Why the benefits of regular screening for breast cancer still elude many Arab women

Many campaigns and events across the region aim to raise awareness of breast cancer. (AFP)
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Updated 20 October 2022

Why the benefits of regular screening for breast cancer still elude many Arab women

  • Cancer is often associated with social stigma in Arab societies, leading to late diagnosis and higher mortality 
  • Early breast cancer diagnosis can result in much less aggressive treatments and a far higher survival rate

DUBAI: Despite significant efforts at early detection and new treatments, breast cancer claims the lives of over 680,000 women every year. In the Middle East, Arab women can be divided into categories including the proactive, fearful and negligent, as well as many who lack access to finances and proper care.

Afrah, a Dubai-based learning assistant from Yemen, is constantly encouraged by her husband to visit a breast-screening clinic for an exam. She repeatedly replies: “I don’t think it is necessary, as I am performing self-examination at home,” the 42-year-old told Arab News. “I think I am supposed to start visiting a breast clinic for a checkup now.”

Her tone does not suggest that she will do so, and she is not the only one.

Despite national breast cancer awareness campaigns across the Middle East launched every October, inspirational survivor stories, technological advancement in early detection and treatment, and the moderate growth in the number of women visiting clinics for mammograms, a large number of Arab women are still hesitant, with many afraid of possibly receiving terrible news.




Financial and social factors also keep women from accessing regular screening. In many Arab countries, annual mammograms are not covered by health insurance. (German Jordanian University)

Fawziah, a 44-year-old Emirati engineer, who lost her mother to cancer, has been going for her annual checkups for 10 years. “Women who feel reluctant to do regular checkups always come up with different excuses. But in my opinion, all these excuses are just evasion and fear,” she told Arab News.

In 2020, there were 2.3 million women diagnosed with breast cancer. In the five years up to the end of 2020, there were 7.8 million women alive who were diagnosed, making it the most prevalent cancer worldwide.

With significant advancements in early detection and massive awareness campaigns, breast cancer mortality rates have certainly reduced over the past four decades.

However, the danger continues to lurk in the darkness as long-held taboos, shame and negligence overwhelm conservative communities. Many countries across the region have been working to educate the public and stress the importance of early detection.

Burying one’s head in the sand can be risky, said Dr. Millicent Bello, a prominent breast oncoplastic surgeon at Fakeeh University Hospital in Dubai.

“I think there is a bit of anxiety and fear of (being diagnosed with) breast cancer in the majority of women. Even (among) doctors, nobody wants to be told they have breast cancer,” she told Arab News.

Bello said that not going for regular tests was “just like allowing some small fire to become a major, major fire.” 

Misconceptions and misinformation also play a role as many women get their information on mammograms online or from relatives, said Dr. Shireen Ahmad, a radiologist at King’s College Hospital London-Dubai.




A large number of Arab women are still hesitant to visit clinics, with many afraid of possibly receiving terrible news. (FOCP)

Women are also afraid of the effects of radiation, Ahmad explained to Arab News. “I tell all my ladies: ‘Do you think twice about jumping on the plane and flying to London for your shopping? You don’t. You don’t even think about the amount of radiation you get on a flight.’ It is equivalent to the dose you get from the mammogram,” she said.

Financial and social factors also keep women from accessing regular screening. In many Arab countries, annual mammograms are not covered by health insurance.

When a lump is found the patient is required to keep checking it regularly. “This can be stressful, and costly, too, so she stays away from screening from the very beginning,” Faten, a Jordanian nurse who requested anonymity, said in an interview with Arab News from Amman.

“Not all the segments of society realize that cancer can be cured and patients can resume their normal life,” Faten added, explaining that female cancer patients prefer not to share their status to avoid questions about details they consider private and personal.

Researchers say that cancer in general and breast cancer in particular is associated with significant social stigma in many Arab societies. There are feelings of shame and guilt, and sometimes cancer is even viewed as a sign of punishment for undisclosed sins.

Earlier this year, a study published in the American Society of Clinical Oncology Journal titled “Cancer Burden Among Arab-World Females in 2020: Working Toward Improving Outcomes,” said that one in six women will develop cancer during their lifetime, and one in 11 women will die from the disease.




