Partnership Expansion Activities in the West Bank and Gaza

By: Chris McKallagat, Country Lead, West Bank and Gaza

Chris McKallagat with Mariam Awad from Bethlehem University’s Faculty of Nursing and a member of the Partnership’s Advisory Planning Committee working to develop a breast cancer nursing training of trainers workshop in conjunction with the Oncology Nursing Society (ONS).

Recently, I traveled to the Palestinian territories to meet with key stakeholders, including the Palestinian Authority Ministry of Health (MOH), to initiate Partnership expansion activities. Recognizing the leading role of the MOH, the Partnership’s activities will strengthen and complement the Palestinian institutional response to breast cancer and help raise awareness among women and families. Breast cancer is the most commonly diagnosed cancer among women in the Palestinian territories and too many lives are lost unnecessarily. In fact, breast cancer kills more women in the Palestinian territories annually than the next three most frequently diagnosed cancers combined.

In response, the Partnership supports an approach to addressing breast cancer that works to improve institutional capacities, such as training for health care professionals and capacity-building of local organizations, while at the same time raising awareness at the community level through grassroots advocacy support and community mobilization and education.

American Near East Refugee Aid (ANERA), will spearhead an initial set of activities on behalf of the Partnership to strengthen the ability of Palestinian public and private institutions to work collaboratively in the areas of breast cancer prevention and management. In order to truly make an impact on breast cancer in the Palestinian territories, it is clear that greater coordination and collaboration among various stakeholders is needed. With leadership from the MOH and support from the Partnership, Palestinian women and families will be equipped with greater resources to fight breast cancer. The U.S. has gained amazing ground over the past 25 years in decreasing breast cancer mortality by increasing awareness and improving early detection and screening. The Partnership is pleased to actively support Palestinian women in their fight back against breast cancer.

Check out the Partnership’s Baseline Assessment of Breast Cancer Awareness and Care: West Bank, Gaza, and East Jerusalem
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Le Partenariat Indroduit un Programme Régional au Maroc lors d’une Table Ronde

Dans le cadre de l’extension de ses activités au Maroc, le Partenariat Etats-Unis – Moyen Orient pour la Sensibilisation et la Recherche sur le Cancer du Sein a tenu une table ronde Mardi le 23 Juin au Royal Mansour Le Meridien à Casablanca. Cette table ronde a été organisée en vue de lancer le Programme au Maroc et surtout d’établir le dialogue avec les professionnels du Cancer du sein et les associations actives dans le domaine. Ce fut la première fois au Maroc que les oncologues, les chercheurs, les psychiatres, les associations de lutte contre le cancer, les survivantes du cancer du sein se réunissent ensemble pour échanger sur une maladie qui concerne les femmes de toute classe et de tout niveau social.

La table ronde a été inaugurée par Rob Jackson, chargé d’affaires à l’Ambassade des Etats-Unis d’Amérique, qui a exprimé le soutien de l’Ambassade au Partenariat Etats-Unis – Moyen Orient pour la Sensibilisation et la Recherche sur le Cancer du Sein et son soutien personnel et celui de son épouse étant elle même une survivante du cancer du sein. Monsieur Jackson a félicité l’ensemble des associations et personnes qui oeuvrent pour la lutte contre le cancer du sein au Maroc et particulièrement l’association Lalla Salma pour ce qu’elle a accompli en si peu de temps.

Après des présentations sur l’état et l’analyse situationnelle du cancer du sein au Maroc, sur les objectifs Partenariat pour la Sensibilisation et la Recherche sur le Cancer du Sein au Maroc et une présentation Vital Voices (une ONG américaine en charge de la mise en œuvre d’une partie du programme relative au renforcement des capacités des ONGs au Maroc dans le domaine du cancer du sein), les participants se sont livrés à un débat front et fructueux sur les actions et activités à mener dans le moyen et court terme, à savoir :
1. Etablir un réseau réunissant des professionnels de la santé et associations actives dans la lutte contre le cancer du sein, qui pourrait être baptisé « Alliance Nationale du Cancer du Sein » ;
2. Etablir des groupes de travail par région ainsi que des groupes de soutien ;
3. Elaborer un flyer pour l’autopalpation ;
4. Etablir un guide des étapes à poursuivre en cas de cancer de sein depuis le dépistage;
5. Former des infirmières sur le cancer du sein et sur les soins palliatifs ;
6. Mettre en place une ligne téléphonique spéciale sur le cancer du sein « Hot line »
7. Mettre en place des unités mobiles de soins à domicile ;
8. Assurer des campagnes de sensibilisation et de dépistage dans des régions lointaines.

