor for breast cancer. Every woman is at risk having breast cancer in her life time. Men also have breast cancer but of every 100 persons presenting with breast cancer 1% will be men. Momoh MI and Ohanaka EC found this to be 2% in our mega study. Studies in Enugu was 2% (Ezeome ER, Emegoakor CD, Chianakwana GU, Anyanwu SNC 2010) and about 9% in Zaria and 3.7% in North Eastern Nigeria (Dogo D, Gali BM, Ali N, Nagada HA 2006) . Olu-Eddo AN and Momoh M. I. in our 20 year review of all histologically diagnosed breast cancer at the UBTH found that 2.8% were men. The men folk are therefore alerted to also check themselves for breast cancer
Age: The older a woman gets the higher the risk of developing breast cancer. Breast cancer has a peak incidence at 45 to 55 years in Nigeria and sub-Saharan Africa. However in the developed world the peak incidence is from 55 to 65 years

41. RISK FACTORS
Family History: Breast cancer in a family indicates that patient's mother, sisters, aunty, nieces are at a higher risk of developing breast cancer in their life time. In the developed world, screening procedures are intensified in these family members to detect the disease at an early stage
In Nigeria the culture is predominantly to still keep ailments a secret from other family members. Breast cancer patients hardly had information on similar illness in the family in the past. In our practice we have managed only three sets of first degree relations with breast cancer.
In North America tests can now be done to identify the faulty gene that predisposes a woman to having breast cancer and if this gene is also present in the daughter, then that daughter must embark on screening procedures much earlier and more frequently.

42. RISK FACTORS
4. MENARCHE and MENOPAUSE: Menarche is the age of commencement of menstruation of a female and menopause is the age at final cessation of menstruation. The lower the age at menarche and the higher the age at menopause the higher the risk of breast cancer The age at menarche has been reducing by one year per decade in the last five decades. Thus in communities where girls had menarche at 16 years 50 years ago, girls in that same community now see their period at the age of 11 years. In our study "Age at Menarche of School Girls in Edo State" across Edo state MI Momoh and C Okonkwo (2008) found that menarche ranged from 9 to 14 years. Among children of the upper middle class in urban Benin City, Auchi and Irrua the average age was at 11 years whereas it was 13 years in rural dwellers

43. Menopause is the final cessation of menstruation for one year and it is functionally related to the decline of the female hormone oestrogen. Late menopause is understood to mean attaining final cessation of menstruation at age 55 or above. In our study " Menopausal status of breast cancer patients" MI Momoh, AN Olu-Eddo and C. Okonkwo (2008) found 49 years to be age at menopause for both our breast cancer patients and our controls who did not have breast cancer. This we thought is a fall out of the low life expectancy of 48.5 years for our women a decade ago when the study was done
At the centre of all these is the female hormone called oestrogen (the chemical that makes one a woman). Thus a woman who sees her period for the first time at the age of 10 and sees it till 55 years has been exposed to oestrogen for 45 years where as another woman whose menarche was 15 and menopause 45 years has been exposed for 30 years. The former with 45 years exposure has a higher risk for breast cancer.

44. 6. Parity (Number of children delivered).
5. Age at first delivery
Best reproductive years ( obstetricians)
Earlier deliveries protect against Breast Ca.
First delivery after 35 years carries higher risk than early delivery.
6. Parity (Number of children delivered).
More children protect against breast cancer.
No children at all increase risk of breast cancer.
Still the hormone Oestrogen.
2 children is 4 years of lower oestrogen
10 children means 20 years of less oestrogen

45. Breast cancer also grows very rapidly during pregnancy and breast feeding. EC Ohanaka, MI Momoh and AN Olu-Eddo in our study Management of Pregnancy Associated Breast Cancer found these dilemmas.
The goal of treatment of breast cancer in pregnancy is to give optimal treatment to mother to give her maximal chances of survival whilst minimizing risk to the foetus.
What do you do when a pregnant woman has breast cancer?

46. 7. BREASTFEEDING: Women who breast feed their children for 18 months to 2 years are better protected against breast cancer. This again derives from risk factor 6 above. There are many passages in the holy scriptures referring to breast feeding as being joyful, rewarding, a blessing to mother and child and more than nutrition (Isaiah 88:10 -13, 1Peter.2:2, 1Samuel. 1:21-24) Therefore conjecture the reverse when there is no breast feeding
My dear wife even as a very busy Resident doctor and young consultant ophthalmologist then, breast fed each of our six children for about two years, yet her breasts till date remain the "lovely deer, a graceful doe. Her breasts fill you with delight at all times and get you intoxicated always in her love" Proverbs 5:19.

