Dubai: Despite knowing that early detection is key in cancer treatment, the average UAE resident does not go in for preventive screening owing to the cost factor, cultural sensitivities and a psychological denial about the disease, a recent Gulf News survey has revealed.
Nearly 88 per cent of the respondents replied in the negative when asked whether they go for screenings. They said they had not undergone any kind of preventive cancer screening for over a year.
A key factor in cancer management is early detection, cancer specialists and international health bodies say.
The American Cancer Society (ACS), for example, has a raft of guidelines for men and women for early screening protocols. Women are advised to go for screenings for cervical cancer from the age of 21, while those who have crossed the age of 40 need to go for regular check-ups for breast cancer. Other guidelines by the ACS recommend men above the age of 50 undergo screening for prostate cancer. According to the UAE cancer registry, the top five cancers that affect both genders are breast, colorectal, gastric, thyroid and lung. The key to managing cancers is early screening, which can make the difference between life and death in most cases. Lifestyle factors such as smoking and family history are also important markers to be kept in mind by individuals when it comes to paying attention to cancer screening, according to ACS.
Analysing the reasons for reluctance, Dr Mohanad Diab, consultant oncologist at NMC Speciality Hospital, Abu Dhabi, held all three reasons as the major causes of such tardiness in patients. He told G
ulf News: “The cost of preventive cancer screening is prohibitive as these are not covered by insurance. A mammogram costs a minimum of Dh500, while a Prostrate Specific Antigen (PSA) test for prostate cancer costs Dh300. People feel reluctant to spend such amounts from their own pockets.
The second important reason why people avoid going for a cancer screening is a mixture of fear and complacency.“It’s a tussle between ‘what if I have cancer?’ and a false sense of security brought on by ‘cancer happens to other people, not to me’”, he said.
Dr Diab added said the only way to counter complacency among residents was intense education: “I have noticed that when we launch an intense awareness campaign through text messaging, email, etc, of the ten women we contact, at least five come in for screening. When a patient tests positive for the BRAC gene that can cause breast, ovarian or cervical cancer, we immediately advise these patients to bring in all the women in the family for screening, sometimes offering them a discount on the screening. We also make it a point to tell them of the high risk the women in their family face with this gene and the need to regularly screen them even if they are found to be cancer-free for the moment.
“Health authorities need to become more aggressive about educating the public by launching campaigns through television, posters, public service channels and providing constant reminders on cancer awareness. It will definitely make people more proactive about opting for preventive screening,” Dr Diab said.
Dr Hassan Jafar, consultant oncologist at Tawam Hospital, Al Ain seconded this viewpoint. ““Over the last few years, women have become more proactive about breast cancer [screening] only because of sustained campaigns and we see that they volunteer for mammograms.” Howeve, he attributes a reluctance to go in for preventive screenings in the case of many cancers such as colorectal, ovarian, cervical, prostrate, bladder etc to cultural sensitivities of the region. “These cancers require a thorough, invasive examination and people who are shy are distinctly uncomfortable subjecting themselves to such screenings. They keep putting it off when they have minor discomfort and agree to it only when things get out of hand. By then, patients are already in stage three or four of the disease wherein the cancer may have metastised [spread from one area of the body to the other] and Unfortunately, screening programmes for other cancers have not met with a similar response, said Dr Jafar.
“The health sector needs to get more interactive with the people by involving them in discussions, workshops and ensuring that the message of early detection is drilled into their minds. Constant education is the only way to reach out to the masses,” he added.
Dr Raza Seddiqi, executive director, RAK Hospital and CEO of Arabian Healthcare Group, has observed natural human response to disease and sickness very closely over the years and attributes fear as the main deterrent. “As human beings, people have an ostrich-like approach towards preventive cancer screening. They don’t want to know, and the fear of being diagnosed with cancer serves as a strong deterrent. They are also scared of the repercussions that come with the disease — losing jobs and ostracism, for example. I know of many educated people — including doctors — who inadvertently avoid preventive screening, pushing it at the back of their minds and not giving it due importance. Even free health check-ups do not convince them to go for it.”
He added: “The cost factor comes second because in most cases, insurance does not cover preventive screening. I feel this reinforces the denial factor, giving people yet another excuse not to opt for it. Having said that, I think if somebody is convinced that prevention is better than cure, they will spend any amount of money on their health check-ups. As for cultural sensitivities being a deterrent, it probably figures last on the list.
No insurance cover
Insurance companies operate upon the principle of probability of a disease onset and are more futuristic in their approach and not pre-emptive. Dr Sanjay Paithankar, proprietor of a Third Party Insurance Provider in the UAE, explained: “Worldwide, preventive care costs, including immunisations, have never been included in insurance plans. However, many insurance companies now include pre-insurance check-ups to rule out pre-existing conditions. If residents really want to go in for subsidised preventive screenings, there are many new companies that are offering reasonable complete health check-up packages that also include preventive cancer screening.”