Dr Ksenia Butova, founder and CEO of Longevium, examines the interval between a woman’s first breast consultation and her first specialist assessment in the UAE. She argues that primary care can shorten diagnostic delay through urgent referral standards, closed-loop tracking, earlier risk stratification and use of health information exchanges, and proposes a single, measurable benchmark: time to first specialist review.
October fills the UAE with pink lights and screening reminders, and the message is reaching women. The next gain lies in what happens after a woman raises a concern, and primary care is well placed to lead it.
Every October the UAE turns pink. Landmarks light up, clinics run screening offers and social media fills with reminders to check, book and share. The campaigns have done real work. Breast cancer is the most common cancer among women in the UAE, and I would be surprised to meet a woman in Dubai who has not heard that she should be screened.
So when late diagnosis is described as an awareness problem, I tend to disagree. Some of the women who reach a breast clinic late did exactly what the campaigns asked. They noticed a change, booked an appointment and saw a doctor. The time that matters most is what follows, and that part of the pathway belongs to clinicians.
I am not a breast surgeon and I do not treat breast cancer. I see this from the front door of care, in preventive medicine, where women come for hormone panels, metabolic check-ups, weight management and skin treatments, and where a breast concern is often mentioned at the end of an unrelated visit. From that position the pattern is hard to miss.
Where time can be lost
In any health system, a common sequence can look like this. A woman in her early 40s finds a lump and sees a general practitioner. She is told it is probably hormonal and asked to come back after her next cycle. Or she has an ultrasound at one centre and the report goes to a clinic she does not return to. Or she receives a referral letter and is asked to book with a breast specialist, and nobody checks that the appointment happened.
Each step looks reasonable on its own. Together they can leave no one responsible for the interval between “something is wrong” and “a specialist has examined it”. A highly international, mobile population makes continuity harder still, because patients change providers, insurers and cities. Stage at diagnosis shapes both the treatment a woman needs and her outlook, so time lost at this point carries a real cost.
What primary care can do next
- Treat a new breast symptom as an urgent referral with a deadline. A lump, nipple discharge, a skin or nipple change, or new swelling in the armpit should trigger referral to a breast service for triple assessment—clinical examination, imaging and, where indicated, biopsy. Some health systems set explicit time standards for suspected cancer referrals, and UAE providers are well placed to set their own. “Wait and see” should be a decision a specialist makes rather than a default in primary care.
- Do not let one normal result close the question. In a woman with a palpable lump, reassuring imaging still has to be reconciled with the clinical findings by someone with breast expertise. Triple assessment exists because each test misses things on its own.
- Close the loop on every referral. The clinician who orders the test or writes the letter owns the outcome until a specialist has accepted the patient. That takes a named person, a tracking list and a phone call when an appointment has not happened. Hospitals call this closed-loop referral. It is standard in many safety-critical settings and worth extending to every outpatient referral. At Longevium we build care around one physician who is responsible for the whole patient, and the principle applies to any pathway.
- Assess risk as well as age. Women in the UAE tend to be diagnosed younger than in much of Europe and North America, so risk assessment should start earlier than a fixed age threshold suggests. A family history of breast or ovarian cancer, or a known BRCA variant, should move a woman into earlier or closer surveillance. Primary care can record these facts systematically and use a validated risk tool where one is available.
- Use every visit. Women see doctors for contraception, hormone therapy, fertility, thyroid problems, weight loss and skin care. Each visit allows 3 questions—when was your last mammogram, is there a family history, have you noticed any change? Clinics that prescribe hormone therapy can document breast screening status before they start. Aesthetic and wellness clinics, which see many healthy women who may not otherwise see a doctor regularly, have the same opportunity.
- Use the shared record. The UAE has already built the infrastructure. Health information exchanges such as Malaffi in Abu Dhabi and NABIDH in Dubai exist so that a patient’s history follows her. Providers can make uploading imaging reports a routine step, so the next doctor does not start from zero. Most of these changes need a protocol and a named person to own it, and a clinic can put them in place without new equipment.
Awareness campaigns brought women to the door. The next gain will come from what happens after they walk in. Every provider could track one number: the time between a woman’s first breast consultation and her first specialist assessment. If primary care clinics across the UAE tracked it from this October, the country would have a clear baseline, and next year’s campaign could report on speed as well as reach. The UAE is well placed to lead the region on this.