In 2020, there were 2.3 million women diagnosed with breast cancer. (AFP)

The study acknowledges that data on female cancers in the Arab region is “scarce.” However, it is the most common cancer in incidence and mortality among Arab women, who account for nearly 48 percent of the 445 million Arab population.

Another study, “Breast Cancer in the Arab World,” published in Springer, stated that the exact prevalence and incidence of cases are not known due to the lack of structured cancer registries.

“In addition, mortality registries and disease-specific mortality records are lacking and largely unknown.” 

The study added that most Arab countries do not have structured universal screening programs and “most women who undergo mammograms are either self-motivated, advised by afflicted family members, or motivated (by) physicians.”

Moreover, mammography centers, trained personnel, and “existing units are not universally monitored for quality, results, and reporting by any overseeing agency.”

Delay in seeking medical advice and impaired access to adequate care leads to Arab female cancer patients being diagnosed in the more advanced stages of the disease compared to women in Western countries, according to the study.

“With few exceptions … Arab countries lack universal access to comprehensive cancer care centers or patient care by specialized cancer care teams with the adequate advanced oncologic training and expertise needed to provide required complicated treatment plans, leading to suboptimal cancer care,” the study stated.




Researchers say that cancer in general and breast cancer in particular is associated with significant social stigma in many Arab societies. (AFP)

For example, “the rate of modified radical mastectomies in Arab countries is much higher than that in internationally reported literature,” reaching up to two-thirds of cases. Nearly 21 percent of patients undergoing such a procedure will develop clinically significant lymphedema or swelling, which could be avoided in some patients.

Radical mastectomies, in which the entire breast, chest muscle, and often the lymph nodes are removed, are often performed due to insufficient radiation therapy. More advanced techniques and procedures, such as removing the lymph nodes for biopsy, are also unavailable.

Moreover, reconstructive surgeries are not always available, and health insurance does not cover them when they are.

The high cost of cancer treatment in the Arab world adds to patients’ burdens. Researchers noted that medications and financial coverage by governmental and non-governmental insurance plans are limited. New and expensive treatments for breast cancer are available in some high-income Arab countries.

The introduction of “immuno-oncology” and targeted therapy drugs were among the leading cancer treatment developments in the past few years in treating cancer, Dr. Khawla Abu Izza, an Arab-American pharmaceutical development and CMC, or Chemistry, Manufacture and Control, regulatory consultant, told Arab News.

These drugs generally are reserved for patients at an advanced stage of the disease. There are few exceptions, said Abu Izza




Burying one’s head in the sand can be risky, said Dr. Millicent Bello, a prominent breast oncoplastic surgeon. (Breast Cancer Foundation of Egypt)

“There have been several significant developments in the treatment of breast cancer, each contributing to the improvement of the outcome for patients, but we cannot point to a single major development that made a huge difference … Some of the developments were in the dosing regimens for radiation therapy or improvements in the surgical procedures.”

In some of the medical institutions in the Gulf region, highly advanced screening machines have become available, and their results are very precise, according to Ahmad.

New technology in screening machines can test the softness and the hardness of lesions, and dye can be used to highlight tumors.

Ahmad said wire localization biopsies and radioactive seed localizations are among the procedures used to identify the targeted area before surgical procedures are done.

Bello stressed that research into breast cancer is continuously underway to achieve better results. “Over the years, research into breast cancer has continued regardless of COVID … Surgeries are more personalized, and there is no one size that fits all.” 

However, the core message remains the same: Early diagnosis leads to less aggressive treatment and a much higher survival rate.


Israeli court delays demolition of West Bank village again

Updated 08 February 2023

Israeli court delays demolition of West Bank village again

  • Right-wing Israeli group Regavim had taken the government to court in order to force officials to raze the village
  • Opponents to the demolition believe levelling Khan Al-Ahmar would pave the way for the expansion of Israeli settlements in the area