Les témoignages de plusieurs survivantes a éclairé davantage les participants ainsi que l’équipe du Partenariat sur la difficulté de certaines patientes des régions lointaines et défavorisées à détecter le cancer du sein à temps, de trouver des laboratoires spécialisés, de bénéficier des soins à domicile en plus du cout élevé des soins et l’absence du soutien psychologique et sociale.

Le Partenariat Etats-Unis – Moyen Orient pour la Sensibilisation et la Recherche sur le Cancer du Sein se félicite du lien étroit qu’elle a créée entre professionnels et activistes dans le domaine
du cancer du sein et a promis de mener des actions à grand impact dans la limite du temps et du budget alloué par MEPI.
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To Combat Breast Cancer, End the Stigma

The Partnership would like to share the following editorial, which ran in the July 14th issue of The National, an English newspaper launched by the Abu Dhabi Media Company.

‘Nothing in life is to be feared, it is only to be understood. Now is the time to understand more, so that we may fear less.” These are the words of Marie Curie, the Nobel-prize winning scientist who was the first to treat cancer with radiation. Her words are more relevant than ever today in the Emirates, where breast cancer has taken such a deadly toll on women, and the stigma attached to the disease continues to prevent women from getting diagnosed early enough to survive it. The mortality rate for women with breast cancer in the UAE is unacceptably high. As The National reports today, four out of five women diagnosed with breast cancer in Dubai have an advanced form of the disease by the time they finally seek treatment. And largely as a result of such late detection, 44 per cent of breast cancer cases are fatal...
For a country in which women have made remarkable strides in other facets of life, these are distressing statistics. Women make up over 60 per cent of students in state universities and consistently outperform their male peers in school. Female literacy in the Arab world is near 80 per cent; in the UAE it is 92 per cent. Women hold prominent positions in the Government and are also leading initiatives in the fields of arts, business and fashion. Why then has this society not realised its collective obligation to take the steps necessary to reduce the number of deaths from breast cancer?

The stigma associated with the cancer is doubly concerning considering that the UAE has some of the most state-of-the-art facilities to treat cancer. But despite the presence of world-class medical personnel and equipment, many women remain reluctant to have routine examinations and only do so when it is too late. Rashid Hospital in Dubai has even introduced two new methods of early detection that are found nowhere else in the Gulf. With all these options, there should be no reason for so many cases of breast cancer to be diagnosed at such a late and lethal stage. Yes, effective health care depends on individual responsibility. But women need to be better informed of what is at stake.

Over one million cases of breast cancer will be diagnosed this year worldwide, according to the World Health Organisation, and more than a third of women with breast cancer will eventually die from the disease. Even though medical breakthroughs may continue to decrease the number of deaths associated with the disease, early detection is still the single greatest factor in helping women beat the disease.

In these circumstances, a public dialogue about the importance of breast cancer screening is even more important than any set of technological advances. Dubai Hospital is to be commended for launching an awareness campaign that will generate a public conversation aimed at changing attitudes towards the detection and treatment of breast cancer. We have the material means; all we need is to change the way people think.

Now is the time we must understand this disease more and fear it less.

http://www.thenational.ae/article/20090714/OPINION/707139910/1033
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Jordan Workshop on Starting a Support Group Energizes Local Advocates

By Susan Brown, Director, Health Education, Susan G. Komen for the Cure®

Susan and colleague, Sandy Finestone, conducted a workshop with members of the Jordan Breast Cancer Program in Amman, June 3-4, 2009. Together, they are developing a curriculum and materials for institution-based support groups.

