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HEALTH: New Task Force Targets Poor in Breast Cancer Fight

Chryso D'Angelo

NEW YORK, Nov 4 2009 (IPS) - The rate of breast cancer in developing countries is on the rise, according to the Harvard School of Public Health, which estimates that the poor will account for more than 55 percent of breast cancer deaths this year.

“Women are coming in with high stage breast cancers – stage 3 or higher – and lesions that are protruding,” Dr. Felicia Knaul, director of the Harvard Global Equity Initiative, told IPS. “By the time the disease is diagnosed, it is often too late for effective treatment.”

To meet this global challenge, cancer experts, government officials, and representatives of international organisations participated in an international conference Nov 3-5 in the United States.

“Breast Cancer in Developing Countries; Meeting the Unforeseen Challenge of Women, Health and Equity” was held at Harvard School of Public Health, Harvard Medical School, Dana-Farber Cancer Institute and Brigham Women’s Hospital.

The task force is seeking out ways to procure and deliver cancer drugs at affordable prices and to expand access to early detection treatment and survivorship.

The spike in breast cancer cases is partly due to the effective eradication of communicable disease like tuberculosis and malaria. Women are living longer and cancer is usually a disease of the aged, thus an increase in life span has opened the door for cancer.

However, early research from the Harvard School of Public Health suggests that breast cancer is being detected on average in younger women.

Countries projected to be hit hardest by increasing breast cancer cases include United Arab Emirates (78 percent), Qatar (60 percent) and Saudi Arabia (57 percent), according to the Harvard School of Public Health. The largest absolute increases will be in Asia (with almost 180,000 in China in 2020 and 131,000 in India).

While the United States leads with 240,721 new breast cancer diagnoses expected this year (one in eight U.S. women will develop breast cancer at some time in their lives), the majority of these cases are detected and treated in early stages, when the five-year survival rates are 98 percent, according to the American Cancer Society.

The causes of the growing breast cancer epidemic are still unclear. While some experts look to genetic and environmental causes, Dr. Peggy Porter, a professor of pathology at the University of Washington School of Medicine, notes that the “westernisation” of the developing world is the most widely cited reason for the increase.

In the recent New England Journal of Medicine article “‘Westernizing’ Women’s Risks? Breast Cancer in Lower-Income Countries”, Porter explains that “western” influences such as negative changes in diet, less exercise, delayed childbirth, families with fewer children, less breast feeding, and hormone replacement therapy are all thought to increase the risk of breast cancer.

Whatever the cause, health care systems in the developing world are limited in their training to detect it and in their technology to treat it.

“Resources people take for granted in the United States and Canada don’t exist in much of the world,” said Dr. Lawrence Shulman, M.D., chief medical officer at the Dana Farber Cancer Institute. “That includes mammography, the ability to do needed surgeries, and the availability of radiation.”

Knaul, herself a breast cancer patient who has been treated in Seattle and Mexico, sees the disparity firsthand.

“The poor may suffer more from communicable diseases like malaria than those in the developing world, but they also suffer from non-communicable diseases, like cancer. Often they suffer more. We have to rethink our health systems and how we reach out them,” Dr. Knaul told IPS.

Conference planners are outlining concrete steps to address the challenges, which include a lack of awareness of the growing epidemic of breast cancer, little access to early detection and treatment, marginal health care, and social and cultural barriers.

“In Latin countries, the pervasive machismo culture means women are reluctant to seek a diagnosis that might involve breast surgery,” said Dr, Julio Frenk, dean of Harvard’s School of Public Health.

“Women in Mexico have said, ‘If I have to have a mastectomy, my partner will leave me,'” Dr. Knaul told IPS. “It’s the cancer machismo – the other cancer we have to eradicate to do something about breast cancer.”

Other cultural barriers include the taboo associated with female patients disrobing for male doctors.

“Doing a good breast clinical exam requires training, practice and the ability to get closer to women and to explore their breasts and teach them how to explore their breasts,” said Dr. Knaul.

To encourage women to have screenings, the initiative is pushing for female midwives, nurses and community healthcare promoters to be trained to examine women’s breasts for possible signs of breast cancer.

The task force is also lobbying to make life-saving drugs available to cancer patients.

“Ten years ago the new drugs that turned AIDS from a death sentence into a manageable chronic disease were not available to poor countries. There was a global movement to change that. It took 10 years, but it happened,” said Dr. Frenk.

Making treatment practical for women who can’t spend time away from home is another goal. Considerations include offering chemotherapy outside of the hospital setting.

“Why should a patient come to the capital city miles away for twelve infusions of chemo if most of this can be done in the district hospital?” Dr. Knaul said.

Even an Internet connection can help expedite treatment. The Dana-Farber Cancer Institute joined Partner in Health, another Boston-based group, to support communities in Malawi, Rwanda and Haiti.

“Oncologists at Dana-Farber are on call by e-mail or phone 24/7 to advise and offer direct treatment at these sites,” Dr. Shulman told IPS.

“We have managed dozens and dozens of patients this way, very successfully. We also have a web share point site for posting large files such as x-rays and pathology to review. This has made a difference in countless lives,” he said.

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