47. 8. BIRTH CONTROL PILLS: It is established that the use of oral contraceptive pills (OCPs) predispose women to breast cancer. High dose oestrogen forms of OCPs increase the risk of breast cancer by about 10% to 30%. Lancet 1996; 347:
9. MENOPAUSAL HORMONE THERAPY(MHT)
Gynaecologists sometimes put women on oestrogen/progestin preparations for a short while to alleviate peri-menopausal symptoms. However, prolonged unsupervised use of these oestrogen preparations will put these women at risk of developing breast cancer. Cheblowski RT, Anderson GL, Gass M. et al in Estrogen plus progestin in breast cancer incidence and mortality in post menopausal women. JAMA Celebrities and show business women often take MHT unsupervised. This behaviour put these women at grave risk of developing breast cancer

48. 10. BENIGN (INNOCENT) BREAST LUMPS:
Not all breast lumps are cancer. In fact majority of breast lumps are not cancer. Female teenagers and women up to 40 years have breast masses, usually small (1-3cm) that are usually rounded and smooth and are benign. No matter how these lumps feel, they must be excised and sent to the histology laboratory for confirmation that they are benign or otherwise. While these benign lumps are not known to change to cancer, it has been established that women who have had these lumps have a slightly higher risk of (0.3%) developing breast cancer

49. 11. OBESITY AND PHYSICAL ACTIVIVTY:
There is two times increased risk of breast cancer in women who are obese post menopause. Worldwide there is increased body mass index (BMI) of women in the last three decades. In Australia the average BMI of women increased from 23.6kg/sq.m to 26.8kg/sq.m
Women who engage in active physical activities tend to be protected against breast cancer. They have a 12% lower risk of developing breast cancer.

50. 12. TOBACCO AND ALCOHOL: Women who smoke cigarettes heavily and for many years are at a higher risk of breast cancer. The American Cancer Society research finding is that women who start smoking before the birth of their first baby have a 21% higher risk of developing breast cancer than those who have never smoked. Even passive smoking increases the risk of breast cancer in pre menopausal women
Alcohol consumption also increases the risk of breast cancer by 7% to 10%.
The above risk factors are the established risk factors.
13. TERMINATION OF PREGNANCIES (ABORTIONS): Multiple or serial terminations of pregnancies are thought to increase the risk of breast cancer. This is supposedly controversial because studies from different institutions draw different conclusions. Proponents and opponents of a positive association between induced abortion and breast cancer are pitched against each other . (Pro-choice Vs Pro-life)

51. What is however not controversial is that the current wave of the near epidemic prevalence of breast cancer in the US and Europe came years after abortions were legalized in most States of the US in the mid 1950s. As abortions began to be freely obtained the incidence of breast cancer increased years later
The basic physiology of pregnancy and lactation and the consequences of sudden disruption of the pregnancy would seem to support the increased risk of breast cancer that is associated with induced abortions. We all know that one of the earliest signs of pregnancy even before a period is missed are changes in the breast especially the nipple areola complex. From the first day of pregnancy the breasts start to prepare for breast feeding and the events at the end of pregnancy are gradual and deliberate steps to let down milk within minutes of birth. When a pregnancy is terminated abruptly as is usually done this systematic, deliberate and ordered activities are disrupted and the breast is left in a "quandary and or confusion"

52. Here at the University of Benin, MI Momoh and AN Olu-Eddo in our study ”Induced abortion and risk of breast cancer: Observed relationship in Benin City” (2008) found that among breast cancer patients, those who have had termination of pregnancies, had a peak age incidence of years instead of the years in Nigeria and years in developed countries. Thus those who have terminated pregnancy tended to develop breast cancer at an earlier age. As I said earlier abortion has not been listed as an established risk factor for breast cancer. We are continuing to study the relationship between abortions and breast cancer.

53. We have devoted our teaching and research to these risk factors because understanding them will create awareness that will engender early detection of breast cancer.
Every woman, all doctors and healthcare providers even and especially at the Primary Healthcare Centre (PHC) level should know these risk factors. The community as a whole, including men should have an understanding and buy into the concept of breast cancer surveillance for their mothers, wives, nieces, aunties and even the men.

54. Modifiable Vs Non-Modifiable RFs
It can be seen that there is nothing we can do about the first four risk factors. We cannot determine our gender nor how long we live nor the age women attain menarche and menopause. There can however be benefits from family members knowing who in the family has breast cancer. It puts other women in the family on alert to be more serious with screening procedures.
The "faulty gene" (BRCA1 and BRCA2) that predisposed the patient to breast cancer can now be identified in the patient and then searched for in the other family members to determine their risk of developing breast cancer.
In the larger Nigerian family nation we still keep ailments of public figures and celebrities shrouded in secrecy. The best we hear is that the public figure battled with some cancer which again makes cancer sound like a mystery.

