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Sun 26 Oct 2008 04:00 AM

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Awareness angels

There is an enormous effort afoot to educate and help women protect themselves against breast cancer in the UAE. Meet the people pushing for greater awareness and find out what they advise.

There is an enormous effort afoot to educate and help women protect themselves against breast cancer in the UAE. Meet the people pushing for greater awareness and find out what they advise.

In the Gulf region, the fight against breast cancer is growing stronger every day. Which is just as well, since breast cancer is uncommonly rife in this part of the world where women tend to get it a decade earlier than in the west.

Since 2006, when First Lady Laura Bush formed the US-Middle East Partnership for Breast Cancer Research and Awareness, there has been a surge in education and screening efforts by the medical community and corporate sectors in the UAE, Jordan and Saudi Arabia.

In a speech last year, while visiting Saudi Arabia, Mrs Bush said: "The cure for breast cancer can come from a researcher in Washington or a young doctor in Riyadh." Indeed. In this crucial area of health, the combined resources of the USA and the Gulf countries are already starting to impact lives.

But who are the people spearheading this awareness movement in the UAE? And what are they advising women to do on a practical level to reduce their risk?

Dr Ayesha AlmutawaVice President, Center for Healthcare Planning & Quality, Dubai Healthcare City

Dr Ayesha Almutawa heads the Dubai Healthcare City breast cancer awareness program. She is a medical doctor and holds a masters degree in public health, with a focus on health policy and management, and health behaviour and education.

Because the UAE has such a high rate of breast cancer and young women are at higher risk than in other countries, Dr Almutawa stresses that from a young age girls need to have awareness about the disease. She adds that it's crucial women in the region know that the risk begins at age 16 onwards and extends to age 65.

But there's a lot women can do to reduce their risk profile and early detection is key. The focus of the Dubai Healthcare City awareness program is empowerment. Women are taught what steps to take to manage their risk profile.

Protective steps you can take: At age 16 - 35

So what steps can a woman take if she wishes to find out her risk profile? Dr Almutawa recommends that girls or women aged from 16 to 65 follow these guidelines to reduce their risk profile for breast cancer:

• Awareness Dr Almutawa says, "You need to fully understand the nature of breast cancer as a disease and to be aware of its triggers and predisposing factors. As a girl or a woman you need to be sufficiently familiar with how your body looks in its normal state - in the absence of any disease - that you're able to detect any abnormalities or suspicious changes if they occur, and then take immediate action"

• Screening "If you are under age 35, ultrasound is recommended rather than a mammogram," she says. "But if your doctor finds something suspicious it's advisable to also do a mammogram, which is the gold standard for breast screening. For additional assurance as needed and recommended by your physician an MRI would be an excellent tool"

• Genetic tests & blood tests "If you have a family history of breast cancer, it's advisable to do genetic testing and blood tests to ascertain hormone levels that could indicate your readiness to have the disease (your susceptibility) - not that you will definitely have it," explains Dr Almutawa.

At age 35 - 40

Dr Almutawa says "For this age group I recommend a ‘combo' treatment (ie "check everything") approach, because this is the age at which alarms bells should start ringing."

• Screening If you have a high risk profile discuss additional screening options with your doctor

• Genetic testing You need to do genetic testing at this age if you haven't done it earlier

• Check your hormone levels by having blood tests "Age 35 is when levels of progesterone begin to drop and oestrogen levels become more dominant. In the hormonally-dependent type of breast cancer this is considered a high-risk factor," says Dr Almutawa

• Know your body She adds, "Notice any changes in your body. Examine your body's appearance by looking at it first. Then you can examine it by feeling, which is not a random process. If you wish you can follow the self-exam routine taught by your local clinic"

• Exercise Dr Almutawa emphasises the importance of exercise: "Exercise is so beneficial because not only are you losing weight (fat cells store toxins) but you're also boosting your circulation and lymph drainage, which gets rid of waste. Waste is an accumulation of toxins that we consume every day. If it accumulates in our body in large amounts it can trigger disease that the body might not have had normally.

Emily CallahanMD, Marketing Communications, Susan G. Komen for the Cure, Dallas, Texas

Emily Callahan, Managing Director at the global cancer organisation, Susan G. Komen for the Cure says the company "provides training and tools based on our documented best practices to local partners in the UAE, to help educate people about breast cancer and to empower people, businesses and organisations to work together to help end the disease.

So far, we've helped conduct "train-the-trainer" sessions about breast cancer education, and sessions about cause-related marketing through the "Making It Our Business" initiative, which engages UAE companies in the fight against breast cancer."

So what are Emily's and Susan G Komen's recommendations for women?

Protective steps you can take:

Emily says, "At Susan G. Komen for the Cure, we recommend people be aware of their breast health. This involves more than regular screening, although that is a very important aspect. Komen recommends:"

• Know your risk by learning about your family health history and talking to your health care provider about your own personal risk

• Get screened by having a mammogram every year starting at 40 if you are at average risk

•Have a clinical breast exam at least every 3 years from age 20 and every year from age 40. Ask your doctor which screening tests are right for you if you're at a higher risk. MRI and ultrasound may be good options for women at higher risk

• Know what is normal for you and report any changes to your doctor right away Make healthy lifestyle choices that may reduce your risk of breast cancer

• Gene testing We recommend genetic counselling prior to genetic testing so that people understand what the test can tell them, how the information may affect them and their families and also to think bout what actions they might consider to reduce their risk if they test positive for the mutation.

