Family doctors are vital for cancer fight

Early detection of cancer in the UAE is hampered by a lack of reliance on primary care physicians.

ABU DHABI // Primary care doctors hold the key to improving the early detection and successful treatment of cancer, experts said at a conference yesterday.

Patients should think of their primary doctor as more than someone who refers them to a specialist - and regulators and insurers should educate people to this end, they said.

Dr Waleed Hassen, chairman of the department of urology at Tawam Hospital in Al Ain, said: "Our biggest problem is we don't have a primary healthcare system that is proactive in identifying patients, catching them early, getting them appropriate care, getting them screened early and regularly, getting them to have annual check-ups with a family doctor who knows their history."

Speaking at the sixth annual Middle East Healthcare Innovation Summit, he said many patients had an advanced stage of cancer by the time they were diagnosed - as was the case in the United States 30 years ago.

Dr Hassen said many patients came to him with advanced and incurable prostate cancer, which was "really a shame and shouldn't happen".

However, he said patients were partly to blame and often didn't have enough trust in their general practitioner or family doctor.

"They tend to shop around, which is something cultural, and they want to be seen straight away by a specialist or consultant."

And no matter how good specialists or consultants might be, he said, they cannot "fix a disease that is so advanced, when it could have been caught early by primary health care".

Prostate cancer in the UAE is generally diagnosed in the late stages in 60 per cent of cases. The figure is also similar for breast cancer, which is diagnosed in the early stages in just 30 per cent of cases, according to the Health Authority-Abu Dhabi.

Although there is no central cancer registry, figures from Abu Dhabi in 2009 show there were 20.8 breast cancer deaths per 100,000 people.

The World Health Organisation also predicts that the number of cancer cases in the Eastern Mediterranean Region, which includes the UAE, will increase by between 180 per cent by the year 2020.

Dr Noora al Hammadi, chairwomman of the radiation oncology department at Al Amal Hospital in Qatar, was also a speaker at yesterday's conference, and concurred that patients' lack of awareness about the importance of primary healthcare doctors was a problem across the region.

"We have found it very hard to get our primary doctors to run screening programmes, because the confidence of the patient is in going straight to the bigger hospital, rather than a primary clinic," she said. "They just don't want to do it."

Dr Aly Abdelrazek, executive director of the Gulf International Cancer Center in Abu Dhabi and chief of radiation oncology, said regulators and insurance companies must teach patients about the importance of a primary care doctor as their first point of call.

"The US and UK model has the patient referring to one family doctor continuously and for all his health needs, and that doctor is the one who refers the patient to specialists when needed, and works with the specialist to tailor the best treatment for the patient," he said.

That same doctor would be the one regularly checking the patient and ensuring there was early detection of any disease, cancer or otherwise, Dr Abdelrazek said.

Instead, primary doctors in the UAE seemed to have one role only, he said, which was to quickly refer their patients to the specialists they wanted to see.

"Changing this way of thinking will decrease the load and the costs on everyone."

Dr Nellie Shuri Boma, chief medical officer at Al Rahba Hospital in Abu Dhabi, stressed that early detection would save lives and money, and added that prevention was always better than treatment.

"There has to be legislation that mandates cancer screening, and at the same time, there should be rewards or incentives for the hospitals and clinics that do that," she said. Rather than screening the entire population, Dr Boma said screening should be provided for the "population of focus".

For a country with vast resources such as the UAE, that should be easy to do, she said.

While the blame fell mostly on cultural tendencies coupled with a lack of awareness about the role of a primary doctor, insurance limitations were also a deterrent, doctors said.

"Insurance does not pay for prevention or for a patient who wants to go for a regular check-up with no complaints; insurance is only ready to pay for the treatment once the disease has set in, which is a lot more expensive than just paying for a check-up," Dr Boma added.