55. Tennis legend Martina Navratilova discovered a lump in her breast, got the diagnosis of breast cancer, had surgery and radiotherapy and went off to attempt to climbs Mount Kilmanjaro. She thus gave so much awareness to breast cancer and demystified it by going ahead to climb Mount Kilmanjaro as she had scheduled before the diagnosis of breast cancer
Senator John McCain in the midst of Presidential campaign some years ago had a malignant melanoma excised and he announced that it was cancer and continued with the campaign
This is why we must commend President Muhammadu Buhari who announced that he had ear infection called Meniere’s disease. It put ear infection in the public glare and I know few persons who had their ear examined by ENT surgeons around that period. Feature articles with well elucidated diagrams of the outer, middle and inner ear also appeared in some daily newspapers.

56. Gene Studies & Breast Ca. Previvors
Gene studies in family members can identify those at grave risk of cancer. It is these tests that super model and famous actress Angelina Jolie did and she elected to have her two breasts removed (double mastectomy) in Her mother and aunty were diagnosed with ovarian and breast cancer respectively, so the actress did the gene studies and found that she had an 86% risk of developing breast cancer. Without any breast complaint or symptom Angelina Jolie had the preventive double mastectomy. Such patients who elect to have their breast removed prophylactically are termed breast cancer PREVIVORS.

58. Mr. Vice-Chancellor sir, we have had near-PREVIVORS in our practice and teaching. A female Professor of a health science in a university in the north-central zone of Nigeria had had recurrent breast lumps excised on three occasions. Even though the test results confirmed that the lumps were not cancerous, the professor said she was very distressed and "died many times before each the test results come out". On account of this stress and anxiety she requested and gave consent for us to do a double mastectomy for her
My Residents and team were excited that we've got our own Angelina Jolie, a previvor and we gave the professor appointment for admission. On the appointed day of admission the husband and older brother who had never accompanied her to the clinic before now came with her to emphasize their disapproval. Mr. Vice-Chancellor sir, if a female professor does not have the final word on what to do with a body part that is a potential threat to her life, which category of women will have their say and their way.

59. Yet a retired Chief Nursing Officer who had had a right mastectomy done requested that we remove the left breast that did not have any complaint. She had heard us teach the Medical students that there was risk of cancer in the left breast if the right had been diagnosed with cancer. Again her husband a retired Federal Chief Pharmacist/Permanent Secretary objected.
Then we had a female domestic servant who went to the UBTH Centre for Disease Control for routine check up and the lump found in her breast was cancerous on histology testing. Her husband rejected the wife and the result. He said it was the wife who "take im leg waka go carry sickness put for her breast" and that the matter " no concern me". It was public spirited individuals who donated to pay for the basic treatment of wide local excision which was all she needed as the disease was very early, non-invasive intra-duct carcinoma.

60. The first two couples highly educated upper middle class healthcare professionals and the last third couple from the lower social class and yet the attitude were the same. It is only a Catholic nun who has volunteered to have the remaining breast excised after the other developed cancer. The Reverend Sister did not have to seek consent from any husband and that made the difference. It is all about women empowerment.

61. Modifiable Risk factors
There is serious challenge as regards the fifth risk factor on the age at first delivery of live baby. Pursuit of higher education and career target attainment must be subjugated to child bearing and breast feeding at the optimum times. Women should have many children and breast feed them. The world's economic and social problems are caused by inept and corrupt political leadership and a docile followership and not by so called overpopulation
We can say an emphatic NO to the other risk factors namely the use of oral contraceptive pills (OCPs), the use of menopausal hormone treatment (HMT). Reject termination of pregnancies, cigarette smoking and alcohol consumption and avoid obesity
The other very important value of knowing these risk factors is that a woman who has 3 to 5 of these risk factors will be more circumspect as regards screening procedures 

62. Management of Breast Cancer
I must dispel two wrong notions 1. breast cancer can be cured and 2. It’s not every case of breast cancer that we remove the breast. The notion that breast cancer cannot be cured and that every case of breast cancer results in the removal of the breast is one of the reasons many uninformed breast cancer patients stay away from hospital till very late
Management of breast cancer includes
tissue diagnostic tests to confirm diagnosis
tests to stage the disease as X-rays, Ultra Sound Scanning, Computer Tomography Scanning, Magnetic Resonance Scanning and Radio-Isotope scanning
Blood tests are done to determine the patient's fitness for surgery and chemotherapy.

