Breast Cancer Cases Among the Middle East: Breast Cancer Cases Among the Middle East

Breast cancer continues to rise in Iraq, and scientists have established the Iraqi National Cancer Research Program to better understand the underlying molecular and environmental causes in an effort to curb the incidence of cancer. "Breast cancer is the most common type of malignancy recorded in the cancer registries of almost all countries within the Eastern Mediterranean Region. In Iraq, the continuous rise in the incidence rate is associated with an obvious trend to affect premenopausal women," said Nada A.S. Alwan, M.D., Ph.D., director of the National Breast Cancer Research Unit at Baghdad University Medical College and the executive director of the newly established Iraqi National Cancer Research Program.
Alwan presented early data at the second AACR Dead Sea International Conference on Advances in Cancer Research: From the Laboratory to the Clinic, held March 7-10, 2010.
The Iraqi National Cancer Research Program was organized by the Iraqi minister of higher education and scientific research in 2009 in collaboration with the common secretariat for the Council of Ministers and the Iraqi Parliament.
"This project includes within its objectives comprehensive epidemiologic studies on risk factors of the main encountered cancers in Iraq, with a focus on the characteristics and behaviors of cancer in patients inhabiting different geographic areas," said Alwan.
The current study focused on 721 of 5,044 women who complained of breast lumps later diagnosed as cancer. Approximately one-third of the diagnosed patients were between 40 and 49 years old; 71.9 percent came from urban areas and 75 percent were married.
History of lactation was reported in 63.1 percent of the women and 29 percent had taken hormone therapy. A family history of breast cancer was reported in 16.2 percent of cases.
Although 90.6 percent of women detected a lump on self-examination, only 32 percent sought medical advice within the first month. Because of this, 47 percent of them presented with advanced stage breast cancer, either stage III or IV cancer. The main histological type was invasive ductal carcinoma of grade 2 in 56.6 percent and grade 3 in 39.9 percent. Estrogen-receptor positive tumors were noted in 65.1 percent of the cases and progesterone-receptor positive tumors were noted in 45.1 percent of the cases.

One Saudi woman ignored the cancer growing in her breast because she didn't want to risk a referral to a male doctor. Another was divorced by her husband on the mere suspicion she had the disease, while a third was dragged away from a mammogram machine because the technicians were men.

Breast cancer is still considered a taboo in oil-rich Arab Gulf countries like Saudi Arabia even as the disease claims more and more victims, but some women are pushing for greater openness about the illness.
Their efforts received a boost this week: a visit from U.S. first lady Laura Bush to the region to raise awareness for breast cancer.
On Wednesday, her second day in Saudi Arabia, Bush met with a group of breast cancer survivors in the western seaport of Jiddah. As a token of their appreciation for her efforts, they presented her with a long black scarf — the kind women use to cover their hair in public — with pink ribbons symbolizing the disease attached to both ends.
They then helped her wrap it around her head, though visiting female dignitaries are exempt from strict Saudi dress codes for women.
"No campaigns, ads or programs would have had the kind of impact that Laura Bush's trip has given to breast cancer awareness in the kingdom," said Samia al-Amoudi, a gynecologist diagnosed with the disease in April 2006.
"Her trip will make people ask, 'Why is she here? For breast cancer? Is it that serious in this country?'" she added.

Number 1 killer of women
In Saudi Arabia, the issue is very serious. About 70 percent of breast cancer cases are not reported until they are at a very late stage, compared with 30 percent or less in the U.S., according to al-Amoudi.

She also said 30 percent of Saudi patients are under 40 years old, compared to 5 percent in the U.S.
Breast cancer is the No. 1 killer of women in the United Arab Emirates, according to official statistics, with many dying because the stigma surrounding the disease prevents them from seeking early detection.
Breast cancer awareness campaigns are becoming more prevalent in the Arab world. In Lebanon, for instance, a public service TV announcement shows two round, lit candles. One of them is extinguished as an announcer reads statistics about the disease and reminds women to do mammograms.

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But in the more conservative Gulf region, such campaigns are less aggressive, not as organized and unlikely to use such bold imagery.
In Saudi Arabia, a campaign that began this month gives discounts for mammograms and, in billboards, urges women to "Do the test now, for peace of mind."
The problem is not a matter of resources. The kingdom has some of the world's best equipment and doctors and even the poor have access to free medical care.
The problem is in people's mindsets. Many Saudis, like other Arabs, won't even refer to cancer by name, calling it just "that disease" because of the fear surrounding it. Some families are afraid no one will marry their daughters if a mother's illness becomes known.

Stigma of exams by male doctors
For others, however, the greatest obstacle is the idea women being examined by male doctors.

Al-Amoudi, who chronicled her struggle with cancer in a local newspaper, recounted the story of a woman whose husband always pulls her away from the mammogram room because the technicians are male.
"The first thing women ask me when I tell them to get a mammogram is: 'Will the radiologist be male or female?'" she said.
Asma'a al-Dabag, a radiologist for 27 years, said the woman who was divorced turned out to be cancer-free, while the woman who had it kept her disease a secret even from her two brothers — both of them doctors.
"Some people feel that this is something private and if they talk about it, they become exposed," she said.
Al-Dabag said awareness is even missing among many gynecologists, who rarely talk to patients about self examinations or routine mammograms.
She has also yet to hear from the government about a proposal she presented months ago about the importance of conducting research to find out why the disease strikes at an early age in the kingdom and recommending that a comprehensive center be established where patients will learn to cope with all aspects of the illness.
Al-Amoudi has urged the kingdom's clergymen to "enlighten the people and take up the issue of women's health in their sermons."
Somaia al-Thagafi, 32, who discovered a lump in her breast while on vacation in London a couple of months ago, was happy with the support she got from her husband and immediate family but depressed by some of the other reaction she received.
"Some treated me as if I was on my deathbed," she said. "Others told me stories about women who died while doing reconstructive surgery. Some even told me to drop my treatment and take herbal medicines instead."
Fawzia al-Zewid, a 45-year-old mother of six, said her husband's support was overwhelming after she was diagnosed with the disease two years ago. When she began losing her hair, he shaved her hair before shaving his. Her two young sons chose to do the same.

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