Advances in therapy are improving outcomes for breast-cancer patients across Egypt, as Ghada Abdel-Kader discovers "I am very proud that God has chosen me to have breast cancer. It puts my faith to a serious test," says Maha Kassem, a 34-year- old chemist and survivor of breast cancer. Kassem's ordeal was lightened by her family, who surrounded her with warmth and love, and "they took care of my twins, Batoul and Zahra, as well as my newly born infant, Abdel-Moneim," Kassem remembers. Kassem was afflicted with breast cancer three years ago. "I was at home. I was breast-feeding Abdel-Moneim, and by mere chance I felt a lump in my breast. Although it was part of my study to become a chemist, I didn't discover the tumour early," Kassem recalls, noting that she has a family history of breast cancer as two of her aunts also suffered from the disease. "I was scared, and I had assured myself that pregnancy and breast-feeding would save me from the disease. I went to the doctor and did a mammogram, and the result was positive," she said. According to Omar Zakaria, an assistant professor of surgery at the Egyptian National Cancer Institute, Kassem had an advanced tumour on the right side of her breast. "She was prescribed primary chemotherapy to stop the rapid growth of the cancer cells, and then she underwent a mastectomy on the right breast. She also had plastic surgery to reconstruct the breast after surgery," he explains. Plastic surgery of this sort rebuilds the breast to approximately the same size and shape as before by using tissues from the patient's stomach and lower abdominal wall. "After a year, Kassem also developed breast cancer in her left breast, but it was at an early stage, and there was a good response to chemotherapy," Zakaria adds. Kassem herself has positive memories of the treatment despite her fears. "Thank God, when I woke after the surgery I didn't feel the change, and I did not feel as if I had had my breast removed. This gave me self-confidence and raised my spirits before I started chemotherapy and radiotherapy," she remembers. "I had three lots of surgery, which cost a lot of money. Since I work in the private sector, I do not have state-sector medical insurance, but I was treated by the Egyptian National Cancer Institute for free," Kassem adds. As a result of her experience, Kassem decided to volunteer for the Egyptian Breast Cancer Foundation, feeling that it was her duty to pass on her experience to other women and teach them how to do self-examinations at home. "I noticed through my visits to people's houses that women are afraid of this disease to the extent that they don't even utter its name, preferring to call it the 'bad disease'," Kassem says. She believes the many women are afraid of breast examinations, because breast cancer affects an intimate part of a woman's body, and society prefers to treat woman's issues in total silence. For Kassem, however, it is important that all women undergo check-ups against breast cancer. "Detecting and treating cancer in its early stage costs much less than at a late stage," she affirms and has a much greater chance of success. According to World Health Organisation (WHO) statistics, there were 10 million cancer cases worldwide in the year 2000, and these will rise to 16 million new cases by the year 2020. Most of them will be in developing countries. According to Zakaria, "we don't have exact data about the number of cancer patients in Egypt, but the cancer medical centres intend to carry out a survey of the number of women with breast cancer in each district in all Egypt's governorates." However, as Kassem's experience indicates, breast cancer can today be successfully treated. According to Shahla Masood, professor of pathology at the University of Florida, Jacksonville, many new therapies, types of diagnosis and procedures have become available. Chemotherapy now aims to provide personalised medicine tailored to each patient, Masood said in an interview with Al-Ahram Weekly. "Understanding the disease of every single person helps to make treatment focus on the characteristics of individual tumours," she said. Masood explained that cancer can have multiple causes. Smoking, drinking alcohol, a stressful life, eating unhealthy food, a high-fat diet, being overweight and not taking enough exercise are all risk factors for breast cancer, as are having plastic surgery or breast implants, having cancer in the family history, not having children, or having a first child after the age of 30. For her part, Ibtessam Saadeddin, professor of clinical oncology at Cairo University, believes that the new therapies depend mainly on early detection. As a result of the new techniques, women can maintain their breasts, Saadeddin says, and instead of undergoing total removal, the "patient will have surgery only to remove the infected part of the breast, which is made up of the lymph nodes. This will be followed by radiation therapy, and new forms of chemotherapy that have fewer side effects such as nausea, vomiting, loss of appetite and fatigue. The new techniques help patients live an ordinary life and continue their job without suffering," Saadeddin says. Gene therapy is also a promising new approach in the treatment of breast cancer, she says. This has no side effects, unlike chemotherapy and hormone therapy, and consists of the delivery of a gene to the cancer cells. At present, however, this new technique can only be used in selected cases. Harry J. de Koning, a professor in the Department of Public Health at the University Medical Centre in Rotterdam, the Netherlands, agrees that "breast cancer, if, diagnosed early enough, can be fully recovered from. Any woman should be aware of her breast and should do a self-exam by seeking information on how to do it for the first time. If a woman does this kind of examination on a regular basis, she will get used to the nature of her breasts and become aware of any changes that occur." According to Tarek Shouman, a professor of oncology at the National Cancer Institute, "early detection raises the patient's chances of recovery to 95 per cent. It also saves a lot of expense for the patient and the government. All the new therapies are expensive, and it is difficult for any individual to bear the expense herself. Government policy is to pay for these treatments, however. As an indication, the total cost per breast cancer patient treated with chemotherapy is between LE150,000 and LE250,000." Finally, the founder of the Breast Cancer Foundation of Egypt, Lois Crooks, says that "I was diagnosed by finding a tumour myself 20 years ago. Now I am 76 years old and am a 20-year breast-cancer survivor. I had immediate care in the United States. I don't have a very large family, and I took my own decisions." "I think what we have to do in Egypt is to have more NGOs. No government can do this on their own. NGOs have to work with the government to make up for the lack of certain things. This is citizen's obligation towards society: you have to share if people are suffering," Crooks says. How can I check for breast cancer? Self-Examination : A woman should check her breasts every month beginning at about the age of 20. At this early age, any small lumps are probably just normal breast glands and ducts. Over time, a woman will get used to how her breasts normally feel, so that she will be able to tell if a new lump appears. The best time to check the breasts is a few days after a period. If a woman does not have periods, or if they come at varying times, she should check her breasts at the same time every month. Annual breasts examination : A physician should check a woman's breasts every three years for women aged from 20 to 39. Examinations should take place annually for women aged 40 and over. Regular mammograms or X-Rays : Women aged 40 and over should get a mammogram every one or two years. If there are risk factors for breast cancer, such as a family history of breast cancer, women may want to have mammograms more often or start having them sooner. What are the steps to take after discovering a tumour? - Confirm the diagnosis of breast cancer. - Try to understand the kind of cancer you have, as cancer has multiple types. Ask your physician and make sure you have the best available therapy. - Try to learn as much as you can about the cancer. Don't leap at having therapy immediately: cancer occurs over a long period of some six to ten years. Get a second opinion and see other physicians. Cancer is different from one patient to another, and it is important that patients find the right team to work with.