63. The test to confirm diagnosis of cancer is by tissue diagnosis called histology where by a small piece of the tissue is obtained as a sample, processed and viewed under the microscope to determine the cellular characteristics. This is the test that authoritatively pronounces tissue to be cancer or otherwise. Diagnosis of cancer is a weighty judgment made by only qualified pathologists
Diagnosis of cancer is followed by radical decisions as excising an entire organ or part of it and these are not reversible procedures. Some breast masses and ulcers which were clinically assessed to be cancer were on histology found to be tuberculosis or other form of chronic granulomatous infection. ( Olu-Eddo AN, Egbagbe EE, Momoh MI. A 20 year Clinicopathological Analysis of Tuberculous Mastitis in Nigerians. (2007).

64. Treatment of Breast Cancer
Surgery and Radiotherapy targeting the loco-regional disease and Chemotherapy, Hormone therapy and Target cell therapy as systemic treatment.
With non-invasive in-situ and very early stage 1 disease only, the quadrant where the cancer lump was detected is excised and the breast is conserved. This decision is taken with the assurance that radiotherapy is available.
Mastectomy which is the removal of the breast is the surgery we do for later stages of breast cancer

65. Treatment of Breast Cancer
Radiotherapy is targeted at breast cancer cells in the chest wall, the armpit and other sites the cancer cell may have spread to. A very sophisticated high tech machinery requiring very exacting conditions to function, radiotherapy machines are wont to break down from time to time.
Sometime in March 2016 none of the seven machines in Nigeria was functioning
There are only 7 instead of the recommended 140 Radiotherapy centres in Nigeria. Thanks to the past and current management of the UBTH we are one of those centres

66. Treatment of Breast Cancer
CHEMOTHERAPY: This is the use of anti-cancer drugs to kill the cancer cells that may have spread from the breast to other parts of the body. The combination of drugs are administered every 3 -4 weeks for months as long as the blood count is optimal
HORMONE THERAPY: This aims at making the hormonal milieu of the body tissues unresponsive to further growth of the tumor. This basically counters the female hormone oestrogen. Thirty years ago after the mastectomy the ovaries were also removed. Tests are now available to determine the patients who will need specific hormone therapy, again thanks to the UBTH management, these Immuno-histochemistry tests can be done in UBTH. However as things are in low-resource countries the reagents for the tests are currently unavailable in Benin so we have to send specimens to Abuja, Ibadan or Lagos
TARGET BIOLOGICAL THERAPIES: Based on sophisticated tissue tests patients to benefit from this therapy can be determined and together with chemotherapy are very effective treatments.

67. Mr. Vice-Chancellor sir, the management out lined above last a minimum of one year. In our study of the "Burden of Breast cancer in Benin City" Momoh MI and Olu-Eddo AN estimated the direct cost of treatment and we found that cost of the management of breast cancer outlined above was beyond the capacity of even the upper middle class
The pre-operative tests cost a minimum of N150, , uncomplicated mastectomy cost about N250, , radiotherapy is about N120, Chemotherapy costs range from N80, to N150, per month for at least six months. Target cell therapy cost about half a million naira (N500, ) monthly for six months.
Aside the target cell therapy the total estimated cost of treatment is above two million naira (N2, 000,000.00)

68. This is direct cost and does not include indirect costs such as the loss of productivity of the patient and the friend/ relation and transportation costs.
The hospital and thus the government also bear cost as the treatment in public healthcare facilities is obviously subsidized. When they present late with necrotic and fungating ulcers we showed earlier, even the bed sheets they lie on are lost. The oxygen gas that keeps them going is enormous
The management of the late or advanced disease is very expensive hence we have always advocated for awareness campaigns for early detection that will lead to curable early disease
The good news in all these is that we achieve cure and survival when these patients present with early disease and are able to afford the cost of management outlined above. While the survival rate is about 90% in the United States it is about 10% - 15% in Nigeria and sub-Saharan Africa. Global Cancer Facts & Figures 3rd Edition: 2012.

69. GENERAL SURGERY
Mr. Vice-Chancellor sir, this breast we have been talking about is a very simple organ within the skin, actually a skin appendage like the sweat gland and hair follicle. So in principle and practice the surgery of mastectomy is not challenging and not heroic except when there is massive enlargement of the breast in late disease
As a general surgeon, the abdomen and its content especially the alimentary tract from the stomach to the anus is our field of practice, teaching and research. Breast and Endocrine surgery is our area of focus. Surgery of the abdomen has been very exciting and interesting. No two abdominal conditions are ever the same. Irrespective of what the tests and imaging techniques point to, opening the abdomen and seeing it live is a thriller and is it.
The arrangement of the organs, glands and tissues all functioning in unity deepens ones faith about the amazing powers of our creator the almighty God. In my view the arrangement of organs and tissues in the abdomen is more amazing than the arrangement of the galaxy and its stars.

