Cancers in women -- a growing health challenge in underserved communities

Three years ago, around this time, it was evident that a global pandemic was upon us, where no one would be exempted from the fear and anxiety of a potential infection.?

April 2020 is also the month I found a lump in my breast during a monthly self-exam and learned that I had stage II breast cancer. My treatment started right away with chemotherapy, followed by two surgeries and radiation therapy. I benefited from high quality public healthcare in Denmark -- surgery at Rigshospitalet and radiation therapy at Herlev og Gentofte Hospital, on a Siemens Healthineers TrueBeam system.??

And yet, that period of my life tested me like never before. I was alone throughout my chemo sessions and during surgery as my husband was not allowed in the hospital due to COVID-19 protocols nor could my family in the USA come stay with us to help out with the kids. I was terrified that I might die from cancer despite being well versed with treatment protocols and survival rates from my two decades of work experience in the healthtech industry.

On one hand, I handled the chemo well, continuing my fitness routine albeit at a slightly slower pace as I finished the 18-week chemo protocol. On the other hand, breast cancer could care less that I was relatively young (45 years), physically active, had no family history and tested negative for the genetic markers. Despite early detection and immediate treatment, the cancer spread to my lymph nodes, making a mastectomy necessary. That was tough to recover from, both mentally and physically.?At some point I realized that breast cancer has a high rate of reoccurrence – on-going monitoring would be critical especially in the first ten years after my diagnosis.?

I have been cancer free for two years now. I am closely monitored by my new oncology team in Singapore, again a country with high quality healthcare. If I do experience a reoccurrence, it is likely to be found early, and I will have access to the best possible healthcare.

Why am I sharing my experience??Because too many women do not have access to the quality of care that I received, especially the advanced diagnostics necessary to classify a tumor and quickly begin treatment. I share my story frequently to encourage other women to do a monthly self-exam. I hate to think what would have happened had I not found my lump early. I often encounter women who have never benefited from an awareness campaign, do not have access to breast cancer screening or when diagnosed, do not have the means to pay for treatment expenses.?

Breast cancer, when caught early, has high survival rates. But it remains the leading cause of cancer deaths among women. During 2020, 2.3 million women like me were diagnosed with breast cancer, with 685,000 deaths globally. The burden of avoidable breast-cancer deaths disproportionately affects low- and middle-income countries (LMICs), where over 70% of breast-cancer deaths are premature occurring in individuals under 70 years of age.1

This month of April is also an important work anniversary for me. One year ago, I became the Head of Access to Care at Siemens Healthineers. Since then, I have had many opportunities to interact with healthcare leaders from across the world on the topic of breast cancer and the challenges LMICs face in managing this disease. ?I am truly humbled by these opportunities to engage with those who are working towards bringing early diagnosis and better care to as many women as possible in low-resource settings.

One of my most memorable interactions was at the World Cancer Congress last October where I had the honor to discuss the treatment of breast and cervical cancer in Africa with several African First Ladies and leaders from the continent. What struck me in these dialogues was their personal commitment and focus to tackle this terrible disease, even when faced with limited resources and a multitude of other socio-economic and health challenges. Just because it is difficult, does not mean it should not be done.

Too many premature deaths occur primarily because of late-stage diagnosis. The typical challenges revolve around patient awareness, which is heavily influenced by social stigma, especially in under-resourced communities where women habitually prioritize the health of their families ahead of their own. There is often lack of diagnostic facilities and long wait times for treatment or a lack of consistency along the breast cancer pathway in low-resource settings. Focus on early-detection programs is necessary so that at least 60% of breast cancers are diagnosed and treated early (stages I or II), when treatment is most effective, best tolerated and least costly.1

However, a lot is being done in this space. Many stakeholders have collaborated to improve awareness, strengthen health systems, and make breast cancer screening and treatment accessible.

A mobile mammography van, for instance, considerably improves the issue of early detection. These vans bring the screening test to under resourced communities so women can be scanned in close proximity to where they live, work, and raise their families. To cite an example, Project HEAL is an initiative by the Rotary Club of Mettupalayam and Kovai Medical Center and Hospital (KMCH) in Tamil Nadu, India that runs a mobile mammography clinic and aims to screen over 10,000 underprivileged women annually free of charge while also raising awareness about breast and cervical cancer among these women.

From its base in Barretos, Brazil, Hospital de Amor https://hospitaldeamor.com.br operates 45 mobile mammography vans and screens several hundred thousand women a year across the country, including in the Amazon River basin. The hospital’s program is focused on early detection in order to find breast cancer at Stages 0, I or II, thereby helping to extend and improve the quality of life of women. Hospital de Amor provides free of charge treatment to patients and exemplifies what it means to put patients first.

Cancer is a complex disease. I know from personal experience that the patient journey is non-linear and confusing even in the best of cases. Treatment requires a multi-disciplinary approach and frequent interactions with healthcare providers over months or even years, which is often neither accessible nor affordable for patients in LMICs. Setting up rural cancer centers close to where patients live can drastically improve patient outcomes by closing the care gap. I have personally witnessed this at Hospital de Amor in Brazil. ?A similar example is nearly completed in the Northeast of India, where Tata Trust is setting up rural cancer centers with advanced diagnostics and treatment facilities to manage the rising cancer burden of this region.?These, and many other examples, demonstrate that it is possible to achieve equity in access to care for women’s health.

Next month, I will have the honor of hosting a dialogue focusing on improving access to breast and cervical cancer care for LMICs on the occasion of 76th World Health Assembly in Geneva. I am looking forward to learn from leaders representing the full spectrum of stakeholders in women’s health on how we all can collaborate for better cancer management so that women in low resource settings also benefit from the same advancements as developed health systems. Early detection of breast cancer has led to a remarkable improvement in survival rates over the past 30 years in well funded health systems. It is our obligation to ensure these lessons are applied for women across the world, no matter where they live.

The breast cancer burden is projected to increase to 2.74 million new cases and 857,000 deaths annually by 2030, worldwide.1 It is time to come together globally across sectors to make an impact and provide sustainable, affordable and equitable cancer care in women. Because where you live, shouldn’t determine if you live.

Source

1 Global Breast Cancer Initiative Implementation Framework 2023 by WHO