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.”


Saudi pursuit of ‘green Kingdom’ goal gets a boost

Updated 57 min 12 sec ago

Saudi pursuit of ‘green Kingdom’ goal gets a boost

  • Agreement between agriculture ministry and Dubai's ICBA aimed at conserving natural resources
  • Kingdom's biosaline agriculture research and systems stands to benefit from ICBA's expertise

DUBAI: Agricultural development and environmental sustainability in Saudi Arabia will receive a boost in the coming years, thanks to a new agreement between the International Center for Biosaline Agriculture (ICBA) in Dubai and the Saudi Ministry of Environment, Water and Agriculture.

The agreement aims to enable Saudi Arabia to achieve its goal of preservation and sustainable management of its natural resources by raising the quality of biosaline agriculture research and systems.

The ministry says that the agreement will make use of the ICBA’s expertise in capacity development besides agricultural and environmental research, especially in the fields of vegetation development, combating desertification and climate change adaptation.

“It also includes training programs for Saudi technicians and farmers,” the ministry said. “In addition, it will localize, implement and develop biosaline agriculture research and production systems for both crops and forestation, which contributes to environmental and agricultural integration.”

Dr. Ismahane Elouafi, the ICBA’s director general, told Arab News: “The agreement had been in the making for about two years. That was when we were approached by the Saudi government.”

Dr. Ismahane Elouafi, ICBA Director General, at the center's Quinoa fields in Dubai. (Supplied photo)

She said: “We put forward a proposal to demonstrate how the ICBA can help the Saudi government to implement its Green Kingdom Initiative, through which the ministry is trying to restore green coverage in the country and revive old conservation practices.”

Geographical features and climatic conditions very greatly from one part of the country to the other.

In the past, experimentation with such crops as potatoes, wheat and alfalfa proved detrimental to the Kingdom’s environment and natural resources due to faster rates of groundwater withdrawal.

“The ministry wanted to put a halt to over-abstraction of water, so they went through different policies,” Elouafi said.

“They made sure, for example, that farmers stopped producing wheat because about 2,400 liters of water is consumed to produce 1 kg of wheat. It was a huge amount,” she added.

“The new strategy is to find more appropriate crops for the farming community, which is quite large in the Kingdom.”

Saudi Arabia has been trying to grow its own food on a large scale since the 1980s. 

The objective of the Green Kingdom Initiative is to reduce the agricultural sector’s water demand by finding alternatives to thirsty crops.

The agreement will require the ICBA, over the next five years, to build for Saudi Arabia a new biosaline agriculture sector. 

As part of this shift, cultivation of a number of crops, notably quinoa, pearl millet and sorghum, will be piloted in high-salinity regions and then scaled up.

“The crops did very well in the UAE,” Elouafi said. “We’re looking at Sabkha regions, which have very high salinity and wetlands, and are on the ministry’s environmental agenda.”

Another objective is “smart” agriculture, which will involve raising water productivity, controlling irrigation water consumption and changing farming behavior.

Elouafi said that getting farmers in the Kingdom to stop cultivating wheat took some time as they had become accustomed to heavy government subsidies. In 2015, wheat production was phased out, followed by potatoes a year later and then alfalfa. 

“Farmers were provided everything to the point where they got used to a very good income and a very easy system,” she said.

“Now farmers are being asked to start producing something else, but the income won’t be the same, so it’s very important at this stage that the ministry has a plan and it’s fully understood.”

The agreement envisages preparation of proposals for ministry projects that involve plant production, drought monitoring, development of promising local crop and forestation varieties, and conservation of plant genetic resources.

“We’re also discussing capacity building because the ministry is big and has many entities. Because Saudi Arabia is a large country and has the capacity to meet some of its food requirements internally, what’s required is a better understanding of the country’s natural capabilities in terms of production of the crops it needs, like certain cereals,” Elouafi said.

“The way the authorities are going about it right now is more organized and more holistic. They’re trying to plan it properly.”

Elouafi said that having a better understanding of Saudi Arabia’s water constraints and managing the precious resource is essential.

 

Although almost the entire country is arid, there is rainfall in the north and along the mountain range to the west, especially in the far southwest, which receives monsoon rains in summer.

 

Sporadic rain may also occur elsewhere. Sometimes it is very heavy, causing serious flooding, including in Riyadh.

“They (the government) are very interested in drought management systems. The Kingdom has a long history of agriculture,” Elouafi said.

“It has large quantities of water in terms of rainfall, and certain regions have mountainous conditions, which are conducive to agriculture.”

Clearly, preservation of water resources is a priority for the Saudi government. But no less urgent is the task of conversion of green waste to improve soil quality, increase soil productivity and water retention, and reduce demand for irrigation.

The Kingdom is one of at least three Gulf Cooperation Council countries that are taking steps to develop a regulatory framework for the recycling of waste into compost.

Saudi Arabia, the UAE and Oman are respectively aiming to recycle 85 percent, 75 percent and 60 percent of their municipal solid waste over the next decade, according to a report by the Economist Intelligence Unit (EIU) entitled “Global Food Trends to 2030.”

Saudi Arabia and the UAE rank in the bottom quartile of the 34 countries covered by the EIU’s Food Sustainability Index, with low scores for nutrition and food loss and waste. 

The answer, according to many farmers, policymakers and food-industry experts, is a shift toward more sustainable management of each country’s natural resources.