70. It is in this abdominal surgery that we have met with, and by the grace of God overcome challenges. 3 of these patients readily come to mind.
Gunshot injury to abdomen of an Irish Priest
Similarly R.I., a young man visiting from the United States in 1999 was shot at point blank at Uwasota Street
A 65 years old lady from a very prominent Edo family, resident in Canada came home for the first time in 25 years was vomiting blood from a bleeding Peptic Ulcer.

72. These are just a few examples
These are just a few examples. Now it may have been noticed that I am nearly 100% local content. While we may not have trained abroad, our work have gone abroad and have been greeted with accolades
Apart from these emergencies, surgeries to remove giant goitres have been challenging and gratifying
Surgery to remove the entire anus and rectum and replacement with a permanent colostomy for cancer of the ano-rectum is the most challenging procedure in my specialty and we do this routinely with very good results for those who accept surgery early.
As the anus is very sensitive symptoms of a new growth present very early and the diagnosis is made early. The challenge usually is that the patients do not accept to have a permanent colostomy the “artificial anus" on the left side of the abdomen (belly). When they accept the decision early and we do the surgery before spread to the liver the patients usually survive.

74. Contributions
From 1994 to 1997 I was the first member of the Edo State Hospitals Management Board with former two time Dean of the School of Medicine Prof. Ambrose Isah as chairman and Dr. Simon Imuekemhe as Director of Hospital Services/CEO
I served in the UBTH management as Chairman, Medical Advisory Committee(C-MAC)/Director of Clinical Services and Training of the University of Benin Teaching Hospital from September 1998 to March 2003 under Prof. A. O. Obasohan as Chief Medical Director. In this period we brought at least twelve projects namely CT Scanning, Renal Dialysis, Oxygen Plant, Printing Press, and Movement to the Accidents and Emergency Unit, from conception to completion. These set the hospital on a progress path which I am glad successive managements have built upon

75. Contributions
In late 2008 I was persuaded to serve as a member of the Edo State Executive Council and Honourable Commissioner for Health. From January 2009 to January 2011 we supervised the renovation of all the maternity and children wards of all the 20 General hospitals and the three Central Hospitals in Edo State. The Primary Healthcare Centres were also renovated with emphasis on water projects. We got development partners to commence the renovation of the massive medical stores along Medical Stores Road in Benin City. In the 2009 Edo State budget, N700mn was the initial budget for Central Hospital Benin City. The Comrade Governor was not happy with the state of the hospital. Some group argued that there should be general renovation, painting and brilliant lighting of the hospital premises.  

76. We argued that the then 102 years old hospital should be demolished and re-built in phases and thankfully His Excellency Governor A. A. Oshiomhole agreed with us. We convened a stakeholders meeting of the hospital in my office. Then Chief of surgery and now Permanent secretary HMB Dr. Ofure Eboreime, Dr. Moses Imologomhe, Dr. Matthew Oriakhi, Chief of Laboratory services now PS Dr. Moses Aigbirior, Director of nursing services and pharmacists met with me and we decided that what the hospital needed most was a modern, spacious and tropicalized and functional Accidents and Emergency centre with surgical wards
At the next meeting of these stakeholders firms of architects pre-qualified by the State government were briefed on our concept and they produced designs. The Comrade Governor was thrilled with the projected outcome of the facility and he gave his all to the project. The earth breaking ceremony was done early in January 2011 and the result is the magnificent edifice at the city center today.

79. The State Schools of Nursing, Midwifery and Health Technology were all renovated and upgraded. A state of the art modern Eye Clinic was established at the Stella Obasanjo Women and Children's Hospital (SOWCH). The Drug Revolving Fund was reorganized and drugs were continously available. Immunizations were aggressively pursued and epidemics that broke out around Edo state were kept abey from the state. There was general staff recruitment with emphasis on specialist consultants for the three Central hospitals at Auchi, Uromi and Benin City such that by now they would be admitting medical graduates for the mandatory one year houseman-ship training
We have trained scores of Residents to be specialist consultants in all specialties of Surgery. In my sub-specialty of general surgery in the last fifteen years we have trained the following, Dr. N. Nkeonye now Chief Consultant surgeon in Delta state, Dr. Emmanuel Sule a Senior Lecturer at DELSU, Dr. Esosa Okoro consultant surgeon in the UK, Dr. Omorodion Irowa Lecturer/Consultant, Dr, Nnamdi Nwashili Consultant Trauma surgeon, Dr. Bright Ederibhalo, Dr. Peter Agbonrofo and Dr. Taiwo Amusan all consultant surgeons.
Our area of research contribution is the association of termination of pregnancies and breast cancer in this part of the world. As stated earlier termination of pregnancy is not an established risk factor for breast cancer. We have in our study shown that among breast cancer patients those who have terminated pregnancies tend to come down with breast cancer at an earlier age. We are continuing to work in this area

