Why Saudi women need a national screening program

There is currently no organized screening program in Saudi Arabia, with the uptake of regular checkups is well below international numbers. Experts across the Kingdom want this to change in order to increase education and save lives.
Updated 13 October 2018

Why Saudi women need a national screening program

  • By the end of the century, cancer will be the No. 1 killer globally and the single biggest barrier to increasing our life expectancy
  • Organized tests for those over the age of 40 would lead to earlier detection, prolonging their chance of survival

DUBAI: Doctors are calling for a national breast cancer screening program targeting all women in Saudi Arabia over the age of 40 to give women a greater chance of survival.

While cancer is one of the biggest killers of women in the Middle East — and breast cancer is the most commonly diagnosed form of the disease — experts say, at present, just ad-hoc “opportunistic” screening exists in the Kingdom.

“There is no organized screening program in Saudi Arabia,” said Professor Fatma Al-Mulhim, consultant radiologist and head of the breast unit at King Fahd Hospital of the University (KFHU) in Khobar and founder of the Breast Cancer Early Diagnosis Committee. “At present screening is opportunistic, which means ladies are not invited to come to regular organized screenings; they come upon their own will. So the uptake of screening and regular checkups is far below international numbers.”

She believes fewer than 20 per cent of women who should be screened are attending routine health checks for breast cancer.

“This reflects a very low number,” she said. “For us, in the Eastern Province of Saudi Arabia, this is our 10th year to host educational campaigns across the city in addition to offering screening through mobile units belonging to charity organizations, government hospitals and the Ministry of Health, among others. 

“I do believe if there are no official programs then the uptake of screening will still be low, because you cannot continue to leave this as an option for ladies. 

“We still need to do a lot of work to educate women, as well as encouraging doctors, mainly in the primary care sector, to educate their patients and to send them to send them for screening after the age of 40.”

According to Susan G. Komen for the Cure, the largest breast cancer organization in the US, while breast cancer is the most common cancer and the leading cause of cancer death among women in Saudi Arabia, many of those affected do not seek medical care immediately.  As a result, women across the region are often diagnosed with breast cancer at a late stage, when there are fewer treatment options and outcomes are worse.

Rola Shaheen, medical director and chief of radiology at Peterborough Regional Health Center in Ontario, Canada, is working alongside Professor Al-Mulhim and fellow experts across the Kingdom to examine breast cancer awareness and protocols for screening across the country as part of an ongoing study titled “Comparative Baseline Needs Assessment for Breast Cancer Awareness and Management in the Middle East and North Africa.”

She too believes an organized population-based screening program is better than the current “opportunistic” approach both in Saudi Arabia and the wider Middle East. 

“Population-based screening is offered systematically to all individuals in a defined target group with a framework of agreed policy, protocols, quality management, monitoring and evaluation while opportunistic breast screening is offered to an individual without symptoms when she presents with healthcare provider for reason unrelated to that disease,” she said. “So almost all the breast screening taking place in the Middle East is falling under the opportunistic part, including Saudi Arabia. 

“While I agree that opportunistic screening is an important step towards fighting breast cancer and helps with early detection and down-staging of the disease, I think it should be offered hand-in-hand within a framework of quality programs to protect women and ensure appropriate high-quality care.

“The population-based/organized screening would be ideal if the resources are available, and in a country like Saudi Arabia, I would think they are probably ready to step into this big commitment. 

“Basically, the advantages are low-lying fruits at this point.”

Shaheen said an organized national screening programme would “bridge the gaps between the “fragmented efforts” currently in place. 

“I would also recommend involving behavioral experts in the population-organized programs to understand within the local settings and cultural norms how to communicate with patients and disseminate invitations and results to women and their doctors.”

The call comes during Breast Cancer Awareness Month, 31 days of charity and campaigning for global breast cancer charities and organizations. <br/>

Early detection is key in order to improve chances of survival. If breast cancer is detected at Stage 1, the chances of survival are
95-100 percent. This compares to 57 percent if detected at Stage 3.  

The number of people around the world who have cancer is “rapidly growing,” with 18.1 million new cases and 9.6 million deaths in 2018 alone, according to a report released last month by the World’s Health Organization’s International Agency for Research on Cancer. 

By the end of the century, cancer will be the No. 1 killer globally and the single biggest barrier to increasing our life expectancy. Breast cancer is one of the top three most common cancers worldwide. 

So far in 2018, it is estimated that 627,000 women have died from breast cancer across the globe, which is about 15 percent of all cancer-related deaths among women.

Dr. Aref Hammam, a consultant in general surgery at UAE’s Bareen International Hospital, said breast cancer is a growing condition with women in the region. 

“However, many women identify the condition only at an advanced stage,” he said. 

Dr. Nazura Siddiqi, a specialist in obstetrics and gynaecology at the hospital, said breast cancer has four stages, defined by the prevalence and size of the tumor. The chances of survival are between 95 to 100 percent if the breast cancer is detected at Stage 1. But if the condition is detected at Stage 2, the survival chance decreases to 86 percent. If breast cancer is detected at Stage 3, the survival rate goes down to 57 percent. 

These figures, she said, underline the importance of screening and early detection in order to improve the chances of survival. Aside from age, gender, and family history, prolonged exposure to estrogen, in various forms, can also increase the risk of breast cancer in women. 

Those who began menstruating at an early age (below 13 years), those who have not given birth, those who have not breastfed, those who had their first child after age 30, those who have used oral contraceptives, those who had late menopause (after age 50), and those who have used hormone replacement therapy also have higher chance of developing breast cancer.

 “Unhealthy lifestyle choices — drinking alcohol, smoking, physical inactivity, obesity and unhealthy food preferences such as fast food and processed food — also significantly contribute in increasing the risk of having breast cancer. It is strongly recommended that women who belong to any of these categories to be proactive about regular screenings,” added Dr.  Siddiqi.

