Jerusalem24 – To mark Breast Cancer Awareness Month, we hosted a special guest panel to gather key information surrounding this crucial subject.
Lana Nasser Al-Deen, chief of community outreach at Augusta Victoria Hospital, Dr. Wasim Sharbati, medical oncologist at Augusta Victoria Hospital, and Suzan Al-Sahouri, a breast cancer survivor, joined us at Jerusalem24’s studios to provide their input on the strategy for early detection of breast cancer, the support structures that exist for women going through the disease, as well as the general situation here in Palestine.
Breast Cancer Awareness Month dates back to 1985 when a partnership between the American Cancer Society and the pharmaceutical division of Imperial Chemical Industries started to promote mammograms as the most effective tool to fight breast cancer.
In Palestine, many activities are being conducted to raise awareness of breast cancer, Lana says.
“We at Augusta Victoria Hospital, mark October, a month dedicated to breast cancer awareness during the month, and continue our screening programs all over the year.”
So what does a patient’s journey look like, from detection all the way through to recovery?
— Augusta Victoria Hospital (@AVHospital) September 30, 2022
Combatting a lack of awareness
Palestine doesn’t own an established screening program, Lana adds, “but we know that every woman above 40 needs to do a mammogram. There is a lack of screening services, a lack of awareness about the importance of doing mammograms.”
Augusta Victoria Hospital was able to establish a digital mammography mobile unit that moves mainly in marginalized areas of the West Bank and offers free mammography scans to women.
The political situation in the West Bank has been an obstacle in the face of the mobile unit the hospital offers. However, the Augusta Victoria Hospital is determined to get women to do mammogram screening in all parts of the country.
The aim of breast cancer awareness campaigns is to raise knowledge and awareness of breast cancer and decrease the stigma which is linked to symptoms and treatment.
“Sometimes lack of access to services, barriers, the [existence of] the separation wall, a lack of awareness of how important mammogram tests are, and lack of self-checkup prevents a woman from early diagnosis and detection,” Lana says.
The life-saving benefits of early detection
“Mammogram is considered the cornerstone of screening,” explains Dr. Wasim. “Other options of screenings are a self-breast exam, and a clinical breast exam that should be done by a health care professional. These can reduce mortality to 25% or 30%, and early detection allows early diagnosis while symptoms cannot be seen yet on the patient, which allows for a more optimal treatment and less aggressive treatment.”
Suzan first heard of the Augusta Victoria mobile unit through a Facebook post by the Arab Women Union in Beit Sahour in 2021.
“I was encouraged to go; I got my neighbors to go with me.”
A week after Suzan went for her check-up at the mobile unit, she received a report informing her she should go for a further appointment and mammogram.
Suzan was first diagnosed with breast cancer in 2018, but in her case didn’t require any chemotherapy. At the time, she underwent a surgical operation to remove part of her breast.
“I went to Augusta Victoria Hospital and I was informed that I needed immediate chemotherapy. They didn’t care about the tahweleh (referral), they helped with everything.”
The Augusta Victoria Hospital walked Suzan through the process of chemotherapy explaining the sessions and the time treatment was expected to last.
Risk factors and common symptoms
According to Dr. Wasim, a common recommendation by different organizations is to start mammography in your 40s every year. “However, in some situations like having a strong family history, or [certain genetic] mutations, the age of screening should start earlier.”
Breast cancer arises from the breast itself; it not only affects women but also men who account for 1% of the cases, says Dr. Wasim.
The most common symptoms of breast cancer are lumps, skin discoloration, nipple retractions, and swelling of the lymph nodes under the arm, Dr. Wasim explains.
However, notes Dr Wasim, “not all breast lumps and masses are considered malignancies. The most common is considered as a benign disease.”
Breast cancer survivor Suzan tried to perform a self-checkup but wasn’t successful. “I think that’s why I had to go for a clinical checkup. They found a lump, did a biopsy, and then found out that I have cancer. Then we started the chemotherapy and had to remove my whole breast.”
Suzan says that her doctor was very supportive and thoughtful. “They were terrific in explaining all of my options.”
When a woman is diagnosed through the Augusta Victoria Hospital mobile clinic, she gets referred to the hospital for further examination and evaluation.
“If she needs a Tru-cut biopsy or further tests, we refer her to our hospital for free,” Lana says. “It’s important for us to protect her. Usually, it takes over three months to get appointments and referrals, but it takes us two weeks to come up with the diagnosis through our mobile clinic.”
When there is any suspicion of a disease, a needle biopsy is required to determine whether it is malignant or not.