80. Acknowledgements
I am immensely thankful to my maker and creator, the Almighty God that my thoughts and works have found expression through this great intellectual citadel the University of Benin Nigeria to national, regional and international arena/world stage. I am eternally thankful to Almighty God for the parents He gave me to. I dedicate my whole being, all that I have and all that I am to Almighty God.
I dedicate the good thoughts and works of my academic and professional careers to my parents and my family
I thank God for St. John's College Fugar, it gave us sound Catholic Christian education. It reinforced family virtues of truth, honesty and integrity. Like our patron Saint John the Baptist we were taught to speak the truth even at the risk of beheading

81. Acknowledgements
I am particularly thankful to Rev.Bro. Michael Cain, my chemistry teacher who was killed by a logging truck and is interred at the Seminary at Ekpoma. May his soul continue to rest in perfect peace. Run by American Catholic Marianist Missionaries we called our teachers John, Michael, Paul- their first names. At St. John's we are bold, confident, assertive and looked authority in the face almost to the point of aggression as long as we held on to the truth. Thankfully I was admitted to the then elite Government College Ughelli for higher school. GCU was fashioned after the British public schools and order, seniority and hierarchy was emphasized. The cultures of the schools complimented each other and think I am better for it till date. I thank all the Saints from SJCOBA and all the GCUOBA members who are here today

82. Acknowledgements
I am thankful to the University of Benin from its founding Visitor Dr. Samuel Ogbemudia, first indigenous Vice-Chancellor Prof. Tijani Momodu Yesufu through Professors Adamu Baikie, Grace Alale-Williams, Andrew Onokerhoraye, R. Anao, E. C. Nwanze, Osayuki Oshodin and current VC F. F. O. Orunmwense. They all played positive roles from my admission to this university, through graduation, residency, employment and promotion through the ranks to Professor and giving this lecture today. I thank Prof. L. Ezemonye, Prof. A Falodun, Mrs. O. A. Oshodin, Dr. Mrs Omoluabi Idiodi, Dr. Baba Bila.
I thank my Provost Prof. V. Iyawe who we work seamlessly together and all my fellow Deans and Directors.
Our gratitude equally goes to the authorities of the University of Benin Teaching Hospital (UBTH) for providing the clinical facilities for all our practice, teaching and research. We appreciate Prof. J. C. Ebie and Prof A. U. Oronsaye of blessed memory.

83. Acknowledgements
I am particularly grateful to Prof. A. O. Obasohan in whose management I served as C-MAC/Director of Clinical Services and Training. Pioneer CMD Prof. J. C. Ebie and his successor Prof. A. U. Oronsaye are thankfully acknowledged.
I thank Prof. E. E. Okpere and Prof. Mike Ibadin for elevating the hospital beyond where they met it. It is now second to the UCH Ibadan in both bed capacity and services delivered among the teaching hospitals in Nigeria.
In the department of surgery we were the initial first set of trainees who did the indigenous national and regional training programs without any foreign or overseas exposure. In the face of scepticisms and doubts the late Professors U. Osime was a great inspiration and same were Prof. I. Evbuomwan, Prof. Festus Ogisi, Pro. F. Iweze, Prof. Vincent Onuora and late Pro. Victor Odiase. They with Prof. R. Ofoegbu who headed the department at various times have built an enduring institution.
I thank Dr. T. A. Njoku, Dr. Temple Oguike and Prof. E. C. Ohanaka who we struggled together to attain the heights we are today. To God be the glory.

84. My gratitude to all academic and non-academic staff of the School of Medicine where I am the Dean.
My immense thanks go to the Emeritus Archbishop of the Metropolitan See of Benin City, His Grace Dr. P. E. Ekpu, his successor Dr. A. O. Akubeze and the Bishop of the Diocese of Auchi Rev. Dr. G. G. Dunia. I thank all the Priests and Religious my family and I encounter every day in our devotion to our faith and our God. Through Rev. Fr. Dr, G. Ogbenika and Rev. Fr. Richard Enegbuma the parish priests of my home parish Christ the King Catholic Church Fugar, I salute all the priests of Auchi diocese. At St. Albert's Catholic Church UNIBEN/UBTH we have been blessed to have Rev. Fr. Bob Dundon SJ, highly cerebral Oxford educated Very Rev. Fr. Dr. Theophilus Uwaifo and Rev. Fr. Prof. Onwueme all of blessed memory as spiritual guides. Rev. Fr. Augustine Ehigie's brief, incisive and expository sermons have deepened the knowledge base of our faith and thanks too to Rev. Fr. R. Imoni. The very dynamic and energetic Rev. Fr. Andrew Obinyan was home parish priest at St. Vincent's Catholic Church Auchi where he tended to my then aged parents giving me a lot of relief and confidence. He is now my parish priest and great spiritual and infrastuctural builder of my faith and my church. I thank him immensely.
I thank all parishioners of St. Albert Catholic church my second family members.