Sandy Finestone and I spent two days with more than 20 women in Amman, Jordan. The topic of our workshop was “How to Start a Support Group,” but the information and passion shared by participants really extended beyond that topic. We watched women support each other—with a hug, a smile, a pat on the shoulder—when a group member was tearful as she recalled a friend who had lost her life to breast cancer and when another got a call on the second morning that her friend had died...

The women were there because they want to do something to help women in their communities who are diagnosed with breast cancer. No, they really want to do MORE, because they are already at work in their communities helping women with breast cancer.

We observed women think about new concepts, listen hard (as we did) to simultaneous translators to not miss anything that was said, work in groups, exchange ideas, and enthusiastically participate and compete in an ice breaker about old Arabic songs that caused a lot of laughter.

We saw that women who are involved with the breast cancer cause are more alike than not. Wherever they are, they are energetic, passionate, committed, creative, deliberate, and determined. We are eager to learn all of the great things they accomplish in the coming months and years. Read more!

Women are the World's Peacemakers

By Dr. Samia Al-AMoudi
I was proud to be part of the 21-member international delegation supporting the first Susan G. Komen Global Race for the Cure®. Our delegation included women from 18 countries--women from different cultures and races, and with different religious backgrounds. But we all spoke the same language when it came to fighting breast cancer. This was not a political or social fight, but a message of pure love for each other and for every other person on this planet...

We came to tell the whole world that breast cancer knows no boundaries and women's issues are the same everywhere. We might not have been able to prevent our own breast cancer diagnoses, but we are determined to do all that we can so that our daughters can live in a world free of breast cancer.

Dr. Jill Biden, a long-time advocate for breast health education and wife of U.S. Vice President Joseph Biden, said to the Race participants, “You are paving the way for a breast cancer-free world through your efforts."

For the Race, Komen Founder Ambassador Nancy Brinker brought together women from across the globe to write a new page in a new era of peace to make breast cancer history. This is the way I felt as a Saudi woman, and as a breast cancer survivor attending the Global Race. I am a happy that the U.S.-Middle East Partnership for Breast Cancer Awareness and Research is helping to bring us together. I wanted to share my feelings with women of all nations.


Dr. Samia Al-Amoudi isAssociate Professor and Consultant Obstetrician Gynecologist
Head of Sheikh Mohammed Hussein Al-Amoudi scientific chair for breast cancer
King Abdul-Aziz University, Jeddah, Saudi Arabia

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Daughters’ Marriage Prospects Top Concern for Woman with Cancer

By Hana Abu Shareb
As a nurse, Hana Abu Shareb, Health authority Abu Dhabi has worked with many people with cancer for the past eight years. She shared with the Partnership how one patient’s reaction to a breast cancer diagnosis has really stayed with her.

“I worked with a 45-year-old woman who was shocked to receive a breast cancer diagnosis. Her shock quickly changed to concern for her daughters who she felt would lose many marriage opportunities based on her diagnosis. While this is not unusual in our culture—not just for breast cancer but for any life-threatening disease--I was still surprised to hear her voice this as her primary concern.

Women, especially mothers, regularly put their needs behind the needs of their families. But, because this woman shared her concerns with me I am prepared to discuss this with other women and better guide them in the next steps for referral and treatment. I do not know how things ended up with this courageous woman because she returned to her homeland. However, her impact on me continues to benefit others who receive the same diagnosis.” Read more!

Stories from the Field

Alice Rezien, of the Suzanne Mubarak Regional Center for Women’s Health and Development, in Alexandria, Egypt, submitted the following post.

In conjunction with International Women's Day (February 10-12, 2009), the Suzanne Mubarak Center organized and conducted a three-day training program for 30 nurses working in outpatient clinics and family health care centers in different sectors of Alexandria. The training, titled Breast Cancer: Awareness, Early Detection, Breast Self Examination, Treatment Modalities, Peri operative Care and Quality of Life, focused on the development of knowledge, skills, and attitudes necessary to enhance awareness about breast cancer in nurses, and women, in general. Presenters also strove to motivate participants to practice breast self examination. Further, the Center promotes quality care for women with breast cancer throughout the stages of treatment and rehabilitation, with the ultimate goal of ensuring an acceptable quality of life.