JERUSALEM: Israel’s Supreme Court on Tuesday approved a new delay to the controversial demolition of a Bedouin village in the occupied West Bank.
The Khan Al-Ahmar community, which lies on a strategic highway east of Jerusalem, was slated for demolition in 2018 after a ruling that it was built without Israeli permits.
Right-wing Israeli group Regavim had taken the government to court in order to force officials to raze the village, whose 200 residents have drawn international support.
Prime Minister Benjamin Netanyahu’s administration, which took office in December, had requested more time to decide on Khan Al-Ahmar’s fate, telling the court it needed an extension before presenting a plan to demolish the village.
In Tuesday’s ruling, the Supreme Court granted a delay until May 1 but expressed regret that the government was “satisfied with the current situation... postponing its response every few months.”
Prior administrations have delayed their decision on Khan Al-Ahmar eight times.
Opponents to the demolition believe levelling Khan Al-Ahmar would pave the way for the expansion of Israeli settlements in the area, effectively forming a barrier between annexed east Jerusalem and the rest of the West Bank.
Israel has been under international pressure to block the demolition, with European diplomats most recently visiting the community on January 30.
Khan Al-Ahmar is located in Area C of the West Bank, which is under full Israeli control and where it is almost impossible for Palestinians to obtain construction permits.
The West Bank has been occupied by Israel since the 1967 Six-Day War.


Newborn, toddler saved from rubble in quake-hit Syrian town

Updated 07 February 2023

Newborn, toddler saved from rubble in quake-hit Syrian town

  • The newborn girl’s umbilical cord was still connected to her mother, Afraa Abu Hadiya, who was dead
  • Baby was the only member of her family to survive from the building collapse Monday in the town of Jinderis

JINDERIS, Syria: Residents digging through a collapsed building in a northwest Syrian town discovered a crying infant whose mother appears to have given birth to her while buried underneath the rubble from this week’s devastating earthquake, relatives and a doctor said Tuesday.
The newborn girl’s umbilical cord was still connected to her mother, Afraa Abu Hadiya, who was dead, they said. The baby was the only member of her family to survive from the building collapse Monday in the small town of Jinderis, next to the Turkish border, Ramadan Sleiman, a relative, told The Associated Press.
Monday’s pre-dawn 7.8 magnitude earthquake, followed by multiple aftershocks, caused widespread destruction across southern Turkiye and northern Syria. Thousands have been killed, with the toll mounting as more bodies are discovered. But dramatic rescues have also occurred. Elsewhere in Jinderis, a young girl was found alive, buried in concrete under the wreckage of her home.
The newborn baby was rescued Monday afternoon, more than 10 hours after the quake struck. After rescuers dug her out, a female neighbor cut the cord, and she and others rushed with the baby to a children’s hospital in the nearby town of Afrin, where she has been kept on an incubator, said the doctor treating the baby, Dr. Hani Maarouf.
Video of the rescue circulating on social media shows the moments after the baby was removed from the rubble, as a man lifts her up, her umbilical cord still dangling, and rushes away as another man throws him a blanket to wrap her in.
The baby’s body temperature had fallen to 35 degrees Celsius (95 degrees Fahrenheit) and she had bruises, including a large one on her back, but she is in stable condition, he said.
Abu Hadiya must have been conscious during the birth and must have died soon after, Maarouf said. He estimated the baby was born several hours before being found, given the amount her temperature had dropped. If the girl had been born just before the quake, she wouldn’t have survived so many hours in the cold, he said.
“Had the girl been left for an hour more, she would have died,” he said.
When the earthquake hit before dawn on Monday, Abu Hadiya, her husband and four children apparently tried to rush out of their apartment building, but the structure collapsed on them. Their bodies were found near the building’s entrance, said Sleiman, who arrived at the scene just after the newborn was discovered.
“She was found in front of her mother’s legs,” he said. “After the dust and rocks were removed the girl was found alive.”
Maarouf said the baby weighed 3.175 kilograms (7 pounds), an average weight for a newborn, and so was carried nearly to term. “Our only concern is the bruise on her back, and we have to see whether there is any problem with her spinal cord,” he said, saying she has been moving her legs and arms normally.
Jinderis, located in the rebel-held enclave of northwest Syria, was hard hit in the quake, with dozens of buildings that collapsed.
Abu Hadiya and her family were among the millions of Syrians who fled to the rebel-held territory from other parts of the country. They were originally from the village of Khsham in eastern Deir Ezzor province, but left in 2014 after the Daesh group captured their village, said a relative who identified himself as Saleh Al-Badran.
In 2018, the family moved to Jinderis after the Turkish-backed Syrian National Army, an umbrella for several insurgent groups, captured the town from US-backed Kurdish led fighters, Sleiman said.
On Tuesday, Abu Hadiya and the girl’s father Abdullah Turki Mleihan, along with their four other children were laid to rest in a cemetery on the outskirts of Jinderis.
Back inside the town, rescue operations were still ongoing in their building hoping to find survivors.
The town saw another dramatic rescue Monday evening, when a toddler was pulled alive from the wreckage of a collapsed building. Video from the White Helmets, the emergency service in the region, shows a rescuer digging through crushed concrete amid twisted metal until the little girl, named Nour, appeared. The girl, still half buried, looks up dazedly as they tell her, “Dad is here, don’t be scared. … Talk to your dad, talk.”
A rescuer cradled her head in his hands and tenderly wiped dust from around her eyes before she was pulled out.
The quake has wreaked new devastation in the opposition-held zone, centered on the Syrian province of Idlib, which was already been battered by years of war and strained by the influx of displaced people from the country’s civil war, which began in 2011.
Monday’s earthquake killed hundreds across the area, and the toll was continually mounting with hundreds believed still lost under the rubble. The quake completely or partially toppled more than 730 buildings and damaged thousands more in the territory, according to the White Helmets, as the area’s civil defense is known.
The White Helmets have years of experience in digging victims out from buildings crushed by bombardment from Russian warplanes or Syrian government forces. An earthquake is a new disaster for them.
“They are both catastrophes — a catastrophe that has been ongoing for 12 years and the criminal has not been held accountable, and this one is a natural catastrophe,” said the deputy head of the White Helmets, Munir Mustafa.
Asked if there was a difference between rescue work in the quake and during the war, he said, “We cannot compare death with death … What we are witnessing today is death on top of death.”