85. Knights and Ladies of St
Knights and Ladies of St. John International are highly valued and appreciated. My thanks to all my brothers of Etsako Citizens Club and my kindred of the Fugar Progressive Union who are all here in large numbers
My enduring friends over the years, Dr. Muhammad M. Lecky, Mr. Bern Omo-Akhigbe, Senator Matthew Urhoghide, Engr. Chris Ogiemwonyi, Mr. Nelson Ononye, Mr. Emma Ozono, Engr. Osato Edo-Osagie, Prof. Law Ezemonye, Prof. Austin Obasohan Chief Lawson Omonkhodion, Sir Sylvester Egbase, Dr. Sylvester Ojobo, Engr. Paschal Osigbemhe, Chief Athanasius Braimah, Prof. Friday Okonofua, Prof. Mike Ibadin, Prof. M. J. Waziri-Erameh, Prof. E. Pandy Kubeyinje, Prof. Austin Omoigberale, Dr. Tare Biu, Pro. A. Omoigberale, Dr. Margaret Odili, Prof. A. E. Ehigiegba, Dr. Osagie & Prof. Mrs. Dawodu, Dr. Tosan and Dr. (Mrs) Valentina Ideh, Dr. Peter Oside, Engr. Moses Aroko, Comrade Godwin Erahon, Mallam MB Shehu and many many more.
I like to acknowledge with thanks the presence of those who have survived this scourge. I salute their courage, tenacity and faith in almighty God. You may wish to stand for the rest of us to join o thank God for his mercies

86. I thank my parents-in-law and the Okoeguale family of Eguare-Opoji who we are now one family. My father-in-law Mr. Lawrence Okoeguale a most caring gentleman is fondly remembered today and always. May his soul rest in peace – amen. I thank Agatha and Ehidiamen in the UK and Florence, Eromosele and my mother-in-law Mrs. Stella Okoeguale in the US for their support always and especially when my family is abroad.
I thank my siblings for the support and cooperation they have given me especially after the passage of our patriarch and I became the Village Head. I thank Justina, Lucy, Lametu, Veronica, Bridget, Anthony, Imoudu, Idulagbe, Irelamie, Patricia, Augustina, Charles, Celine, Pauline, Philomina, Frank, Josephine, Clementina, Emmanuel, Anthonia, Edith, Oshogwe, Christopher, Constance, Aaron, Taiye, Oshorhiamhe, Imonikhe, Awawu, Isomianwu, Bashiru, Hassan, Inino, Abdullahi and the rest of the Momoh Clan and Apaaduku kindred. I love and thank you all.

87. Acknowledgements
After my maker the Almighty God my children have justified my works and efforts
Oshokha Michael Momoh Esq, a lawyer doing his National Service, Omegie Louise Momoh studying for ACCA at the BPP University Manchester UK, Omokheli Amanda Momoh a student at the Jesuit Canisius College Bufallo New York, Osiano Simon-Peter Momoh SS1 at Olashore International School, Iloko-Ijesa, Esiro Nadine Momoh Primary 4 Our Lady of Apostles Catholic School and Uki-Esi Marilyn Momoh a Primary 2 pupil of OLA.
This youngest one, two years ago taught my wife and I a lesson in giving thanks. All eight of us were complete at home at Christmas and year's end and praying and giving thanks for the achievements and blessings for the year - graduating in Law, Accounting, MSc in Public Health from UK Universities, graduation from SS3 at the Loyola Jesuit College Abuja. At the conclusion of the prayer session Uki-Esi then 5 years old, raised her finger and protested that we did not thank God for her graduating from Kindergarten 3 and passing entrance to Primary 1 in OLA school. My wife and I were humbled yet full of joy and fulfillment that our youngest child was that thoughtful. To GOD be the glory.

