A large-scale review of breast cancer in the UAE shows better screening is reducing the number of advanced cases of the disease and improved survival rates are now comparable with those of leading western nations.
Forty-six doctors compiled anecdotal evidence and research outcomes from 2001 to 2021 to develop a real-time picture of breast cancer in the UAE.
In 2018, an evaluation of 988 UAE patients at Tawam Hospital in Al Ain found 97 per cent had survived for two years, while 89 per cent had survived five years post-diagnosis — a similar figure to the US, Australia and Canada.
Although the most recent statistical data from the National Cancer Registry was collected from 2017, medics used personal experience from daily clinics to present an overall disease assessment.
Of the 834 breast cancer cases in 2017, 26 per cent were found in Emiratis, with 74 per cent from expatriates, mainly from India, Pakistan, the Philippines and Europe.
“All patients ask if we are as good as the US to treat breast cancer and this report tells us that we are,” said Dr Humaid Al Shamsi, director of medical oncology at Burjeel Medical City, who led the study.
“We have the data and the comparison with official US data. We can see we have the same success, in outcomes and survival.
“This should give confidence to the public.”
While historically there have been gaps in official data, annual cancer statistics have been recorded since 2011.
Registry figures not included in the review showed 883 cases of breast cancer were diagnosed in 2019.
The International Agency for Research on Cancer reported 1,030 new breast cancer cases in 2020 in the UAE, or 21.4 per cent of all new cancer diagnoses.
“In the past, we did not have much data to understand the UAE landscape but that has changed in recent years,” said Dr Al Shamsi.
“We know exactly what we are dealing with. Although the number of stage-four cancers are increasing, we can detect it earlier, which is a good sign.”
With 2.26 million new cases and 685,000 deaths, breast cancer became the most commonly diagnosed cancer globally in 2020 and in the UAE.
It is the most likely cancer death in women and the fifth most dangerous overall.
The majority of UAE cases were diagnosed in women under 50, slightly younger than the global average due to a generally older population elsewhere.
Australian Jennifer Croes, who lives in Dubai, was diagnosed with breast cancer during a routine check-up in February last year.
After weekly chemotherapy sessions at King’s College Hospital in Dubai for five months and a lengthy course of radiation therapy and surgery, she is now cancer free.
“There is no medical history of breast cancer in my family so my diagnosis came suddenly and unexpectedly,” she said.
“It would be interesting to see if there has been an increase in cancer figures since 2020 as a result of Covid as there was generally more stress and mental health considerations during that period of uncertainty, which can be contributory factors.”
More late-stage breast cancer diagnoses have been reported worldwide due to medical restrictions enforced by the pandemic that left many women unable to undergo regular check-ups.
Even though Ms Croes had limited options due to flight restrictions to Australia, she was happy to be treated in the UAE as her health insurance covered her treatment plan.
“Australia is highly reputable for its breast cancer treatment but I didn’t even contemplate going home, partly because of Covid and also because I trusted the team at Kings,” said Ms Croes.
“I did not want to go doctor shopping.
“Because of Covid, all of the regular check-ups were put on hold and I could not see any specialists due to Covid-19.
“I was lucky that I was able to start treatment very quickly at the start of March 2021.”
Advanced cases decline
The UAE breast cancer care review reported a relative decline in stage-four cases of the disease, which can be harder to treat.
The proportion of localised disease increased from 10 per cent in 2011 to 25 per cent in 2017 to reflect overall improvements in mammography.
Despite the improvements, survivorship programmes are in their infancy and more support was needed for recovering patients, the review said.
“Better screening and early detection has had a direct impact on the numbers,” said Dr Hassan Jaffar, an oncologist at Burjeel Medical City in Abu Dhabi.
“We used to see more advanced stage of the disease than now and we are also seeing more pre-cancerous conditions, which is a good sign as we can offer treatment earlier.”
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Mercer, the investment consulting arm of US services company Marsh & McLennan, expects its wealth division to at least double its assets under management (AUM) in the Middle East as wealth in the region continues to grow despite economic headwinds, a company official said.
Mercer Wealth, which globally has $160 billion in AUM, plans to boost its AUM in the region to $2-$3bn in the next 2-3 years from the present $1bn, said Yasir AbuShaban, a Dubai-based principal with Mercer Wealth.
“Within the next two to three years, we are looking at reaching $2 to $3 billion as a conservative estimate and we do see an opportunity to do so,” said Mr AbuShaban.
Mercer does not directly make investments, but allocates clients’ money they have discretion to, to professional asset managers. They also provide advice to clients.
“We have buying power. We can negotiate on their (client’s) behalf with asset managers to provide them lower fees than they otherwise would have to get on their own,” he added.
Mercer Wealth’s clients include sovereign wealth funds, family offices, and insurance companies among others.
From its office in Dubai, Mercer also looks after Africa, India and Turkey, where they also see opportunity for growth.
Wealth creation in Middle East and Africa (MEA) grew 8.5 per cent to $8.1 trillion last year from $7.5tn in 2015, higher than last year’s global average of 6 per cent and the second-highest growth in a region after Asia-Pacific which grew 9.9 per cent, according to consultancy Boston Consulting Group (BCG). In the region, where wealth grew just 1.9 per cent in 2015 compared with 2014, a pickup in oil prices has helped in wealth generation.
BCG is forecasting MEA wealth will rise to $12tn by 2021, growing at an annual average of 8 per cent.
Drivers of wealth generation in the region will be split evenly between new wealth creation and growth of performance of existing assets, according to BCG.
Another general trend in the region is clients’ looking for a comprehensive approach to investing, according to Mr AbuShaban.
“Institutional investors or some of the families are seeing a slowdown in the available capital they have to invest and in that sense they are looking at optimizing the way they manage their portfolios and making sure they are not investing haphazardly and different parts of their investment are working together,” said Mr AbuShaban.
Some clients also have a higher appetite for risk, given the low interest-rate environment that does not provide enough yield for some institutional investors. These clients are keen to invest in illiquid assets, such as private equity and infrastructure.
“What we have seen is a desire for higher returns in what has been a low-return environment specifically in various fixed income or bonds,” he said.
“In this environment, we have seen a de facto increase in the risk that clients are taking in things like illiquid investments, private equity investments, infrastructure and private debt, those kind of investments were higher illiquidity results in incrementally higher returns.”
The Abu Dhabi Investment Authority, one of the largest sovereign wealth funds, said in its 2016 report that has gradually increased its exposure in direct private equity and private credit transactions, mainly in Asian markets and especially in China and India. The authority’s private equity department focused on structured equities owing to “their defensive characteristics.”
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