October may seem awash in pink with breast cancer awareness campaigns everywhere, but anecdotal evidence from health practitioners shows that women, often Arabs, still harbour incorrect and, in many cases, harmful beliefs about the disease and its spread. So for Breast Cancer Awareness Month, we debunk some of these myths in interviews with regional experts.
One of these is the first female Emirati surgeon, Dr Houriya Kazim, who decided to specialise in breast surgery after working as an intern at a Dubai hospital. “I had never seen such advanced cases of breast cancer,” she tells GN Focus. “The women hid it until it was too late just because they did not want to show their breast to a male physician. In our culture, it’s also very common for women to refuse to talk about it, they keep it to themselves. A generation or two ago, breast cancer was never openly talked about and even now in my community, you would never say ‘breast cancer’ because saying it surely means you would get it.”
She says the reluctance to talk about the disease wasn’t confined to the Middle East at the time. “In medical school in Ireland 30 years ago, we were not allowed to use the C-word in front of a patient.
“At the end of the Nineties, when I returned to Dubai as a trained breast surgeon, I couldn’t get the word ‘breast’ on my medical licence nor get a stick diagram of the breast on an educational flyer! Now, breast cancer events take place right here in Dubai and every October, you see awareness programmes all over the city, and in every newspaper and magazine. This is a sure sign that things have changed.”
Dr Houriya started a charity and support group called Brest Friends to create awareness of the disease. It recently partnered with Al Jalila Foundation, an NGO established by His Highness Shaikh Mohammad Bin Rashid Al Maktoum, Vice-President and Prime Minister of the UAE and Ruler of Dubai, to promote early detection, facilitate medical treatment, and set up and fund local research on the subject.
Although it is now much rarer in the UAE to see advanced cases of the sort Dr Houriya did 30 years ago, women remain reluctant to discuss the disease and are less inclined to go for check-ups than elsewhere.
“The main problem for women in the Arab culture is the taboo about discussing medical issues that affect female body parts,” says Dr Samia Al Amoudi, a Saudi Arabia-based consulting obstetrician and gynaecologist and breast cancer survivor.
She is the founder of the Shaikh Mohammad Hussain Al Amoudi Centre of Excellence in Breast Cancer, and the author of Breast Cancer, Break the Silence. “If women don’t talk about breast cancer, they won’t have regular detection tests that catch the cancer at an early, curable stage,” she says.
Ninety-eight per cent of cases that are detected early can gain a full recovery, adds Dr Sawsan Al Madhi, Secretary General of the Friends of Cancer Patients (FOCP) society, a UAE-based charity.“We are beginning to see a breakthrough in consciousness about the issue,” she says. “The media [including] social media are all playing a part in getting the message across that early detection saves lives and what signs to look out for. In many ways this also helps to break down stigmas associated with breast cancer as people become more used to talking about it and start to share personal stories of friends or loved ones who have the disease.”
Without more ado, here are some common misconceptions that exist among Arab women.
1. It’s the patient’s own fault
Women may often believe they are to blame somehow for contracting breast cancer, perhaps because they are victimised in other situations or because of low self-esteem. “A common myth is that the breast cancer patient is somehow responsible for having the disease, as if it is some kind of punishment and then this perception feeds the idea that it is a shameful disease and perpetuates the myth that it is culturally unacceptable to talk about,” says Dr Sawsan. “These myths have no basis in fact and are completely untrue.”
2. Only those with a family history need screening
Most breast cancer patients don’t have a family history of the disease. According to the Cleveland Clinic, only 10 per cent of cases are linked to genetic mutations. That’s why women must have regular screenings and periodic mammograms.
3. Underwire bras, antiperspirants and water bottles can cause breast cancer
There is no evidence to support these myths, says Dr Houriya. “The theory that underwire bras cause cancer is that they restrict the elimination of toxins from the breast leading to cancer. But the breast is not toxic. Many women who complain of painful breasts find it resolves when they wear bras without wires.” Scientists are yet to find a link between the disease and antiperspirants and water bottles. Use BPA-free containers to avoid hormone-disrupting chemicals.
4. Birth control pills raise your risk
Most women feel that birth control pills increase the risk, which is not surprising given that numerous studies support this notion. However, scientists at the Fred Hutchinson Cancer Research Center found the risk of breast cancer was 2.7 times greater for women who took high-dosage estrogen, but lower doses resulted in no greater risk. With most women on low or moderate doses, the risk of breast cancer from birth control pills is minimal.
5. Younger women don’t need to be tested
Cancer can strike at any age, but in the Middle East it seems to strike ten years earlier than in Europe and the US, according to a study in The Lancet Oncology. “For the most part, Arab women not only get cancer at younger ages, they also get more aggressive types of cancer,” says Dr Houriya. “80 per cent
of breast cancer tends to be over the age of 50 in the West, and the risk increases with age. Any lump at any age should always be investigated”.
6. All women must do a monthly self-exam
Breast self-examination (BSE), recommended for decades, doesn’t improve chances of survival. In a long-term study of Russian and Chinese women, the rate of deaths was almost identical for women who conducted BSEs as for those who didn’t. Dr Houriya agrees: “Self-exams need to be in conjunction with age-appropriate clinical exams and screening mammograms.” However, Dr Samia says self-exams do help and it is important to report any changes in breast tissue to your doctor.
7. Lumpy breasts are a bigger risk
Having lumpy breasts doesn’t raise your risk of the disease, though it might make cancer harder to find and isolate. Dr Houriya warns that most women have “lumpy” breasts to some degree as the milk-producing tissue is in little lobules. For the very thin, these lobules can feel “lumpy”. However, a lump is no reason to panic. Four out of five breast lumps turn out not to be cancerous, according to the American Cancer Society. Nevertheless, play it safe and check with a doctor about any noticeable lumps.
8. Breast cancer only affects women
This is another common falsehood, says Dr Sawsan. Men also have breast tissue and can develop it as a result of hormonal imbalances arising from liver diseases or obesity, as well as a genetic predisposition. Although less than 1 per cent of all cases are in men and a man’s risk is about 1 in 1,000, for those who do contract the disease, it can be as devastating as any terminal illness. In the US, 2,240 new cases were expected in 2014, with 410 men likely to die from it this year. Since there is very little awareness, the disease goes untreated far longer.
