Advanced breast cancer affects 80% of women diagnosed in Dubai

Hospital data shows that approximately 60% of all those who attend the Department of Medical Oncology at Dubai Hospital have breast cancer, from where they are referred to the dedicated clinic.

Of these 80% are found to have stage two or three disease, a stark contrast to countries with comprehensive screening programmes, where a greater percentage of women present with pre-invasive or stage one disease, according to Dr. Shaheenah Dawood, a senior specialist registrar, and UAE national.

"The earlier you are caught, in terms of staging the disease, the better the outcome. In countries with screening programmes the majority of women present with pre-invasive disease, or stage one. But here most of the women present with advanced stage disease, which is still curable, but has a poorer overall prognosis compared with earlier stage disease,"

Dr. Dawood said.

The late diagnosis situation has prompted healthcare professionals at the hospital to start drawing up plans for a sustainable breast cancer awareness campaign, which will be rolled out across the emirate in the coming year.
Preliminary proposals include integrating breast cancer services in Dubai, educating women in breast self-examination, and creating a breast screening programme for both nationals and non-nationals.

Guidelines for screening, which will include mammography and genetic testing for high-risk patients, are currently being developed by the hospital's multi-disciplinary Breast Cancer Awareness Committee, which was established in May this year.

Arab women fail to seek medical advice for breast lumps because of a widespread cultural fear of cancer, Dr. Dawood revealed, adding that women often delay action because they are embarrassed to reveal intimate medical problems to male relatives.

"In the Arabic population, the word cancer is taboo, and there is not enough awareness in the society as a whole of the disease. But, that attitude is changing among the younger generation," she explained.

"This year we want to promote and educate women about breast self-examination, and to encourage women to come to the clinic as soon as they have a problem, so that they can get maximum benefit from some of the very effective treatments now available," she added.

Dr. Dawood, who joined the oncology department in October last year, presented the findings of her own study on the post-operative treatment of breast cancer at a regional cancer conference in Lebanon over the weekend.

The research was carried out while she was studying in the US as part of a Dubai Health Authority programme that offers local physicians financial support to train overseas. The study was presented earlier this year at the American Society of Clinical Oncology conference.

Dr. Dawood's study examined the survival rates of women with early stage breast cancer, and less than three positive lymph nodes, who underwent mastectomy without post-operative radiotherapy, compared with patients who had a breast lump removed followed by a course of radiation.

Results indicate that women with tumours of less than five centimeters, and one to three positive lymph nodes, have an increased risk of disease recurrence when radiation therapy to the chest wall is not part of their treatment.

"The results are based on retrospective data set and should be viewed with caution. The results simply indicate that the question of radiation therapy in this setting should be studied further in larger prospective clinical trials", Dr. Dawood said.

The Best of the American Society of Clinical Oncology conference was held in Beirut on July 10-11.