Why the benefits of regular screening for breast cancer still elude many Arab women

Special Why the benefits of regular screening for breast cancer still elude many Arab women
Many campaigns and events across the region aim to raise awareness of breast cancer. (AFP)
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Updated 20 October 2022

Why the benefits of regular screening for breast cancer still elude many Arab women

Why the benefits of regular screening for breast cancer still elude many Arab women
  • Cancer is often associated with social stigma in Arab societies, leading to late diagnosis and higher mortality 
  • Early breast cancer diagnosis can result in much less aggressive treatments and a far higher survival rate

DUBAI: Despite significant efforts at early detection and new treatments, breast cancer claims the lives of over 680,000 women every year. In the Middle East, Arab women can be divided into categories including the proactive, fearful and negligent, as well as many who lack access to finances and proper care.

Afrah, a Dubai-based learning assistant from Yemen, is constantly encouraged by her husband to visit a breast-screening clinic for an exam. She repeatedly replies: “I don’t think it is necessary, as I am performing self-examination at home,” the 42-year-old told Arab News. “I think I am supposed to start visiting a breast clinic for a checkup now.”

Her tone does not suggest that she will do so, and she is not the only one.

Despite national breast cancer awareness campaigns across the Middle East launched every October, inspirational survivor stories, technological advancement in early detection and treatment, and the moderate growth in the number of women visiting clinics for mammograms, a large number of Arab women are still hesitant, with many afraid of possibly receiving terrible news.




Financial and social factors also keep women from accessing regular screening. In many Arab countries, annual mammograms are not covered by health insurance. (German Jordanian University)

Fawziah, a 44-year-old Emirati engineer, who lost her mother to cancer, has been going for her annual checkups for 10 years. “Women who feel reluctant to do regular checkups always come up with different excuses. But in my opinion, all these excuses are just evasion and fear,” she told Arab News.

In 2020, there were 2.3 million women diagnosed with breast cancer. In the five years up to the end of 2020, there were 7.8 million women alive who were diagnosed, making it the most prevalent cancer worldwide.

With significant advancements in early detection and massive awareness campaigns, breast cancer mortality rates have certainly reduced over the past four decades.

However, the danger continues to lurk in the darkness as long-held taboos, shame and negligence overwhelm conservative communities. Many countries across the region have been working to educate the public and stress the importance of early detection.

Burying one’s head in the sand can be risky, said Dr. Millicent Bello, a prominent breast oncoplastic surgeon at Fakeeh University Hospital in Dubai.

“I think there is a bit of anxiety and fear of (being diagnosed with) breast cancer in the majority of women. Even (among) doctors, nobody wants to be told they have breast cancer,” she told Arab News.

Bello said that not going for regular tests was “just like allowing some small fire to become a major, major fire.” 

Misconceptions and misinformation also play a role as many women get their information on mammograms online or from relatives, said Dr. Shireen Ahmad, a radiologist at King’s College Hospital London-Dubai.




A large number of Arab women are still hesitant to visit clinics, with many afraid of possibly receiving terrible news. (FOCP)

Women are also afraid of the effects of radiation, Ahmad explained to Arab News. “I tell all my ladies: ‘Do you think twice about jumping on the plane and flying to London for your shopping? You don’t. You don’t even think about the amount of radiation you get on a flight.’ It is equivalent to the dose you get from the mammogram,” she said.

Financial and social factors also keep women from accessing regular screening. In many Arab countries, annual mammograms are not covered by health insurance.

When a lump is found the patient is required to keep checking it regularly. “This can be stressful, and costly, too, so she stays away from screening from the very beginning,” Faten, a Jordanian nurse who requested anonymity, said in an interview with Arab News from Amman.

“Not all the segments of society realize that cancer can be cured and patients can resume their normal life,” Faten added, explaining that female cancer patients prefer not to share their status to avoid questions about details they consider private and personal.

Researchers say that cancer in general and breast cancer in particular is associated with significant social stigma in many Arab societies. There are feelings of shame and guilt, and sometimes cancer is even viewed as a sign of punishment for undisclosed sins.

