Amira El-Naqeeb looks into Egyptian efforts to fight breast cancer "I won't let this disease steal so many lives. Women in Egypt deserve to be empowered with all the knowledge they need to fight it..." Thus Mohamed Shaalan, associate professor of surgery at Cairo University and chairman of the Breast Cancer Foundation of Egypt (BCFE; www.bcfe.org ), which promotes awareness of the disease. The idea behind BCFE, as he explains, dates back to 1999, when Shaalan was living and working in the US: "Though the rate was four times higher than in Egypt, survival rates were three times higher." Lack of awareness in itself can explain this, with even female doctors refraining from any mention of "the bad disease". To this day, indeed, many Egyptians will refer to cancer patients as "God protect us, those who have that disease". Since 2004, with 24 founding members, BCFE, the only registered NGO with this specific mandate, promotes a vision of "life without breast cancer". According to Nevine Tork, BCFE researcher, the foundation offers women free or subsidized services, depending on the finding of the financial assessment system. Direct services include limphadima post surgery programme, prostheses and mammogram tests. Screening programmes as well as support groups are run by breast cancer survivors who studied a psychology course with regard to such matters. The sight of the once empty reception hall at the Information Authority -- now buzzing with activity, thanks largely to the BCFE initiative to visit companies and institutions and perform checkups there -- is in itself a sign of improvement. Here as elsewhere posters demonstrate the screening programme stages while BCFE employees help employees through registration. The programme includes a lecture on the Breast Self Exam (BSE), followed by a clinical examination and a mammogram/sonogram referral paid by the BCFE if needed. The employees whom I joined first fill out a questionnaire checking knowledge of breast cancer and medical history. My companions were mostly middle-aged women as curious as they were anxious. Lawahez Ahmed, for one, recounted how when one family member discovered the lump while being tickled by her granddaughter one day, led her to discover her own. "Had they not come to our doors, I wouldn't have seen a doctor." By the end the stressed out expressions were replaced by calm poise. But the efforts don't stop here, as Tork explains. Called "the hidden enemy" because it has no clear symptoms as such, breast cancer makes for a particularly subtle menace; and the BCFE spares no effort to help people recognise it: "We also have the direct service; people come directly to our offices where we offer different programmes including financial assessment." The latter offers help according to ability; since the work is subsidised, however, the vast majority of services are free. "Run for Cure" -- another initiative -- is an annual free-entrance sports day at the Gezira Club. As BCFE media coordinator Ghada Mustafa explained, "We have participants from different age groups and backgrounds." Few have anything to do with breast cancer. The importance of the event, rather, is that it takes advantage of the presence of large numbers of people to raise awareness. "When a six-year-old runs for breast cancer, they are far less likely to be afraid of talking about it when they grow up," Shallan added. World Health Organisation (WHO) reports indicate that 75 percent of breast cancer will be located in developing countries by 2020. Salah Labib, Health Ministry official and the head of the Cancer Recording and Evaluation (CARE) project, explained how Egypt is gearing up for the challenge, "We had to come up with a national plan; the project, under the auspices of Mrs Suzane Mubarak, has set priorities." Early detection is coupled with a national database of patients, while doctors working in the field are periodically trained; the latter part of the plan has been going on since 2004. Oncology protocols are drafted by the finest cancer professors, and an Internet network of cancer institutions allows for diagnosis by video conference. According to Labib this makes Egypt the first developing country, and the first in the Middle East, with a systematic battle against cancer. CARE also reaches out to all economic strata, holding conferences and lectures on cancer awareness, prevention and treatment: "Two months ago we started reaching out to 302 destinations in different governorates using medical convoys. We will soon be heading out to Upper Egypt as well." National Cancer Institute (NCI) statistics place breast cancer at the top of the list of problems, with 9,233 cases in the national registry by December 2005. According to Labib, the Health Ministry is trying to change the profile of breast cancer in Egypt: "We have printed 20,000 educational pamphlets and distributed them to hospitals, private practises and medical centres. We're not expecting immediate results, but already there is an outcome." As NCI surgeon Mohamed Abul'ela indicates, "We used to have women coming to us with tumours the size of an orange; now they tend to come earlier." Shaalan agrees: "A stage zero or one tumour can be removed by microscopic surgery; then we can spare her the drama of mastectomy." A check-up at a time of uncertainty has saved the life of many women. Sahar Sarwat, a breast cancer survivor, had felt chest pains while sitting around her husband, a heavy smoker. When this became more frequent and was happening in the company of others, she went alone to have an X-ray, answering "Both" to the question of whether she wanted a lung X-ray or a mammogram. When she was diagnosed with breast cancer, she went for a mastectomy only two days later: "I wanted to get rid of the cancer in my body as soon as I could. The day I went in for surgery," she goes on, "there was a demonstration of love outside the room. I had immense support from all my family and friends." It was a confirmation of the power of human relationships in her life. Grateful to be alive, Sarwat is optimistic; and the experience has left her with a healthier lifestyle and a commitment to voluntary work at the BCEF. Others are facing, on top of the illness, difficulties in procuring the required health care; treatment is in itself what many aspire to. At the NCI patients stand in a long queue before they can reach the reception desk; another queue leads to the doctors. The space is badly ventilated; bearing her X-ray, a patient in tears begs the nurse to let her in, then turns to me, having heard me say the doctor's name on the phone: "I just want to ask him a simple question. I came a long way. They won't let me in." This spoke volumes about how psychological factors might cause a deterioration of health following diagnosis. According to Abul'ela, "I don't think there is any counselling to speak of in Egypt, nothing to facilitate rehabilitation. I think much depends on the doctor-patient relationship." On a positive note, Shaalan added that BCFE provides for the training of doctors and nurses on dealing with psychological aspects of cancer. "We have just completed training 100 nurses and the same number of doctors in Alexandria." Proudly, he said, they are reaping the fruit of their work: "We managed to procure 3,800 square metres of land in 6 October City for a comprehensive breast cancer centre to include counselling as well as medical care." Counselling remains a key element in helping patients through this difficult journey. As Labib puts it, "This is partly why we're spreading the word about the importance of early detection. We want to save people the psychological trauma involved." Yet sometimes the problem is the doctor, not the patient. NCI surgery professor Ashraf Saad Zaghloul says that, while there is progress in awareness among women, "The same is not true of some doctors. We need a law that prohibits General Practitioners or any doctor who is not a cancer specialist from interfering with a cancer case." Such doctors, he elaborates, do more harm than good: "And the victim is always the patient. It's the responsibility of the Doctors' Syndicate and the Health Ministry." Labib said this problem is being dealt with through oncology protocols, with the editions updated every year. The importance of this is that patients all over Egypt are treated according to the same clearly defined guide lines: "Yes, there are some GPs not familiar with the new protocols. But this is also the role of the universities -- to keep their doctors updated. As a rule the Doctors' Syndicate will always stand for the patients and their rights if the doctor makes a mistake." To contact the Breast Cancer Foundation of Egypt: Tel&fax:3682431/2; Mob:0101707690 For donations use CIB account 6666