Having the test itself is easy, but the ramifications for individuals and families can be very complicated. We do know that these mutations are rare in the general public and account for only 5 -10% of breast cancer in the US. Nasseem Rouhani

MPH, CHES, Dubai Coordinator/Master Trainer, "Making It Our Business" program, Vital Voices, Dubai

Nasseem Rouhani, a master trainer with Vital Voices, which runs a workplace awareness program in Dubai says, "In Dubai, we've partnered with the Dubai Chamber of Commerce and Industry to educate women about the risk factors for breast cancer. Encouraging them to engage in an early detection routine can go a long way toward ensuring healthy lives."

So far the Vital Voices training programs have been attended by numerous employee trainers in Dubai. Twelve prominent UAE companies have pledged to educate their employees about breast cancer and assist with screening.

According to Nasseem, "From August 2008 through February 2009, all employees of the 12 charter companies in Dubai will be eligible to receive clinical breast exams, consultations with doctors, and reduced costs on mammograms and ultrasounds. Dubai Medical Suites will offer these discounts at Dubai Healthcare.

Protective steps you can take:

According to Nasseem, the Vital Voices recommendations to women include:

• Annual mammography from the age of 40. If you're under the age of 40 and have a family history of breast cancer or any other concerns, discuss alternative screening options with your doctor

• Clinical breast exams at least every 3 years starting at the age of 20, and annually after the age of 40

• Notice changes in your body If you spot any changes in your breasts, consult your doctor.

• Gene testing Nasseem says, "If breast cancer runs in the family and/or if you have inherited a gene mutation (BRCA1 and BRCA2) that has been linked to breast cancer, then I'd highly recommend you undergo genetic counselling and testing."

Resources:

American Hospital Breast Care Clinic: Jane Finch, Tel: 971 4 309 6399,Dr Paul Sayad, general surgeon, Tel: 971 4 309 6553, www.ahdubai.com. Eastern Biotech, gene and blood testing centres, www.easternbiotech.com/test_centers.php, Susan G Komen, www.komen.org, Vital Voices, www.vitalvoices.org

Breast Care Clinic

The American Hospital at Dubai Healthcare City has created a dedicated Breast Care clinic for UAE women. It is managed by Jane Finch, a registered nurse with postgraduate qualifications in breast cancer care and counselling.

The clinic offers a multidisciplinary approach to screening, treatment and follow-up care with a diverse selection of specialists available including: an MRI specialist, a male and female surgeon, an oncologist, 2 endocrinologists, and 2 nutritionists. It also provides a complete clinical and diagnostic service in a single clinic visit - something quite rare in the region. How does cancer grow?Dr Ayesha Al Mutawa, MD, MPH

"The cell grows outside its normal life cycle and proliferates at a far higher speed than normal cells, causing the shape of the cell to distort. It is able to take over a whole area of the body because it grows so fast and takes over the blood supply. In this way it is able to travel to other areas of the body."

A survivor

Sharon Evans is a registered nurse and Survey Manager at Dubai Healthcare City. She was diagnosed with breast cancer in 2002 after discovering a lump during a breast self-exam. After a lumpectomy, total axillary dissection, chemotherapy and radiotherapy, Sharon finally beat her cancer.

Sharon's advice:

• Discuss breast cancer with your family members It's a family disease. Talk about the generations before. Did anyone die of breast cancer - perhaps your great grandmother? Did anyone have polycystic ovarian disease?

• See a doctor to discuss your breast cancer risks Perhaps have some genetic testing done for the BRCA1 and BRCA2 genes, or blood tests to check for oestrogen dominance, which has been shown to be related to breast cancer

• Look at prevention by keeping active. Play sport or do physical exercise where you sweat. Active, lean women are less likely to develop breast cancer, especially as our age goes above 35

• Look at prevention through diet. The best diet is one rich in fruit, vegetables and lean meat, and low in fat and processed food

• Get to know your own breasts. If you find a lump, a thickening, or a strange dimpling, get it investigated by a doctor or nurse

• Have clinical breast examinations. Between the ages of 20 to 39 have a clinical breast examination by a doctor or nurse every 3 years

• Above the age of 40 have a Clinical Breast Examination by a doctor or nurse every year

• Screening Discuss your annual screening options with your doctor

• Don't smoke - cigarettes or shisha

• Don't drink alcohol. Where you can get gene & blood testsEastern Biotech UAE centres:

1. Eastern Biotech & Life Sciences FZ-LLC, Tel: +971 4 369 2061,

2. Wellness Medical Center, Jumeirah Beach Road, Umm equiem 1, Tel: +971 4 395 3115,

3. Jebel Ali Hospital, Tel: +971 4 8845666

4. Harley International Medical Clinic, Nashwan Building, Block B, First Floor, Dubai, Tel: +971 4 398 9988

5. First Medical Center, Level 7, Bu Haleebu Plaza, Muraqqabat Street, Deira, Dubai, Tel: +971 4 297 6868

6. Care Plus Medical Center, Ground Floor, Al Serkal Building, Opposite Dubai Police Headquarters, Dubai-Sharjah Road, Dubai, Tel: +971 4 269 9220

Regional testing centres:

Kuwait City The National Laboratory of Kuwait, Sharq-bin Misbah St, Amiri Hospital, Yellow Tower, Kuwait City. Tel: 242 3241 or 243 4588.

Jeddah Suleiman Habib Medical Center, Riyadh King Fahad Highway - Al-Olaya, Riyadh. Tel: 00966 1 462 2224

Cairo Dr Sherif Ba'athallah's Clinic 75, Kasr El-Aini Street, Flat-4 (near Dar El-Ekma) Cairo. Tel: +202 794 3960

Lebanon Dr Tarek Saleh, Abdel Aziz Street, Blue Building, 4th Floor, Hamra, Beirut. Tel: +961 1 370 020

Muscat Medicare Centre Pathological Laboratory, An Namma Street, opposite Grand Mosque, Ghala. Tel: 245 03 011

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