88. They are a great motivation for me to keep serving man and God
They are a great motivation for me to keep serving man and God. I love them so much, I am so blessed with them that I am always joyful
What then do I say of the mother of these wonderful blessings, my very dear, lovely, elegant, very beautiful, very intelligent, best friend and wife Dr. Rita Omoso Abike Momoh. She on marrying me took charge of a man who was lavishly loved by the mother and adoring sisters. She has risen to the situation. Sweetheart, thank you very much. I love you dearly. Your support for and constructive criticisms of my work as lecturer over the years is giving birth to this lecture today on breast cancer. Your breast feeding each our six children for two years in spite of your busy schedule as an academic and clinician is a teaching and counseling tool for me. It also assures me that you are protected against this monster called breast cancer.

89. MY LOVELY CHILDREN

93. CONCLUSION
Mr. Vice-Chancellor sir, we have shown by our teaching and research that every Nigerian woman is at risk of having breast cancer. By very conservative estimates one in every 20 Nigerian woman will be afflicted with breast cancer in their life time and this is a huge fraction of our 85 million women. Worse still is that 75% of these breast cancer afflicted women will present with late disease which is incurable. This late presentation we have established is due to low level of education, poverty, low empowerment of women, poor referral system and lack of awareness of cancer and breast cancer.
We have also established that women can reduce their risk of developing breast cancer by adopting lifestyles such as not smoking, early childbearing, breastfeeding of their children, avoiding obesity and saying no to abortion.

94. CONCLUSION
Awareness campaigns in the last two decades have been sporadic and episodic and not sustained and our studies show that in this 2016, 73.6% of breast cancer patients are still presenting with late advanced disease and have thus not reduced the huge scourge of breast cancer. This huge burden of advanced breast cancer is a scourge on the afflicted woman, her family and friends, community and on the health facilities and therefore the government.
This ravaging scourge we have alerted afflicts predominantly the economically productive age group of between 35 and 55 years thus compounding the woes of the family who cannot afford the high cost of treatment, the unaffordable cost of treating advanced disease, the fatality it inflicts on them.
As we are, painfully to say, a low-resource or resource-limited nation lacking in diagnostic facilities appropriate for the geographical size and population of 170 million people this scourge is ravaging our women.

95. In our circumstances therefore, our best chance to halt this ravaging scourge is to adopt feasible and practicable strategies that will ensure early detection and diagnosis so that we cure our patients and have 90% survival rate as it is in the developed countries. Mammography as mass screening modality is impracticable in Nigeria on account of cost as 95% of Nigerians do not have health insurance and pay for services from out 0f pocket. In the face of this ravaging breast cancer scourge we make the following general and specific recommendations.
General
1. Free compulsory Universal Basic Education
2. Eradication of poverty.
3. Sustained Awareness Campaigns
4. Finding and using indigenous nomenclature of CANCER in our local dialects.

96. 5. Strengthening Primary Healthcare Centres in all the 10,000 political Wards in Nigeria.
6. Empowerment of Women
7. Eradicating communicable diseases and thus free resources to combat cancers and other non-communicable diseases.
Specific.
1. All clinical healthcare workers from CHEWs, Nurses, Midwives, Community Health Officers, Health visitors and doctors should be very knowledgeable of the risk factors for breast cancer and be able to teach and demonstrate Breast Self Examination and Clinical Breast Examination.

97. Teaching Hospitals should participate in this.
All women who come to hospital for any ailment should be counseled to have a CBE done for them.
All women with a significant risk for breast cancer should have more frequent CBEs and start breasts ultra-sound scanning at an earlier age. Breasts scanning cost about five thousand naira and in low-resource country like Nigeria it can be used as a screening modality
We also recommend that gene studies be done in both the breast cancer victim and the daughters such that if the daughters also have the "faulty gene" that predisposed their mother to the disease the daughters will then be more circumspect with their screening procedures. This gene screening is only now available at the UCH Ibadan.

98. Mr. Vice-Chancellor sir, very distinguished ladies and gentlemen, it is obvious that in our circumstances, in this low-resource nation, CBE is our best mass screening modality as it is cheap and can be made universally available and free of charge for every woman if stakeholders such as government, legislators, heads of health institutions including private hospitals, doctors and indeed all competent health workers agree to offer this service at no cost.
We implore that all our healthcare facilities (All healthcare facilities from the PHCs to the University teaching Hospital) should grant every woman free clinical breast examination (CBE)
Every woman should as a matter of right go to any healthcare facility and register and be clinically screened for breast cancer free of charge twice in a year.

99. God bless the University of Benin God Bless Nigeria
Thank you for listening
God bless the University of Benin
God Bless Nigeria

100. “UNIBEN ANTHEM” “ARISE MIGHTY UNIBEN”

101. NATIONAL ANTHEM