Where is breast cancer?

在哪里乳腺癌?

Loren Bonner, DOTmed News Online Editor | November 01, 2013
From the November 2013 issue of HealthCare Business News magazine

While it would probably be appropriate to comment about the glitches Americans have encountered when logging onto the new health care exchanges, which rolled out under Obamacare Oct. 1, I will let the 30 million other talking heads do that job for me. Instead, I'm going to bring up something health care related of course - that probably isn't on people's minds these days.

The New York Times recently ran an article about breast cancer in Uganda. It's a heart-wrenching piece about fighting stigma, poverty, and corruption for women who have tumors that are so far along, doctors can do little to treat them. Breast cancer in that part of the world is usually not diagnosed until it has reached Stage 4.

But when doctors do intervene, it's usually with mastectomy - even for a small lump -because the technology is not available to perform a lumpectomy.

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It's amazing to think about the strides that have been made in tackling infectious diseases in developing countries, but when it comes to cancer - an increasingly common disease worldwide as people live longer - not much has been done in the way of detection and treatment.

"Cancer has long been neglected in developing countries, overshadowed by the struggle against more acute threats like malaria and AIDS," Denise Grady, the article's author, writes.

However, it sounds like the conversation is just now beginning to take hold. American experts think the best approach is to teach doctors how to use ultrasound to examine lumps that women have already detected. Ultrasound is also an inexpensive and rugged technology perfectly suited for the developing world. Mammography, on the other hand, would not be feasible due too cost and training and also because it might not do the best job of detecting tumors in African patients under 50. Doctors find more aggressive tumors in young African women just like they do in young black women in the U.S. Not an ideal situation, especially taking into consideration the young children these women leave behind.

Cancer detection and treatment in Africa is such a far cry from the rapid pace of progress for detecting and treating the disease in the West, and especially in the United States. Women here, for example, who have an inherited risk of breast cancer, can get a blood test to see if they have a mutation in the BRCA1 or BRCA2 gene, which puts them at a higher risk of developing breast cancer. But in Africa, most women don't even know what cancer is. As one doctor quoted in the article says, "A woman finds a lump in her breast, and cancer doesn't cross her mind. It's not in her vocabulary."

With so many barriers to care, it's hard to know where to begin. I hope I can report more on breast cancer screening around the world.

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