Earlier this year, a study published in the American Society of Clinical Oncology Journal titled “Cancer Burden Among Arab-World Females in 2020: Working Toward Improving Outcomes,” said that one in six women will develop cancer during their lifetime, and one in 11 women will die from the disease.




In 2020, there were 2.3 million women diagnosed with breast cancer. (AFP)

The study acknowledges that data on female cancers in the Arab region is “scarce.” However, it is the most common cancer in incidence and mortality among Arab women, who account for nearly 48 percent of the 445 million Arab population.

Another study, “Breast Cancer in the Arab World,” published in Springer, stated that the exact prevalence and incidence of cases are not known due to the lack of structured cancer registries.

“In addition, mortality registries and disease-specific mortality records are lacking and largely unknown.” 

The study added that most Arab countries do not have structured universal screening programs and “most women who undergo mammograms are either self-motivated, advised by afflicted family members, or motivated (by) physicians.”

Moreover, mammography centers, trained personnel, and “existing units are not universally monitored for quality, results, and reporting by any overseeing agency.”

Delay in seeking medical advice and impaired access to adequate care leads to Arab female cancer patients being diagnosed in the more advanced stages of the disease compared to women in Western countries, according to the study.

“With few exceptions … Arab countries lack universal access to comprehensive cancer care centers or patient care by specialized cancer care teams with the adequate advanced oncologic training and expertise needed to provide required complicated treatment plans, leading to suboptimal cancer care,” the study stated.




Researchers say that cancer in general and breast cancer in particular is associated with significant social stigma in many Arab societies. (AFP)

For example, “the rate of modified radical mastectomies in Arab countries is much higher than that in internationally reported literature,” reaching up to two-thirds of cases. Nearly 21 percent of patients undergoing such a procedure will develop clinically significant lymphedema or swelling, which could be avoided in some patients.

Radical mastectomies, in which the entire breast, chest muscle, and often the lymph nodes are removed, are often performed due to insufficient radiation therapy. More advanced techniques and procedures, such as removing the lymph nodes for biopsy, are also unavailable.

Moreover, reconstructive surgeries are not always available, and health insurance does not cover them when they are.

The high cost of cancer treatment in the Arab world adds to patients’ burdens. Researchers noted that medications and financial coverage by governmental and non-governmental insurance plans are limited. New and expensive treatments for breast cancer are available in some high-income Arab countries.

The introduction of “immuno-oncology” and targeted therapy drugs were among the leading cancer treatment developments in the past few years in treating cancer, Dr. Khawla Abu Izza, an Arab-American pharmaceutical development and CMC, or Chemistry, Manufacture and Control, regulatory consultant, told Arab News.

These drugs generally are reserved for patients at an advanced stage of the disease. There are few exceptions, said Abu Izza




Burying one’s head in the sand can be risky, said Dr. Millicent Bello, a prominent breast oncoplastic surgeon. (Breast Cancer Foundation of Egypt)

“There have been several significant developments in the treatment of breast cancer, each contributing to the improvement of the outcome for patients, but we cannot point to a single major development that made a huge difference … Some of the developments were in the dosing regimens for radiation therapy or improvements in the surgical procedures.”

In some of the medical institutions in the Gulf region, highly advanced screening machines have become available, and their results are very precise, according to Ahmad.

New technology in screening machines can test the softness and the hardness of lesions, and dye can be used to highlight tumors.

Ahmad said wire localization biopsies and radioactive seed localizations are among the procedures used to identify the targeted area before surgical procedures are done.

Bello stressed that research into breast cancer is continuously underway to achieve better results. “Over the years, research into breast cancer has continued regardless of COVID … Surgeries are more personalized, and there is no one size that fits all.” 

However, the core message remains the same: Early diagnosis leads to less aggressive treatment and a much higher survival rate.