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أسبوع الشراكة للعمل الأجتماعي

لتظهر مساندتك لنشر الوعي والتأييد لمكافحة سرطان الثدي: قم بتنظيم فعالية خلال انعقاد أسبوع الشراكة للعمل الأجتماعي الأول للفترة من 24- 30 آيار، 2009

تتشرف شراكة الولايات المتحدة الأميركية والشرق الأوسط لمكافحة سرطان الثدي ونشر الوعي والبحوث أن تعلن عن أنعقاد أسبوع الشراكة للعمل الأجتماعي الأول. حيث سيجتمع في شهر آيار الحالي نساء ورجال مهتمين بموضوع سرطان الثدي قدِموا من الشرق الأوسط وشمال أفريقيا ليعبروا عن آرائهم بصوت مسموع. إذ يمكن لفئة قليلة أن تؤثر تأثيراً فعالاً. ويمكن ان نظهر مدى عزمنا وقوتنا جماعياً لدى قيامنا بتنظيم سلسلة من الفعاليات المحلية حول أهمية نشر الوعي لمكافحة سرطان الثدي والقيام بالكشف والفحص المبكرين عنه. وأليك بعض الأفكار عن كيفية مشاركتك معنا


أعمل على تنظيم أو الأشتراك بفعالية في منطقتك: يمكن أن تشمل هذه الفعالية أي شئ ---- كالقيام بجمع مجموعة من الأصدقاء في بيتك، مكان عملك، أو في أي مكان عام. وكلما كان عدد الأشخاص المجتمعين أكبر كان هذا أفضل.

قم بتشجيع الحضور لهذه المناسبة: يمكنك أن تعلن عن هذه المناسبة في الموقع الألكتروني الخاص بالمنظمة، على صفحتك الشخصية للفيسبوك، لوحة أعلانات المنطقة- وفي اي مكان يمكن أن يشاهده الناس. الرجاء إرفاق الموقع الألكتروني للشراكة (www.bcpartnership.org) وشريط وردي اللون للدلالة على سرطان الثدي.

أعمل على القيام بواجب الضيافة لهذه المناسبة والتقاط بعض الصور: إذ يمكننا حينها أن نتقاسم ما تحصل عليه من نتائج مع شبكة الشراكة كلها (bcpartnership.ning.com).
قم بالتعريف عن نفسك: سنقوم بإدراج الفعاليات الأكثر إبداعاً من التي تصل لآسماعنا على موقعنا الآلكتروني (كما يساعد التقاط الصور وتصوير افلام الفديو على أبراز القصة بشكل أوضح). كما نعمل على أيجاد طرق أخرى تساعد في التعريف بجهودك، لذا إبق مصغياً لنا!

للمزيد من المعلومات، الرجاء زيارة الموقع الخاص بأسبوع الشراكة للعمل الأجتماعي أو أرسال إيميل على العنوان الألكتروني التالي partnership@bcpartnership.org.

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Partnership Community Action Week

Show your support for breast cancer awareness and advocacy: organize an activity during our first Partnership Community Action Week, May 24-30, 2009

The U.S.-Middle East Partnership for Breast Cancer Awareness and Research is proud to announce the first Partnership Community Action Week. This May, women and men from across the Middle East and North Africa who care about breast cancer will come together to make their voices heard. A few people can make a major impact. By holding a series of local activities on the importance of breast cancer awareness, early detection, and screening, we can collectively show our strength. Here’s how you can get involved:

1.) Organize or join an activity in your community: Your action can be anything-- gather a group of your friends together at your home, office, or in a public place. The more people that get involved the better!

2.) Promote your event: You can post your event announcement on the Partnership network, on your organization’s website, your personal Facebook page, on community bulletin boards—anywhere people will see it.

3.) Host your activity and take photos: We can then share your results with the entire Partnership Network (bcpartnership.ning.com).

4.) Be recognized: The most creative actions we hear about (photos and video really help tell your story) will be featured on our website. We also are exploring other ways to recognize your efforts, so stay tuned!

For more information see our Partnership Community Action Week pager
http://tinyurl.com/communityactionweek

Questions? Email us: partnership@bcpartnership.org.

