Breast Cancer: A Big Problem Beyond U.S. Borders

She was a homecoming queen turned professional model. But after my sister, Suzy, was diagnosed with breast cancer in 1977, people in our hometown of Peoria, Ill., crossed the street when they saw her coming. They thought she was contagious, unclean—a modern-day leper. Betty Ford and Shirley Temple had had much-publicized mastectomies a few years earlier, but a culture of fear and confusion still surrounded the disease. Families struggled to talk about it, and doctors struggled to treat it.

After three gruesome years, nine operations, and four courses of chemotherapy and radiation, Suzy was told she was cured. She wasn't. She died in 1980 at 36. She was so frail the last time I saw her at the airport in Peoria—knees wobbly, wig askew—that I thought she might crumble in my arms.

Less than three decades later, the picture is very different for those diagnosed with breast cancer. Early detection and survival rates have improved dramatically, a shift that Susan G. Komen for the Cure—the organization I established in my sister's honor—has been proud to promote. Personalized programs have replaced a "one treatment fits all" approach, and the five-year survival rate has leaped from 74 to 98 percent. Some 2.5 million women—and some men, too—can now call themselves breast-cancer survivors.

But that's in the U.S. Elsewhere, the picture is bleak and getting bleaker. Once an affliction faced by mostly white, mostly affluent city dwellers in America and Europe, breast cancer is ravaging the rest of the world at an alarming rate. Of the more than 1 million new cases expected next year, almost half will be fatal—and 55 percent will come from poorer countries in Africa, Asia, and Latin America, according to a recent Harvard study. By 2020 researchers expect 70 percent of new breast-cancer cases to be found in these comparatively disadvantaged parts of the world, where treatment is scarce and the social climate makes '70s-era Peoria seem progressive.

With shame comes secrecy and misinformation. Last summer I was pulled aside by a newly diagnosed woman in central India who wanted to know whether she would infect her children. In other areas, breast-cancer patients are still forced to use separate plates and spoons, and their husbands are more likely to leave them after mastectomies. Since breast-saving radiation equipment is scarce in most of the world, many women are forced into an ugly choice: death or divorce.

It's a travesty that one in three women worldwide doesn't have access to mammograms or chooses not to get them. It's also a tragedy. In developing areas of India, more than two thirds of cases aren't caught until the cancer has spread to other parts of the body. In the U.S., by contrast, more than half of cases are caught locally, when cancer is confined to the breast.

Mammograms, the subject of much recent debate, are not perfect. They lead to false positives, unnecessary biopsies, and profound anxiety. The technology must become more capable of distinguishing between deadly, aggressive tumors that need to be treated and relatively safe slow-growers that don't. But right now, mammograms are the best screening tool we have; they save thousands of lives each year in this country. So rather than debate what age to start screening, and how frequently to do so, we should focus on increasing access to mammograms for everyone—not creating artificial impediments for the relatively few women who are able to get one.

When I began this work, breast cancer was scandalously underfunded relative to other cancers, and corporate titans tossed me out of their offices at the word "mammogram" (bad for business, they said). We've come a long way in America toward improving attitudes and treatment. The same must now happen beyond our borders.

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