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Introducing Breast Cancer in Gaza

April 29, 2011

One day as I became immersed in the chaos of patients coming in and out of the crowded clinic room where the two intern doctors and another ten medical students were competing to impress the consultant surgeon, I found myself propelled into an overwhelming sense of perspective. With an initially glazed focus I casually sift through the faces of the three middle-aged women who were successively introduced into the room and I soon got pinched by the realisation that the vast majority of women with a diagnosis of breast cancer walk out of the room with an A5-size paper and a date for their mastectomy surgeries.

Studies show that breast cancer among Arab women is more violent, with a younger age of onset and higher mortality rates than among women of European origin. In Gaza, where breast cancer is the most common among women accounting for 30 to 40% of all cancer cases, news that the 5-year survival is 40% at best compared to over 70% in European countries raise questions about the reasons behind this tremendous variation which seems under-explained by the supremacy of health care in the developed Europe. Moreover, according to Palestinian Health Ministry figures, up to 60% of the women in Gaza who have been diagnosed with breast cancer were diagnosed after the cancer had already spread in their bodies. In Israel, with its European-like figures, only 5 to 7 percent of the women with breast cancer are diagnosed after the cancer has spread to other organs.

Treatment options for breast cancer include surgery, drugs (hormonal therapy and chemotherapy), radiation and immunotherapy. Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely and it provides the single largest benefit, with surgery alone being capable of producing a cure in many cases. To increase the likelihood of long-term survival, several chemotherapy regimens are commonly given in addition to surgery. Radiation may be added to kill any cancer cells in the breast that were missed by the surgery, which usually extends survival somewhat. In Gaza however, surgery is often the only option in use with virtual absence of other options including breast-conserving surgical techniques.

According to a research paper by Schragi Schwartz, a Summer school participant with Physicians for Human Rights – Israel, the disparity of survival rates is caused by numerous factors: Firstly, there is the lack of facilities in the Gaza Strip; lack of screening programs, impaired accessibility to existing screening units, and lack of trained oncologists. Secondly, limited treatment options. No radiotherapy in Gaza; no advanced hormone tests; no bone density scans. Thirdly, difficulties in accessing facilities in Israel and abroad. Palestinian Authority reluctance to refer patients abroad due to economic reasons; Israel is reluctant to accept Palestinian patients due to “security” reasons.

Adding to the aforementioned:

–      Screening is a globally-recognized tool enabling early detection of cancer and thus improving the chance of early intervention and longer survival. The lack of screening programs in Gaza poses a significant negative effect on survival rates.

–      For years, the siege on the Gaza Strip has prevented doctors from leaving for specialized training and further study.

–      With over 50% of Palestinians in Gaza living beneath the poverty line and unemployment rates close to 30%, many are unable to pay for adequate treatment.

–      Medications are not arriving in the Gaza Strip with regularity and most patients are not managing to get medical treatments even if they could afford it.

–      Radiological screening and some diagnostic tools are not allowed into Gaza because of Israel’s opposition which stems from the use of radioactive materials in the treatment.

In short, the health system in Gaza is unable to cope adequately with the diagnosis and treatment of the number one cancer in Gazan women.

During my ten-week surgery rotation, I have seen elderly women who had unmistakable malignant masses yet for ignorance and lack of belief in health system they waited for months before seeking medical care. Other women expressed fear of the negative stigma which can affect a woman’s standing in the community and her daughters’ chances of marriage. More than once, I was overcome with the intense feeling of desolation that radiates so strongly from these women as they wrestle with the beast the destiny has thrown at them.

The emotional impact of cancer diagnosis, symptoms, and subsequent uncertainty and body-image problems inherent in cancer treatment can be devastating and may lead to increased anxiety, shame, and occasional ideas of suicide. Breast cancer survivors will not only have to deal with the physical and emotional trauma of the surgery, they additionally have to suffer the difficulties of a life of scarcity under a crippling siege.

Hanan, a breast cancer patient in her thirties, asked for a treatment that can preserve her breast. The consultant replied:”We are sorry. There are no other options. Nothing more we can do, not in Gaza!”. Silence prevailed for few seconds as Hanan nodded her head, put the paper with the date of her mastectomy operation in her colourful burst and walked out of the clinic room.

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From → MEDICINE, PALESTINE

3 Comments
  1. mciarlaith permalink

    It’s sad that it is like that in Gaza! Why can’t we all just be treated the same??? Your pleas for help involve simple facilities we use everyday! Not fair

  2. Mohammed permalink

    That’s really sad!
    I am not so much into technicalities. But I think that we should launch awareness campaigns among women about breast cancer. That’s the least we can do right now, as early detection of this disease is so helpful!
    Good Work GazaDoctor

  3. Nice read. You got your facts right which is good.
    One more thing that may have slipped your mind is how shitty diets are around here. I can honestly say that more than 95% of people have no idea about what they consume. Diets are high in sodium, MSG, artificial flavorings and colors…etc of this crap. With such diets and a pretty much nonexistent advocacy for proper dieting and workout, we are lucky to have these cancer figures.

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