Netanyahu convenes Iran war drill, scorns UN nuclear watchdog

Netanyahu convenes Iran war drill, scorns UN nuclear watchdog
Updated 12 sec ago

Netanyahu convenes Iran war drill, scorns UN nuclear watchdog

Netanyahu convenes Iran war drill, scorns UN nuclear watchdog
  • Iran had provided a satisfactory answer on one case of suspect uranium particles and re-installed some monitoring equipment originally put in place under a now-defunct 2015 nuclear deal

JERUSALEM: Israeli Prime Minister Benjamin Netanyahu ramped up threats to attack Iranian nuclear facilities on Sunday, convening a rare cabinet war drill after he accused UN inspectors of failing to confront Tehran.
With Iran having enriched enough uranium to 60 percent fissile purity for two nuclear bombs, if refined further — something it denies wanting or planning — Israel has redoubled threats to launch preemptive military strikes if international diplomacy fails. Israel has long maintained that for diplomacy to succeed, Iran must be faced with a credible military threat.
“We are committed to acting against Iran’s nuclear (drive), against missile attacks on Israel and the possibility of these fronts joining up,” Netanyahu said in a video statement from Israel’s underground command bunker at its military headquarters in Tel Aviv.
The possibility of multiple fronts, Netanyahu said while surrounded by security cabinet ministers and defense chiefs, requires Israel’s leadership “consider, if possible consider ahead of time,” its major decisions.
Netanyahu’s office issued footage of the drill. The publicity around the preparations appeared to depart from Israel’s 1981 strike on an Iraqi nuclear reactor and a similar sortie in Syria in 2007, carried out without forewarning.

UN WATCHDOG SAID IRAN PROVIDED SATISFACTORY ANSWER
Earlier, Netanyahu levelled sharp criticism of the International Atomic Energy Agency (IAEA), following a report last week by the UN watchdog that Iran had provided a satisfactory answer on one case of suspect uranium particles and re-installed some monitoring equipment originally put in place under a now-defunct 2015 nuclear deal.
“Iran is continuing to lie to the International Atomic Energy Agency. The agency’s capitulation to Iranian pressure is a black stain on its record,” Netanyahu told his cabinet in televised remarks. The watchdog risked politicization that would lose it its significance on Iran, he said.
The IAEA declined to comment.
On Wednesday, the agency reported that after years of investigation and lack of progress, Iran had given a satisfactory answer to explain one of three sites at which uranium particles had been detected.
Those particles could be explained by the presence of a onetime Soviet-operated mine and lab there and the IAEA had no further questions, a senior diplomat in Vienna said.
In an apparent reference to this, Netanyahu said Iran’s explanations were “technically impossible.”
However, the Vienna diplomat also said the IAEA’s assessment remained that Iran carried out explosives testing there decades ago that was relevant to nuclear weapons.
After then US President Donald Trump quit the Iran nuclear deal in 2018, Tehran ramped up uranium enrichment. Israeli and Western officials say it could switch from enrichment at 60 percent fissile purity to 90 percent — weapons-grade — within a few weeks.
In a 2012 UN speech, Netanyahu deemed 90 percent enrichment by Iran a “red line” that could trigger preemptive strikes.
Military experts are divided, however, on whether Israel — whose advanced military is believed to be nuclear-armed — has the conventional clout to deliver lasting damage to Iranian targets that are distant, dispersed and well-defended.
Focussing domestic attention on Iran might provide Netanyahu with respite from a months-long crisis over his proposals to overhaul Israel’s judiciary. But opinion polls showed that both those concerns are trumped, for Israelis, by high living costs.

 


Kuwaiti, UN official discuss global food security 

Kuwaiti, UN official discuss global food security 
Updated 04 June 2023

Kuwaiti, UN official discuss global food security 

Kuwaiti, UN official discuss global food security 
  • Kuwaiti deputy FM received UN Coordinator for the Black Sea Grain Initiative

KUWAIT: Mansour Alotaibi, Kuwait’s deputy foreign minister, met on Sunday with  Abdullah Dashti, UN Coordinator for the Black Sea Grain Initiative, Kuwait News Agency reported. 

During the meeting, the two discussed issues relating to global food security.

The UN and Turkey brokered the Black Sea Grain Initiative between Moscow and Kyiv last July to help tackle a global food crisis aggravated by Russia’s February 2022 invasion of Ukraine, a leading global grain exporter.

