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Sharp Increase in Breast Cancer: An Urgent Call for Action

Posted by On December 13, 2013
Earlier this month, I had the privilege of presenting a keynote on “Pink Ribbon Red Ribbon: Combatting Cervical and Breast Cancer” at the biennial conference of the African Organization for Research and Training in Cancer (AORTIC) in Durban, South Africa.  Among the many conversations that followed was the very unique one I had with a renowned Ghanaian breast surgeon, Dr. Beatrice Wiafe Addai.  She told of a 37-year-old Ghanaian woman who presented in her hospital recently.  This lady had breast cancer, but because of stigma and her own lack of knowledge, she had chosen not to seek care.  When she finally decided to see a doctor because of excruciating pain, she got into a taxi.  On her way to the hospital, the severely ulcerated and fungating tumor dropped into the taxi!  In utter dismay, but a desire to help, the taxi driver stopped at a pharmacy, bought gentian violet, and applied it to the woman’s skin as a first-aid measure, and drove her quickly to the hospital.  The surgeon admitted her with Stage 4 breast cancer, and started her on the best available treatment.  As of the time of my conversation with Dr. Beatrice, the patient was still alive, but for how long? The truth is that the story of this Ghanaian woman is a tragically common one.  On December 12, 2013, the International Agency for Research on Cancer (IARC), the specialized cancer agency of the World Health Organization, released the latest data on cancer incidence, mortality and prevalence worldwide: http://globocan.iarc.fr/.  One of the major findings in this report is a sharp rise in breast cancer worldwide.  In 2012, 1.7 million women were diagnosed with breast cancer (up from 1.6 million in 2008), and there were 6.3 million women alive (up from 6.2 million in 2008) who had been diagnosed with breast cancer in the previous five years.  Since the 2008 estimates, breast cancer incidence has increased by more than 20 percent, while mortality from the disease has increased by 14 percent. Breast cancer now represents one in four of all cancers in women, is the most-frequently diagnosed cancer among women, and is the leading cause of cancer death in low-income countries. Cervical cancer is now the fourth-most common cancer in women worldwide (down from third in 2008), and remains the second-most common cause of cancer deaths in women worldwide (275,000 deaths in 2008 compared to 266,000 in 2012, according to IARC), as well as in developing countries.  These numbers are unacceptably high for a disease that represents an avoidable cause of death in women.  Low-tech and inexpensive screening tools exist for early detection and treatment, and could significantly reduce the associated burden, morbidity and deaths.  Women need to be educated to seek early and appropriate care, cancer-associated stigma needs to be addressed, and services should be made widely available in low-resource settings.  And for young adolescents, we have the vaccine against the Human Papillomavirus (HPV), which guarantees 70-percent protection against cervical cancer. The good news is that people are taking action.  In September 2011, the George W. Bush Institute, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), Susan G. Komen ® and the United Nations Joint Programme on HIV/AIDS (UNAIDS), in collaboration with private-sector and non-profit partners, launched Pink Ribbon Red Ribbon, which is now the leading public/private partnership combating breast and cervical cancer in sub-Saharan Africa. In cooperation with local African organizations, Pink Ribbon Red Ribbon seeks to accelerate progress on countries’ own strategies, plans, and priorities to address women’s cancers.  We work with local partners to assess the burden of disease and define the most-effective investments.  The goal is to enable public and private providers in developing countries to cover the entire continuum of cancer services more rapidly and efficiently, through the sustainable, collaborative, country-accountable execution of high-quality programs that work.  We leverage the expertise of our members, by collaborating with multilateral organizations and local businesses, Governments, civil society and non-profit entities to pursue strategies grounded in scientific evidence and practical experience:  The partnership’s areas of focus are vaccination against HPV, simple screening and treatment for cervical cancer, early detection of breast cancer, more-advanced diagnostics, advanced treatment, and palliative care.  Pink Ribbon Red Ribbon members work to increase the global resources available for women’s cancers, by filling particular gaps identified by individual countries, and coordinating activities to use resources more efficiently, without gaps or duplications.  We currently support efforts by national Governments and other local actors in Botswana, Zambia, and Tanzania; and have facilitated the screening of over 60,000 women, as well as the vaccination of over 23,000 girls in Botswana and Zambia. With increased support from donors and partners, and with the greater involvement of women (and men) worldwide, we can help make stories like the one I heard last week from Ghana a thing of the past.  Come join us.