To some extent, the high mortality rate reflects the fact that women don't get treated until late in the course of the disease. "Early detection is a problem in Africa," Anderson says, "because it is commonly believed that breast cancer is associated with things you did wrong. It's a 'dirty' disease that happens from wearing dirty clothing or putting money inside a bra or sucking on a nipple." (As a reminder of how far we have come in the United States, Moddelmog says local newspapers wouldn't print the words "breast cancer" in their coverage of the first Race for the Cure 26 years ago.) Anderson says many African women believe that if they see a doctor, he will cut off their breast and they will be dead in two years anyway. There's some truth in that, he says, since many women come in after their cancer has already started to spread and they frequently get no additional therapy after a mastectomy. Because their cancers are often so advanced, Anderson says, "the treatment options are limited and very expensive. If we find it earlier, it's much more affordable."

Overcoming that dangerous delay in detection and treatment will not be easy. In addition to dispelling cultural beliefs about breast cancer, doctors also have to compete with herbalists who claim to be able to cure everything from breast cancer to stroke, using traditional medicines, Anderson says.

Promoting early detection is a critical first step. For now, that means more physical exams, which are not the best way to catch cancers in the very initial stages. Screening mammograms—standard in this country—are rare in Africa. At this point, because machines and trained technicians are scarce, mammography is mainly used to diagnose cancers when a woman has a suspicious lump.

The benefits of reaching out to the developing world could flow both ways. Research on African women is already yielding insights that may someday help scientists understand more about how the disease affects women in this country as well. A particularly aggressive form of the disease known as triple-negative breast cancer is much more common among African and African-American women. (It's called triple negative because it is negative for the three most common markers of breast cancer: estrogen receptors, progesterone receptors, and HER2, the human epidermal growth factor.) No one yet knows why. "It may be that the breast cancers that Africans and African-Americans get are more prone to be aggressive," Anderson says. "Or it may be that Caucasians are more likely to be screened regularly so that their breast cancer is detected at earlier stages." He says it's possible that undetected cancers could develop into the more deadly triple-negative form.

Compared to Komen's extensive support of research in the United States—the organization has given away more than $100 million in grants so far this year—the African mission is relatively small, costing about $250,000 in Ghana. But Moddelmog hopes it will inspire more of what she describes as "health diplomacy," a way to build bridges of goodwill connecting women around the world.

© 2008