This October, the UAE will join countries across the globe in marking Breast Cancer Awareness Month. However, with diagnosis here occurring at a younger age and more advanced stage than in the western world, the region’s experts say more needs to be done to catch cases here sooner…
According to the American Cancer Society, the median age of a woman at the time of breast cancer diagnosis is 61, with similar statistics for Western European countries. Here in the UAE, however, doctors report seeing women being diagnosed at a much younger age.
“We still don’t have a proper national cancer register but from numbers collected through hospital registers in Abu Dhabi, it does appear our women get breast cancer ten years younger than those in America and Western Europe,” says Dr Houriya Kazim, an eminent breast cancer surgeon based in the UAE.
Dr Annett Al Hamadi, consultant general and breast surgeon at Dubai’s City Hospital, agrees. “In our breast cancer centre we diagnose and treat women with breast cancer at earlier ages than elsewhere,” she says. “In general, there seems to be a shift into the younger age groups; we can only discuss our own statistics, but we have an average age of around 43 for diagnosis of breast cancer in our patients, compared to more than 60 in Western European countries.”
Disappointingly, no clear scientific cause for this has currently been uncovered. “One [reason] could be the demographic in the UAE, as we have more of a young population in the workforce and not so many elderly people,” says Dr Annett, while Dr Houriya says she’d guess a combination of genetics and contributing environmental and/or lifestyle factors.
Concerningly though, the disease tends to be diagnosed at a later stage here in the UAE than elsewhere. This could partly be due to the types of cancer typically seen here, according to Dr Houriya. “The types of cancer we see are some of the more aggressive types, which would present at a later stage than other – better – breast cancers,” she explains. Breast density is also an issue, as is awareness. “Young breasts are relatively dense, making lumps harder to pick up,” Dr Houriya says. “And younger women may not go for mammographic breast screening, thinking that it’s only for older women. We still don’t know what age to start screening with mammography here, as although mammograms are the best tool we have for picking up cancer early, a mammogram doesn’t necessarily give us as much information in a young, dense breast.”
Dr Annett agrees lack of awareness could be a potential cause for later diagnosis, perhaps because of life events common for younger women. “It could be that the onset is during pregnancy or breastfeeding, and the symptoms can be covered by this,”
Being diagnosed at a younger age doesn’t significantly alter treatment plans, say the doctors, although Dr Annett notes there may need to be extra considerations. “Diagnosis at a younger age means not only breast cancer treatment based on international accredited guidelines, but also on fertility options, as many women don’t even have children at the time of diagnosis,”
So, given that doctors aren’t yet aware of any scientific causes for this phenomenon, it stands to reason there’s little knowledge of what women here should or shouldn’t be doing to try to prevent developing breast cancer. All they can do, say the doctors, is follow general international guidelines. “Women should be aware of any breast changes, which is best achieved through monthly self-examinations; noticing breast changes leads to earlier diagnosis and better survival in general,” explains Dr Annett. “Guidelines to preventing cancer also advise a healthy balanced life with a moderate amount of exercise, and avoiding being overweight.”
Over and above self-checking, Dr Houriya recommends regular clinical breast exams with a specialist physician. Eating a healthy Mediterranean diet with plenty of olive oil, ensuring you exercise regularly – even just a 20-minute walk a day – and keeping vitamin D levels in the normal range can all help prevent breast cancer developing at any age.
In addition to cancer treatment, many women who undergo a mastectomy also opt to see a plastic surgeon for breast reconstruction. Dr Rory McGoldrick, consultant plastic, reconstructive and aesthetic surgeon at Euromed Clinic in Dubai, says there are a number of choices. “The fundamental decision is dependent on whether the skin and the nipple have been preserved, and the starting size of the breast,” he explains. “Starting simply, the missing breast can be replaced with a breast implant, with or without additional fat transfer. Moving onto more complicated surgeries, skin and muscle from the back can be used – with or without an implant – and finally tissue can be completely removed from other parts of the body, commonly the tummy but also the buttock or inside thigh, and transferred to recreate breast tissue.”
If you’re going for reconstruction, should you do it when you have the mastectomy or wait until later? Some doctors suggest the former, according to Dr Rory. “There is a body of evidence that suggests immediate reconstruction is better psychologically for the patient, related to the fact that there’s no time the woman has to live with no breast,” he explains. “There’s also only one operation and one single recovery period.”
And if you do have a reconstruction, will this affect your chances of the disease recurring later? Not at all, says Dr Rory. “There is no medical evidence to suggest this; the most recent concerns were regarding the use of fat transfer, as the fat has stem cells that were thought to theoretically awaken cancer cells, but there is no evidence to suggest this.”
In light of the anecdotal evidence that women here get breast cancer earlier than elsewhere, breastfeeding concerns would be understandable, but Dr Rory insists reconstruction needn’t impact. “The ability to breastfeed is related to the presence of the nipple and milk ducts, rather than reconstruction,” he says. “Any disease removal surgery that removed these structures will affect breastfeeding, but reconstruction, in itself, will not.”
“since having cancer I’ve changed completely”
Emma Rymer was in her early 40s and mum to a young son when she was diagnosed with late stage two breast cancer
I was diagnosed with late stage two breast cancer – it would have been classed as stage three as it had already spread to my lymph nodes, but the tumours thankfully weren’t very big. The beginning of everything – going through a battery of tests to diagnose and stage the cancer – was the hardest part; you’re in shock, in denial, fearing the worst, and it’s all quite overwhelming. I’d think of my little boy growing up without me, which was devastating, and I’d go from numbness to complete breakdown all the time. It was only once I’d accepted the diagnosis, made up my mind to fight this beast of an illness and begun my treatment, that things started to feel a little less desperate.
My first stage of treatment was ACT chemotherapy to shrink the tumours, then a mastectomy with lymph node removal. Then I had radiation, targeted immunotherapy and oral chemotherapy, and I’m now taking hormone therapy medication for a total of five years. Treatment is definitely hard, especially the chemo, but it’s not nearly as bad as fearing death or – worse still – fearing it’s inevitable and you’re powerless.
Cancer runs in my family, but I thought if it happened to me it’d be later in my life, not when I was a young mother in my early 40s. I used to check myself from time to time, but I’d never had a mammogram which, in hindsight, was incredibly stupid.
Since having cancer I’ve changed completely, and forever. Whilst I am still me, my priorities have totally shifted. I used to be a workaholic, I had been all my life. Now, although I still work part-time, my family takes first place and my priority is being a mum to my boy for as long as I can. Nobody knows when their time is up and I’m not going to waste whatever precious years I have left chained to my desk, getting stressed out about things that aren’t important. I’m focusing on making happy memories, healing myself physically, mentally and emotionally, and loving, laughing and living. Cancer was a tough lesson but in many ways it saved my life and, for now, I’ve never felt better.