By Hatem El Kadi, Pfizer Middle East, Russia, and Africa Regional Oncology Lead
In the MENA region, female breast cancer incidence rates have significantly increased over the past three decades. It remains the most common cancer among women in the region, accounting for approximately 38% of all new cancer cases: the number of new breast cancer cases in Middle East was more than 86,000 in 2020, while the number of deaths due to this disease exceeded 33 thousand[i].It is a disease that knows no boundaries and does not discriminate. Globally, breast cancer is the most diagnosed cancer today[ii] . Two million individuals[iii] and their loved ones, are affected by this disease worldwide each year.
These staggering numbers do not even begin to describe the scale of the problem – especially when considering the important role of women in the region’s society. In the Middle East and Africa, women are critical to the development of children and their family’s finances. Any health condition that affects women significantly impacts their communities as well, beyond the initial devastation of the diagnosis.
Each case of breast cancer is as individual as the person diagnosed, spanning multiple stages and subtypes, and there is no one right way to tackle the challenges that come with the treatment of this disease. This is an important consideration to take as 50% of people living with breast cancer worldwide are 65 years or older[iv]. Additionally, patients over 75 years do not always receive appropriate treatment[v].
The lesser-known fact is that men can also be diagnosed with breast cancer – for them, the lifetime risk of the disease is about 1 in 833[vi]. This may not sound alarming, but this is why this issue is critical – according to the U.S. Food and Drug Administration (FDA), due to the rarity of breast cancer in males, limited clinical trials include men, resulting in fewer approved treatment options[vii].
There is work to be done to enhance access to breast cancer treatment
Metastatic breast cancer, the most advanced stage of breast cancer in which the cancer has spread beyond the breast to other parts of the body (i.e., organs and bones), remains an incurable disease.[viii],[ix] HR+/HER2- disease is the most common subtype of breast cancer, representing about 73% of all cases, followed by HER2+ and then triple negative breast cancer.[x],[xi],[xii],[xiii]
Over the years, great progress has been made in the treatment and care of breast cancer, including its metastatic form, but there is still more work to be done. This is especially true within underserved and hard-to-reach communities who often experience critical gaps in their care. According to expert estimates, a quarter of people with metastatic breast cancer live in rural areas[xiv]. At the same time, research has shown that geographic location can impact ability to access screening services, treatment and support groups. [xv] When looking at the disproportionate impact of poverty in the Middle East and Africa, it highlights that the healthcare sector needs to continue reaching out to communities to ensure that they have the resources to address breast cancer.
Taking action is key to reducing the mortality rate of breast cancer
To beat cancer, health organizations can take action against breast cancer by making information about the disease more accessible. That is, creating information in languages spoken by their populations such as Arabic and Swahili without jargon that is easily understandable by the people most affected by breast cancer. This will help ensure that people know how to navigate health systems and access the resources available to them.
It is also imperative that we continue enhancing clinical decision-making by promoting the use of Real-World Evidence and Randomized Controlled Trials in breast cancer as well as supporting changemakers across cancer, aging, and minority communities through relevant projects and collaborations addressing barriers to care.
Investment in removing barriers that stand in the way of timely and affordable treatment options are critical. Likewise, it’s also important to invest in expanding resources and programs that address current disparities across age, race, gender, and location.
For example, thanks to earlier screening, increased awareness and better treatments, breast cancer deaths have continued to decrease in older women – from 2013 to 2018, the death rate went down by 1% per year.[xvi]
In 2020 Pfizer global biopharmaceutical company launched the Take Action campaign aimed at raising awareness in the community about the different cancers, its prevention, diagnosis and treatment. One of the key focus points of the initiative has been to spread knowledge on the methods of self-diagnosis, which can truly save lives.
Early signs and regular check-ups
Learning the early signs and getting checked regularly are important ways to reduce the risk of breast cancer. Self-examination detects breast cancers earlier and at smaller tumor sizes than without screening. Doing this regularly can lead to earlier tumor diagnosis and eventually improving survival rate[xvii]. Changing lifestyle is also very important as physical activity lowers insulin levels, reduces inflammation, and improves cellular immunity, decreasing breast cancer risk. Choosing low-calorie foods, abstaining from smoking and excessive alcohol, and maintaining an ideal weight for one’s age can also lower the risk[xviii]. It is important to ensure that the public has access to this information through various channels, including media and social networks, as well as healthcare specialists, who should be able to discuss such topics openly and empathetically and promote early detection in a simple and understandable way.
Healthcare providers, patients, and the general public – all of us – can and should work together to make sure that everyone is energized to take action in the fight against cancer. Implementation of regular screenings and early detection can lead to better treatment outcomes and higher survival rates. By familiarizing yourself with the common signs of breast cancer, showing empathy and being a compassionate listener, everyone can make a positive impact in the lives of breast cancer patients and their families.
References:
[i] Mahdi H, Mula-Hussain L, Ramzi ZS, et al. Cancer burden among Arab-world females in 2020: working toward improving outcomes. JCO Glob Oncol. 2022;8:e2100415
[ii]Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021 May;71(3):209-249. doi: 10.3322/caac.21660.
[iii] World Health Organization. Breast Cancer Fact Sheet. https://gco.iarc.fr/today/data/factsheets/cancers/20-Breast-fact-sheet.pdf. Accessed August 18, 2021.
[iv] Elomrani, Et al. Management of early breast cancer in older women: from screening to treatment. Breast Cancer:2015; 7: 165–171.
[v]Breast Cancer Research Foundation (BCRF): Breast Cancer in the Elderly: How BCRF Researchers are Treating this Growing Patient Population
[vi] American Cancer Society: Key Statistics for Breast Cancer in Men. https://www.cancer.org/cancer/breast-cancer-in-men/about/key-statistics.html. Accessed August 18, 2021.
[vii] U.S. FDA. Male Breast Cancer: Developing Drugs for Treatment Guidance for Industry. Accessed August 18, 2021.
[viii] American Cancer Society. Treatment of invasive breast cancer, by stage. https://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-treating-by-stage.html Accessed August 18, 2021.
[ix]O’Shaughnessy J. Extending Survival with Chemotherapy in Metastatic Breast Cancer. The Oncologist. 2005;10:20-29
[x] Yersal O and Barutca S. “Biological subtypes of breast cancer: prognostic and therapeutic implications.” World J Clin Oncol. 5.3 2014; 412–424. PMC.
[xi] Esserman LJ and Joe BN. Clinical features, diagnosis, and staging of newly diagnosed breast cancer. Up-to-Date. (Burstein H, Vora SR, eds). 2017.
[xii] Boyle P. et al. Triple-negative breast cancer: epidemiological considerations and recommendations. Annals of Oncology. 2012;6,1:vi7–vi12.
[xiii] Kohler et al. Annual report to the nation on the status of cancer, 1975-2011, featuring incidence of breast cancer subtypes by race/ethnicity, poverty, and state. JNCI J National Cancer Inst. 2015: 107(6):1-25.
[xiv] Pfizer. Data on File. Ipsos. Patient Sizing Analysis. mBC. September 2020.
[xv] Cancer Network. Challenges of Rural Cancer Care in the United States. September 15, 2015.
[xvi] American Cancer Society. How Common Is Breast Cancer? https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html. Accessed August 18, 2021.
[xvii] Wilkinson L, Gathani T. Understanding breast cancer as a global health concern. Br J Radiol. 2022;95(1130):20211033.
[xviii] Costa M, Saldanha P. Risk reduction strategies in breast cancer prevention. Eur J Breast Health. 2017;13(3):103-12.