Although breast cancer has one of the highest survival rates worldwide, in Palestine, the survival rate is lower than in any other country. “The reason is that most of the patients come to us in late stages,” says Dr. Wasim.
Breast cancer is the most common cancer in Palestine and accounts for 17% of all cancer cases. It is also the second leading in mortality, after lung cancer.
“Most of our cases are diagnosed at advanced stages of the disease, 60% of the cases are diagnosed in advanced stages. About 15% are diagnosed with metastatic disease – meaning in other organs of the body. Unfortunately, these cases don’t have the chance to be cured.”
In 2021, about 800 cases were diagnosed with cancer, which Dr. Wasim says is a very large number.
Stress as a risk factor
“There is no main cause of breast cancer,” says Dr Wasim. “However, there are risk factors that can cause breast cancer, such as a strong family history, age, gender, and long-term hormone exposure – for example, late menopausal status, or nulliparity [never having given birth], and lifestyle.”
Stress is also a known cause and a risk factor for developing many types of cancer, mainly breast cancer.
“In Palestine, the situation is very complicated, there are checkpoints and recurrent wars in Gaza. The travel itself can cause continuous stress for women. There is a strong association between stress and decreasing in the immune system.”
Dr. Wasim stressed the importance of early detection and encouraged women to get checkups annually. “We have strong and enough data to support the screening program. We know that a mammogram can save your life. As a medical oncologist, I prefer to treat a patient in the early stages before symptoms start to show, the cure rate is very high and the aggressiveness of the disease is low.”
Every case of breast cancer is different, and so is the treatment, Dr. Wasim explains. “We prepare a treatment plan that will be discussed with the patient. In most cases, surgery is the standard of care.”
In many cases, Dr. Wasim explains, doctors work on down-sizing the size of the tumor before setting a date for surgery, by using medical treatments like hormonal therapy and chemotherapy.
“Mastectomy is the old modality of treatment. Today we try to avoid this surgical procedure because the comorbidity is high – and for women, to remove the breast causes psychological trauma.”
Early-stage diagnosis allows for early treatment resulting in higher survival rates – but there are other crucial factors at play, as Suzan explains.
Solid, constant medical support was a big boost for Suzan, who stresses how important it is to believe in one’s self and the doctors who provide the medical treatment.
During every single chemotherapy session, Suzan had to do blood tests and was told what awaits, “Nurses explain the same process every single time over and over again, sometimes I say “I know that”, but they insist on walking me through the process.”
Suzan also made friends throughout her treatment journey. She advises all women to go for a check-up and get any necessary treatment.
Dr. Wasim explains that patients who underwent full treatments, including surgery, chemotherapy, and radiotherapy, should go through at least five years of follow-up. According to Dr. Wasim, disease recurrence is high in the first five years following treatment.
“The first two years should be evaluated regularly by medical oncologists or primary oncologists every three months for physical exams and lab tests. Every six months they have to do an ultrasound. And a mammogram once a year.”
If there are any suspected findings, patients should be referred as soon as possible to do a further investigation like a CT, Dr. Wasim stresses.
“As doctors, we should follow up regularly with these patients. The incidence of recurrence also depends on the type of tumor. If the tumor is aggressive recurrence is high in the first two years. If the tumor is less aggressive, the incidence of recurrence is lower.”
Support is another key component of recovery. Through the community outreach program and the Augusta Victoria Hospital, support is provided both for patients and survivors.
“This month, we had a pampering day for cancer patients and survivors, and next Friday we have another activity for women, Yoga on the beach in Yaffa,” says Lana. “Throughout the day they share experiences, they talk to each other, and they feel more relaxed when sharing their experiences.”
However, Lana adds, on a national level cancer patients and survivors are not provided with the support groups they need.
Suzan believes that Palestine lacks a medical health system that is efficient and effective.
Sharing survival stories, saving lives
Fortunately though, throughout her own personal treatment and recovery, Suzan was provided with the psychological and mental support she needed.
“I have received great support from my family, friends, and the team at the Augusta Victoria Hospital from the minute I walked in. Your fear fades when you enter the hospital due to the relaxing and comforting experience.”
Suzan believes that this kind of support makes such a difference for patients. “Now, I try to encourage the women who were also detected with me to go out and enjoy their social life.”
Deeply touched by the support she received, Suzan wants to start her own committee in Beit Sahour to provide a space where women encourage each other and stand by each other throughout their journey.
Suzan believes that the more survival stories are highlighted and shared, the more women will be encouraged to undergo checkups, and be saved.
Watch the full interview below.