Ukraine would be ready to continue exporting grain across the Black Sea as part of a “plan B” without Russian backing if Moscow pulls the plug on the current grain export deal and it collapses, Ukraine’s farm minister said on Friday.
 


Palestinian residents ‘in constant fear’ over eviction threat

Palestinian residents ‘in constant fear’ over eviction threat
Updated 04 June 2023

Palestinian residents ‘in constant fear’ over eviction threat

Palestinian residents ‘in constant fear’ over eviction threat
  • Israeli Supreme Court has approved the expulsion of Palestinians from Masafer Yatta, claiming the area is a “firing zone”

RAMALLAH: Residents of Masafer Yatta, south of Hebron in the West Bank, are living in constant fear they will be forced from their homes by Israeli troops. 

The Israeli Supreme Court has approved the expulsion of Palestinians from Masafer Yatta, claiming the area is a “firing zone.”

Most roads leading to the collection of villages have been closed by the Israeli army, residents said, while Israel has also allowed the establishment of six settlement outposts in the area.

About 3,000 people live in Masafer Yatta, spread over 14 villages.

Residents, many living in tin-roofed dwellings and in caves, say they will not leave whatever the cost.

The Palestinians say they could be evicted at any time amid an escalation of the Israeli army’s campaign to demolish homes in Area C in the West Bank.

Palestinians’ fears are growing following a rise in the number of violent settler attacks against them and the establishment of settlement outposts on their land.

Settlers also burn residents’ crops, and prevent livestock from reaching pastures or water springs.

Grazing areas have been seized, and residential caves and Palestinian farms destroyed.

There are also concerns over what the Palestinians see as a decline in popular and international pressure on the Israeli government to back down from implementing the court’s decision to evict them.

Masafer Yatta residents on Friday called for urgent action to protect them from attacks and attempts to expel them.

Nidal Younis, head of the Masafer Yatta Village Council, told Arab News that settler attacks on residents have increased dramatically in recent weeks.

The Israeli army tolerates the violence, he said.

Residents have filed complaints with the Israeli police, but to no avail.

Shawan Jabarin, director general of the Palestinian Al-Haq Association for Human Rights, told Arab News that European and international diplomatic pressure on the Israeli government had eased, which may embolden the Israeli authorities to implement the court’s decision to evict the residents.

Palestinian sources believe Israel’s right-wing parties will push to have the West Bank annexed before the fall of the current regime, he said.

Jabarin said the International Criminal Court should pressure the Israeli government to back down on the eviction plan.

Settlers have become “tools used by the Israeli army to seize large areas of Palestinian land, from Masafer Yatta in the south to the northern West Bank,” he said.

Younis Arar, head of the International Relations Unit in the Settlement and Wall Resistance Commission, told Arab News that he feared Israeli military authorities could deport the residents of Masafer Yatta at any moment.

He described any deportation attempt as “a new catastrophe,” and said there was no European, international or even Arab pressure on the Israeli government to discourage it from taking such a step.

The Palestinian National Initiative movement described the Israeli court’s approval of the expulsion plan as ethnic cleansing committed by Israel against the Palestinian people.

“The successive Israeli occupation governments have been seeking for several years, through their arbitrary measures and continuous repression of our people in Masafer Yatta, to uproot and expel them to implement their settlement expansion plans,” it said.


Christian opposition backs Jihad Azour’s nomination for Lebanon presidency 

Christian opposition backs Jihad Azour’s nomination for Lebanon presidency 
Updated 04 June 2023

Christian opposition backs Jihad Azour’s nomination for Lebanon presidency 

Christian opposition backs Jihad Azour’s nomination for Lebanon presidency 
  • MPs press for new election after uniting around single candidate

BEIRUT: Patriarch Bechara Al-Rai has praised Christian politicians as they united around a presidential candidate, in a move that could end a nearly eight-month power vacuum in Lebanon.

His blessings during Sunday sermon came after opposition parliamentary blocs agreed to support the nomination of Jihad Azour, a former minister who is the director of the International Monetary Fund’s Middle East and Central Asia department.