“Early detection is the key.”

Misk Global Forum: Panelists spoke about future skills, AI and social intelligence on the first day

Updated 15 November 2018

Misk Global Forum: Panelists spoke about future skills, AI and social intelligence on the first day

  • Princesses and politicians, entrepreneurs, an Olympian and football legend joined forces to power a skills revolution

“What does the future look like, in a world where everything is changing?” This question rang out as a video montage played at the “Skills for Our Tomorrow” Misk Global Forum on Wednesday.

From the vantage point of  the third annual forum in Riyadh, the future buzzed with possibilities as more than 3,500 delegates were treated to sessions with political ministers, princesses, inventors, entrepreneurs and athletes. They had all assembled to share their vision of what is needed to deliver the skills that will be needed in future.

Weam Al-Dakheel, the first woman to anchor the main evening news on Saudi Arabian TV, introduced the forum’s executive manager Shaima Hamidaddin. “We want you to be inspired, not just by our speakers, but by your fellow guests,” said Hamidaddin, as she welcomed delegates. 

Hamidaddin asked for a show of hands from different parts of the world, showing that there were delegates from every continent except Antarctica — the forum would work on that for next year, she promised. She then asked for a show of hands for those under the age of 35 to demonstrate that this was the youngest Misk Global Forum yet.

She added that thanks to technology, we are already more connected than ever before, but urged people to interact with the speakers and guests from different cultures. “We must seize the opportunity for uniquely human collaboration,” she said.

As the moderator of the first session, “It’s All About Skills,” Arab News’ editor in chief Faisal J. Abbas began by holding up the morning’s newspaper: “Two years ago people used to read the news like this,” he said.

But as he pointed out, the news industry has changed drastically, with digitally connected audiences increasingly using online platforms such as Twitter.

With media tweeting out his comments, Abbas introduced his guests: Ahmed bin Suleiman Al-Rajhi, the Kingdom’s minister of labor and social development; Shaima Hamidaddin; Jayathma Wickramanayake of Sri Lanka, the UN Secretary-General’s envoy on youth and Sue Siegel, chief innovation officer for General Electric.

Abbas asked Al-Rajhi how the government was tackling the challenge of finding jobs for young people. “With Vision 2030 programs ... we have a lot of initiatives and there is potential,” the minister said. “We all need to work together and collaborate with the education system, employers who create the jobs and the ministry to give a clear direction of where we are going today.”

Arab News Editor in Chief Faisal J. Abbas hosted a panel on skills. (Ziyad Alarfaj/Arab News)

Asked whether job creation is considered to be an issue worldwide, the UN youth envoy said: “It is not a national or regional issue but a global one: Our world is younger than it has ever been before.” 

Wickramanayake said that by 2030, South Asia and Africa will supply 60 percent of the world’s workforce. “We have a large majority of young people who are working but still live in poverty,” she said, adding it is important to invest in them. “If we are serious then this is the time to make those investments to be productive citizens and employees and employers.”

A group that has been making just this sort of investment in Saudi Arabia is the forum’s organizer, the Misk Foundation, which. was founded by Crown Prince Mohammed bin Salman in 2011. 

Abbas asked the question that is on everyone’s minds these days: Are machines going to take our jobs? Siegel answered that while everybody looks at artificial intelligence and has this fear, actually AI will create new jobs and be used for more mundane tasks. 

AI was the topic of another session later in the day. Julia Glidden, general manager, global government industry for IBM Corporation in the US, said it is really important to know what AI is not. “It comes back to you and what you bring to your societies, which is your humanity, your passion, your vision and creativity, because machines will never replace that,” she said. 

Another panel on the topic of social intelligence stressed that technology could sometimes hinder people from interacting with the world around them.  Adeeb Alblooshi, the UAE’s youngest inventor, said it is important to develop social intelligence. 

He advised young people: “You have to start simple by understanding little things people do and that’s how you can gain experience. You don’t need to have the best equipment and the latest technology to develop. Just don’t give up ... always have faith.” 

Princess Reema bint Bandar, deputy of planning and development at the Saudi General Sport Authority. (Basher Saleh/Arab News)

The day wasn’t just about skills and intelligence. Athletes led the afternoon sessions, including a panel on the Future of Sport moderated by Princess Reema bint Bandar, deputy of planning and development at the Saudi General Sport Authority. 

Lubna Al-Omair, the first Saudi female Olympic fencer, interviewed Amir Khan, the Olympic medalist and light-welterweight world champion, who appeared wearing traditional Saudi clothes. He said that he hoped to help the next generation of Saudi boxers to become Olympic champions, and the only way to do this is by opening academies here. 

British boxing legend Amir Khan. (Ziyad Alarfaj/Arab News)

Khan said he believes there is a reason Saudis are good boxers: “Maybe it is in their blood — they are warriors.”

Winding up the day, Brazilian football legend Ronaldinho appeared on stage to a chorus of cheers and gave a talk entitled “The Discipline — and Fun — of Teamwork. ”

His advice for the audience? “Prepare yourself and help your colleague or team member,” he said. “Humility is important. Try to stay humble.”

He also said to train hard, read as much as you can and don’t fear failure. “I failed a lot of times,” he said. “Football is like that. You can’t always win. You have to seek lessons from the defeats and not lose hope.” 

Now retired, Ronaldinho is more concerned with giving back. “After I stopped playing, I have soccer academies. That’s what I’m proud of, and it has given me pleasure. To give something back (as a) thanks to football and everything it has given me.”

The forum was continuing at Four Seasons Hotel Riyadh at Kingdom Center on Thursday.

Brazilian soccer great Ronaldinho. (Ziyad Alarfja/Arab News)