OPINION: Turning the tide on breast cancer in the Middle East and Africa

Breast cancer is a life-altering, and often life-limiting disease that has ramifications for all of society [1]. It is the leading cause of death for women across the Middle East and Africa region; every two minutes another woman develops the disease. There are currently 280,000 new cases across the region every year, but by 2040 that is expected to increase by 140 per cent to 660,000, representing a new case roughly every 40 seconds [2].

The projected increase in breast cancer rates in the Middle East and Africa in the coming decades is not inevitable. However it will take concerted and sustained effort to reverse this trajectory by setting new standards for patient outcomes, from diagnosis through to treatment and beyond, as well as building capacity and infrastructure. We owe it to our mothers, sisters, daughters, and friends – to our communities – to prove this prediction wrong. 

As with most cancers, early detection of breast cancer can mean the difference between life and death. That’s why awareness raising directed specifically at women in high-risk demographics is key. We know our bodies better than anyone and should feel confident in seeking help when something does not feel right. National-level campaigns like the Jordan Breast Cancer Programme, led by the King Hussein Cancer Foundation, can empower women to take responsibility for their health and help them understand their options. 

Prevention is another area that deserves more public attention, particularly when it comes to understanding key risk factors. For example, new technologies now allow for predictive testing for high-risk breast cancer genes. The private sector has a crucial role to play in working with governments and healthcare providers to make these medical innovations accessible and affordable. In Egypt, AstraZeneca has partnered with Baheya Foundation, to promote BRCA testing for women in order to improve early diagnosis and patient outcomes and has already reached 700,000 women with awareness initiatives. 

Others risk factors are lifestyle choices that can sometimes be addressed by behaviour change, including smoking and secondhand smoke inhalation, high blood-sugar, and physical inactivity. Better public understanding of the links between these risks and breast cancer will also help reduce overall rates. 

Routine screening cannot prevent cancer from occurring, but it is does help to pick up early signs of the disease, and countries where this is part of standard health care packages demonstrate lower mortality rates [3]. This service is currently inaccessible to most women in the Middle East and Africa. Supporting governments to implement national breast cancer screening programmes could help improve survival and be cost-effective for health systems in the long run.  

Efforts to improve breast cancer prevention and detection, as well as treatment, must be underpinned by fully trained and equipped health workers who are able to support women along their patient journey. Initiatives like the Phakamisa programme in South Africa sponsor specialist breast cancer training for nurses, supporting the government’s strategy to increase the number of breast cancer specialists in all clinics and hospitals across the country. 

Finally, gender inequality is the root of many barriers to safe and effective medical care for women in our region. At the individual level, economic disempowerment, stigma, cancer myths, and cultural taboos can all contribute to a delay in women seeking medical attention. Breast and cervical cancer are shown to receive less funding and public attention in low- and middle-income than in high-income countries [4].

Most of us have been impacted by breast cancer – whether directly or indirectly. Breast cancer awareness month has become associated with pink ribbons, which can now be seen on lapels and campaign materials across the Middle East and Africa. Alongside this outward sign of solidarity, we will only begin to make progress against breast cancer if we are also addressing barriers to prevention, awareness, screening and care, through continued innovation and collaboration with governments, patients and industry.

[1] NCBI, ‘Breast Cancer in Low- and Middle-Income Countries. Why We Need Pathology Capability to Solve This Challenge’. Available at https://bit.ly/3sAT7J5. Accessed September 2022.
[2] Estimated new cases of breast cancer from 2020 – 2040, International Agency for Research on Cancer, accessed here: https://bit.ly/3sEhdmw
[3] Ren W, Chen M, Qiao Y, Zhao F. Global guidelines for breast cancer screening: A systematic review. Breast. 2022 Aug;64:85-99. doi: 10.1016/j.breast.2022.04.003.
[4] Samarasekera, U., & Horton, R. (2017). Women’s cancers: shining a light on a neglected health inequity. The Lancet, 389(10071), 771-773.

By Pelin Incesu

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