He is expected to contest the presidency against Suleiman Frangieh, the preferred candidate of Hezbollah, the Amal Movement and their allies.

Al-Rahi also sent Bishop Paul Abdel Sater on Sunday to meet Hezbollah Secretary-General Hassan Nasrallah as part of “dialogue with non-Christian forces, especially Hezbollah, to elect a president for all of Lebanon.”

The bishop is expected to continue visiting all political forces this week.

Sunday’s move by the opposition parliamentary blocs follows an announcement by the Free Patriotic Movement on Saturday.

There is now agreement between Christian MPs, Change MPs and some independent MPs to nominate Azour after Michel Moawad, an MP, withdrew from the election on Sunday.

Some had previously supported Moawad, whom Hezbollah saw as a provocative candidate.

The Progressive Socialist Party bloc is due to announce its position on Azour on Tuesday.

The decision to back Azour by the FPM, the largest Christian party in parliament, came after its leader Gebran Bassil fell out with Hezbollah after the group’s nomination of Frangieh.

“In the event of a call to a presidential election session, the FPM will vote for the agreed-upon name instead of submitting a blank ballot,” he said.

Waddah Sadek, an MP, told Arab News that estimates of the opposition indicate that Azour will receive more than 65 votes, which means he would win if a vote went to a second round.

“The ball will then be in the court of Parliament Speaker Nabih Berri, who has been delaying the call for an election session since January unless he and his allies secure the election of Frangieh,” he said.

MPs have failed in 11 sessions to elect a new president due to the lack of quorum in the second round of each, as a result of the withdrawal of Hezbollah and Amal Movement MPs.

Hashem Safi, the head of the party's political council, dismissed the significance of Azour’s nomination.

“There is no single party capable of electing a president in Lebanon, regardless of the candidate's name, nature, affiliation, color, or political choices,” he said. “Therefore, unless the parties agree with each other, we cannot accomplish the presidential election."

During his sermon, Al-Rahi said: “If the political officials invoked God, they would have elected a president within the two months before the end of Michel Aoun’s term.

“They would have rushed to agree on electing a president that Lebanon needs in the face of complete political, economic, financial, and social collapse.”

Mohammed Khawaja, an Amal MP, said that the nomination of Azour was a ruse to block Frangieh, adding that he lacked the reformist vision that Lebanon needed.

Former MP Fares Souaid, head of the National Council to End the Iranian Occupation of Lebanon, described the Christian parties’ reconciliation as “brave.”

He said that confronting Hezbollah could not be done through ballot boxes or electoral alliances.

“The confrontation lies in re-forming internal unity around the Lebanese choice based on the Taif Agreement and coexistence,” he said.

“Confronting one sect against another is dangerous. A ballot box against a gun is dangerous. Spreading illusions in the face of killing is dangerous.”


Dubai Customs seizes narcotics destined for Canada 

Dubai Customs seizes narcotics destined for Canada 
Updated 04 June 2023

Dubai Customs seizes narcotics destined for Canada 

Dubai Customs seizes narcotics destined for Canada 
  • Narcotics found in shipping containers originating from an Asian country

DUBAI: Dubai Customs have aided Canadian authorities with the seizure of more than 547 kilograms of drugs destined for the country, Emirates News Agency reported on Sunday. 

The narcotics were found in shipping containers originating from an Asian country. Officers used sophisticated systems for tracking suspicious shipments, the news agency said.

The drug seizure was in line with the authority’s efforts to combat cross-border crimes and prevent the trafficking of illegal substances, it said. 

Dubai Customs Director-General Ahmed Mahboub Musabih  commended his officers “for their exceptional work in intelligence analysis, shipment tracking, and the seamless exchange of information and expertise in all aspects of security and customs operations.”

Dr. Khaled Al Mansouri, Director of Customs Intelligence Department at Dubai Customs, added: “The aim is to bolster the UAE's standing in global security. 

“To this end, the government organization dedicates all its resources and capabilities to safeguarding the global supply chain. 

“With internally developed innovative systems, Dubai Customs effectively analyzes data and monitors high-risk operations, driven by its skilled workforce.”