Quake imperils cross-border aid to Syria: UN

Updated 07 February 2023

Quake imperils cross-border aid to Syria: UN

  • "The cross-border operation has itself been impacted," Jens Laerke, spokesman for the UN humanitarian agency OCHA, told reporters
  • A spokesman for UN Secretary General Antonio Guterres, Stephane Dujarric, said the Bab al-Hawa crossing itself is "actually intact"

GENEVA: The sole border crossing used to shuttle life-saving aid from Turkiye into conflict-ravaged Syria has seen its operations disrupted by the deadly earthquake that struck the two countries, the UN said Tuesday.
The 7.8-magnitude quake and its aftershocks struck Turkiye and Syria on Monday and killed more than 5,400 people.
“The cross-border operation has itself been impacted,” Jens Laerke, spokesman for the UN humanitarian agency OCHA, told reporters in Geneva.
A spokesman for UN Secretary General Antonio Guterres, Stephane Dujarric, said the Bab Al-Hawa crossing itself is “actually intact.”
“However, the road that is leading to the crossing has been damaged, and that’s temporarily disrupted our ability to fully use it,” Dujarric said.
Disaster agencies said several thousand buildings were flattened across an area plagued by war, insurgency, refugee crises and a recent cholera outbreak.
Concerns have been running particularly high for how aid might reach all those in need in Syria, devastated by more than a decade of civil war.
Humanitarian aid in rebel-held areas usually arrives through Turkiye via a cross-border mechanism created in 2014 by a UN Security Council resolution.
But it is contested by Damascus and its ally Moscow, who see it as a violation of Syrian sovereignty.
Under pressure from Russia and China, the number of crossing points has been reduced over time from four to one.
And now areas surrounding that one border crossing have suffered significant infrastructure damage, while the aid workers on the ground have been hit by the catastrophe.
“Every effort is being done to overcome these logistical hurdles, which are created by the earthquake,” Laerke said.
“There is a window of about seven days” when survivors are generally found, Laerke said, adding that it was critical to get teams to those in immediate need as soon as possible.
“It is imperative that everybody sees it as a humanitarian crisis where lives are at stake,” he said.
“Please don’t politicize this. Let’s get the aid out to the people who so desperately need it.”
He said the UN was intent on using “any and all means to get to people, and that includes the cross-border operation and the cross-line operation from inside Syria.”
But Laerke said access by road was a challenge and pointed out that the quake had impacted the UN’s “own staff, our own contracting partners, our truck drivers that we work with, our national staff.”
“They’re looking for their families in the rubble... That has had an impact on that operation in the immediate,” he acknowledged.
At the same time, he said, partners that deliver aid in northwestern Syria said they were “operational and they are asking for supplies, and they are also asking for funding.”
For now though, the specific Syria cross-border humanitarian fund is empty, he warned.