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“Breast Cancer Detection Under Budget Constraints”; Mammography Screening in Low- and Middle-Income Countries

By Marilys Corbex

The editorial in the last issue of the UICC Global News Alert (the International Union Against Cancer newsletter) is about the use (and abuse) of mammography screening in low- and middle-income countries, which presents an important lesson for advocates working with breast cancer in the Middle East.

The article reflects the growing conviction in the scientific and expert community that low- and middle-income countries should avoid engaging mammography screening too quickly as this consumes a lot of resources without benefiting many women. It also explains that advocates should be careful about pressuring their ministries of health for mammography screening as it can be counter productive to their cause. Instead, advocates should advocate for better treatment and effective early diagnosis that is readily accessible to all women of the country.

The editorial (below), plus other interesting related topics, is available at: http://www.uicc-community.org/templates/ccc/images/GNA_March%202009.pdf

Breast Cancer Detection Under Budget Constraints

By Paola Pisani, Senior Epidemiologist, Oxford University, and Joe Harford, PhD, Director, Office of International Affairs, NCI, Bethesda.

In developed countries, the debate regarding the benefits and harms due to possible overtreatment of indolent tumours discovered by mass screening via mammography continues. The health care infrastructure required for the management of suspicious or abnormal mammograms and for the treatment of breast cancer is generally present in these countries and is taken for granted in discussions.

However, the situation is different in low- and middle-income countries where breast cancer incidence is lower and where the requisite infrastructure for breast health is often suboptimal. In these settings, governments, health providers and advocacy groups struggle to develop sustainable strategic plans to control the disease, which is often the most common cancer in women, although it occurs at a lower rate than in Western countries.

These plans often focus on the introduction of mammography in emulation of early detection and screening programs that exist in more developed countries. There is no question that early detection can have a profound and positive impact on breast cancer outcomes as shown by falling mortality rates—the chief measure of efficacy. However, by focusing exclusively on introducing the detection test, health systems in low- and middle-income countries often fail to ask whether they are really ready to deal adequately with what is found through the new screening program.

Improvements in breast cancer outcomes in the United States and Western Europe began before the introduction of mass screening of asymptomatic women. In these venues, breast cancer awareness grew together with the development of comprehensive health systems that made quality care accessible to the population at large, raising expectations and trust and, eventually, demand. Breast cancer mortality began to fall in the 1960s and 1970s, in generations of young women who used health services for contraception, safer pregnancies and provision of healthcare for their children. At this time, breast cancer incidence was already increasing and state-of-the-art treatment relied largely on surgery and radiotherapy (chemotherapy and tamoxifen were to come later).

In the 1990s, mortality rates began to fall in women of all ages before all those eligible were able to receive a mammogram. The improvement in outcomes caused by the early (prescreening) movement can be attributed to the systems set up, as part of the screening policy, to manage the disease—systems that provided quality diagnosis and treatment to all breast cancer patients, most of whom still presented with overt symptoms of the disease (e.g., a palpable mass). Programs for screening asymptomatic women were implemented in an environment that already had an enhanced capacity to diagnose and treat breast cancer effectively.

In many low- and middle-income countries, breast cancer diagnosis and treatment are usually of low quality, or access to quality care is restricted to those who can afford to pay for it. In many poorer countries, only a small subpopulation of women gets state-of the-art breast health care. The introduction of mass mammography in the absence of a health care system capable of dealing with the suspicious and abnormal mammograms that are inevitable is a classic case of “cart before the horse”. Without generalised access to diagnostic and treatment services, low- and middle-income countries will see neither the early benefits of screening observed in the West nor the late ones that follow 10 years of regular screening.

In those societies where breast cancer awareness is raised, stigma is reduced and barriers to adequate diagnosis and treatment are removed, near-term improvements in breast cancer outcomes are likely to mimic those seen in the West. Health administrators in low- and middle-income countries have every reason to invest in delivering effective care to the population at large rather than investing in mammography screening, which will have a lower yield than in the West. Good management of early—yet symptomatic— tumours produces short-term, measurable reductions in mortality. Success of these programs aimed at reducing mortality and suffering will encourage funding and participation of the population. The consideration of more sophisticated and expensive programs to screen asymptomatic women is not today’s highest priority.
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