Screening for Breast Cancer in Underdeveloped Countries

How Can We Help Our Sisters?

There is much about living in the US that we take for granted. There is much more that we acknowledge. When I talk with women undergoing cancer treatment, they often express gratitude for living near Boston. After all, this is a city with superb medical facilities, probably not exceeded anywhere in the world. People travel from everywhere to receive care here for complicated or serious illnesses. Once we have been diagnosed with a serious illness, we are really grateful to have such wonderful care nearby. 

One thing that does not come up is gratitude for mammograms. I suspect they have been around long enough and are such an ingrained part of our health care that we don’t think much about them. But millions of women around the world do not have access to mammography and are much more likely to present for medical care with advanced disease. In our country, 90% of women with breast cancer survive five years. In India, 66 percent do, and in Uganda only 46%. Every year, more than 70,000 Indian women die of breast cancer; that is the largest number in the world.

Some of you know that my husband and I have been involved for a number of years with a rural mission hospital in Zimbabwe. Our focus has been on cervical cancer screening as that is the cancer responsible for the most deaths among women in that country. It is also a cancer that can often be caught early with PAP smears and with a less sophisticated technique,VIAC, that is also highly effective and economically feasible in underdeveloped countries. At St. Albert’s, breast cancer is barely on the radar. When a woman comes for care for breast cancer, she inevitably has widespread disease, and they can offer nothing but pain control.

It is very heartening to learn of a new method to screen for breast cancer in places where mammography is not available. Mihir Shah and his colleague, Matthew Campisi, developed iBreastExam, a small battery operated wireless machine that can be used by health care workers anywhere in the world. Hand-held, it is painless and radiation-free as it scans a woman’s breast. Best of all, it works. This does, of course, leave the very real problem of what happens next. When a mammogram identifies a potential problem, the woman is quickly referred for an ultrasound or a biopsy. The system usually works pretty well, and she gets what she needs quickly. In underdeveloped countries, it is sadly easy to imagine that resources are not so easily available. If a potential breast cancer is seen by iBreastExam, then what? It is too easy to imagine a frightened woman who now has few options.

If the situation is anything like the one I know in Zimbabwe, the health clinic may be miles from a hospital. The woman may have no access to transportation and can’t leave her family to manage without her. Not to mention, she has no money.

This is a heartening beginning, and I hope that my concerns are exaggerated, but I suspect they are not. None of us is lucky to have been diagnosed with cancer. All of us are, however, very lucky to live somewhere that excellent care is readily available. Our hearts go out to our sisters elsewhere in the world, and we wish that we could share our better fortune with them as we all try to live (and live long) with cancer.