Doctor says bodies “everywhere” in collapsed Iskenderun hospital

Updated 07 February 2023

Doctor says bodies “everywhere” in collapsed Iskenderun hospital

  • There was little amongst the debris to suggest the building was a busy medical facility less than two days before
  • One of the hospital's surviving physicians, who identified himself only as Dr. Deveci, said he found the scene at his workplace hard to witness

ISKENDERUN, Turkiye: Rescue teams and survivors peered through the twisted remains of an Iskenderun hospital on Tuesday, searching for signs of life a day after a major earthquake struck Turkiye and neighboring Syria.
There was little among the debris to suggest the building was a busy medical facility less than two days before.
One of the hospital’s surviving physicians, who identified himself only as Dr. Deveci, said he found the scene at his workplace hard to witness.
“I’m devastated. I see bodies inside, everywhere. Although I’m used to seeing bodies because of my expertise, it’s very difficult for me,” he said.
Much of Iskenderun, a port city located in Turkiye’s southern Hatay province, lay in ruins after the magnitude 7.8 quake hit just after 4 a.m. on Monday. More than 1,200 buildings were destroyed in Hatay alone.
“A doctor said there are about 15 people here, including the patients,” taxi driver Kerim Sahin said as he looked for a colleague in one part of the hospital.
“At the moment, they’re all trapped inside. Nobody can go near the building, only one cabinet is supporting the third floor.”
Sahin said the scale of the damage meant further rescue efforts were reliant on excavation equipment arriving from nearby cities.
The death toll in Turkiye had risen to 3,549 people, President Tayyip Erdogan said on Tuesday as he declared a state of emergency in 10 provinces. In Syria, the toll stood at just over 1,700, with tens of thousands injured or left homeless in several Turkish and Syrian cities.
Turkish authorities say more than 12,000 search and rescue personnel are working in the affected areas, plus another 9,000 troops.

Related


UAE pledges $100 million in quake relief to Syria, Turkiye

The UAE has dispatched planes to both Turkiye and Syria with relief items and rescue teams following Monday’s quake. (UAE MoD)
Updated 07 February 2023

UAE pledges $100 million in quake relief to Syria, Turkiye

  • The sum would be equally split between Syria and Turkiye, with each getting $50 million
  • It was not immediately clear if the funds for Syria included the $13.6 million previously announced

DUBAI: The United Arab Emirates Tuesday pledged $100 million to Syria and Turkiye, one of the largest sums yet following a massive earthquake that killed more than 5,400 people across both countries.
The oil-rich Gulf nation — which had already pledged some $13.6 million to Syria — is spearheading regional relief efforts, having dispatched planes to both countries with relief items and rescue teams following the 7.8-magnitude quake that struck early Monday.
On Tuesday, Emirati President Sheikh Mohamed bin Zayed Al-Nahyan “ordered the provision of $100 million for the relief of those affected,” Emirates News Agency said.
The sum would be equally split between Syria and Turkiye, with each getting $50 million, according to the news agency.
It was not immediately clear if the funds for Syria included the $13.6 million previously announced.
Major General Saleh Al-Ameri, commander of joint operations at the UAE’s defense ministry, said Tuesday that three military planes had been dispatched to Turkiye, carrying search and rescue teams who have since commenced operations.
A total of seven flights are planned to the quake-hit countries, including two to the Syrian capital Damascus, he told local media.
Syria’s official SANA news agency said Tuesday that an Emirati plane carrying 10 tons of food supplies had arrived at the Damascus international airport.
The UAE reopened its embassy in the Syrian capital in December 2018.
In March last year, Assad made a visit to the UAE — his first to an Arab state in more than a decade of brutal civil war.