U.S. Breast Cancer Advocates Reach Out to Africa

Not so long ago, talking about breast cancer was considered taboo in this country. That silence was deadly. Many thousands of women died because they weren't screened, didn't recognize early signs of the disease or were afraid to tell anyone about the lump they could feel in their breast. That's changed dramatically in the United States, but not in much of the developing world where death rates continue to rise and early screening is unheard of or unaffordable.

"There is so much stigma that remains against breast cancer, and that's particularly true in Africa," says Hala Moddelmog, president and CEO of Susan G. Komen for the Cure. "A woman who gets breast cancer in Africa is afraid her husband will leave her and that she will be ostracized by society, and even lose her children if she admits she has breast cancer."

If that assessment shocks you, you're not alone. Too often, Americans' view of women's health issues stops at our borders. Because we've made progress, it's easy to forget that women in other parts of the world are still struggling. American successes against breast cancer and other illnesses that affect women like cervical cancer and pregnancy-related health problems should be models for the rest of the world.

There is still so much to do. Breast cancer is one of the leading causes of death for women in the developing world but there are other threats as well. Last week, during the annual debate at the United Nations in New York, officials of many countries got together to pledge support for international efforts to reduce maternal mortality. Their target is a disturbing statistic: every minute of every day, a woman somewhere in the world dies of causes related to pregnancy or childbirth. These losses have a dramatic effect on children as well; infants who lose their mothers are at greater risk of disease and death themselves. (If you're interested in becoming active in this issue, there are some good links at this United Nations Population Fund Web site.

In addition to these international efforts, American non-profits like Komen for the Cure are also beginning to reach out to women around the world. As one of the country's leading breast cancer advocacy groups and the largest funder of research into the disease after the U.S. government, Komen has been highly effective in drawing attention to the cause. On Oct. 13th, a delegation of doctors and advocates organized by the Komen Foundation will travel to Ghana to help dedicate a medical center that will educate, screen and treat breast cancer. Komen is also sponsoring its first Race for the Cure in Tanzania.

It's a critical mission, according to one of the doctors set to make the trip. "Fifty-five percent of breast cancer deaths occur in developing countries," says Dr. Ben Anderson, chair and director of the Breast Health Global Initiative at the Fred Hutchinson Cancer Center and a professor of surgery at the University of Washington in Seattle. If no changes are made, that percentage could increase in coming years because of demography alone. Right now, western Africa, for example, has a relatively young population with few women in their 40s, 50s or 60s—the ages when cancers start becoming more common. "By 2020, and particularly by 2050, these populations will age and there will be much more of this disease," Anderson says.

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.