Breast cancer awareness scheme tears down taboos

The National looks at how women in the Saudi province of Al Qassim are actively responding to calls they be examined.

Volunteers examine a mammography machine in the Breast Cancer Awareness Mobile Clinic.

AL RASS, SAUDI ARABIA // The walls are freshly painted pink and purple, international colours of the battle against breast cancer. And the five technicians in white lab coats and black face veils are delighted at the reception they are receiving from their target audience.

"Before, we thought it would be so difficult to ask a lady who is healthy to come and do this screening," said Munirah Ali al Romeh, the supervisor of the new mammography screening unit. "But we were really surprised. They are coming, knocking on the door, asking 'Can I come in?' Really, this is what is happening." Despite its reputation as home to a religious conservatism that stubbornly resists modernity, the central Saudi province of Al Qassim boasts one of the kingdom's most aggressive breast cancer awareness programmes.

Run by the local health department in co-operation with the King Abdul Aziz Women's Charity Committee, the campaign has launched a major effort to persuade 64,794 women between the ages of 35 and 65 - or 9.4 per cent of Al Qassim's population - to report for a free mammography and learn how to examine their own breasts at home. It is not a moment too soon. In incidence of breast cancer, Al Qassim ranks fifth among the kingdom's 13 health sectors. And like the rest of the country, more than 90 per cent of breast cancers - as opposed to 30 per cent or less in the United States - are diagnosed in a late stage, when chances of the woman's survival are very low, said Dr Mohammed Ali al Habdan, the executive chairman of Al Qassim Mammography Screening Programme.

The new screening facility in the main hospital of Al Rass, Al Qassim's third largest city, is one of four units set to open in the province over the coming months. Mrs Romeh said her "mammo team" are all nurses who were selected for training on the equipment from a pool of 100 applicants. The screening effort also features a mobile mammography van designed by Dr Habdan. The huge pink lorry will not only spark public interest but also bring screening to remote areas of the province.

In an unusual move, health officials have decided to include women as young as 35 in their targeted population because in Saudi Arabia, as in other Arab countries, breast tumours increasingly are being found in women in this age group, which is 10 years younger than in western women. "This is the first in the world to screen a younger population - under 40," Dr Habdan said. As a result, "we will treat this screening programme as a pilot programme" to look for possible lifestyle explanations for this phenomenon.

Atef M Surour, who supervises the breast cancer awareness programme as director general of Al Qassim health affairs, said a 2005 survey of 300 women in the province was alarming: only 23 per cent knew that a lump was a symptom of breast cancer, and only 30 per cent had heard of self-examination. "Let us be frank, this part of the body is difficult to examine because it's a private part," said Muzamil Hassan Abdelgader, a medical adviser to the campaign.

"People were not aware about breast self-examination. That's why this programme is unique in giving women the skills to examine themselves." This is where the volunteers from King Abdul Aziz Women's Charity Committee come in. With the encouragement of Princess Noura bint Mohammed al Saud, the wife of the provincial governor, a group of women were selected from the charity's network of volunteers to receive training on early detection of breast cancer.

Tahani al Akeel, the secretary of the charity's cancer awareness volunteer committee, said most of those selected came from among nurses and social workers who are used to working alongside men in hospitals. Women from the local education department tended not to be chosen, she said, "because they are very conservative. They don't want to meet with men." The volunteers were given seminars by local physicians on how to do self-exams, why a mammography is useful, good nutrition and risk factors for the disease. Some were also sent to Texas for more workshop training at the Dallas-based Susan G Komen for the Cure, a non-profit foundation devoted to spreading awareness of breast cancer.

The Dallas training is part of the US-Middle East Partnership for Breast Cancer Awareness and Research, an initiative announced last year under which the governments of Saudi Arabia, Jordan and the UAE have joined forces with the US state department, the Komen foundation and doctors at the University of Texas's MD Anderson Center to raise women's awareness of the need for early detection of breast cancer.

So far, almost 80 women have attended workshops in the kingdom modelled on the Komen programme as the first step in expanding breast cancer awareness. In Al Qassim, the volunteers, armed with the slogan "Break the Wall of Silence", are using innovative ways to reach women. Most recently, they set up booths for four days in two shopping malls in Buraida, Al Qassim's capital. "All the customers were surprised, asking, 'How can you do this awareness in the mall?'" said Ms Akeel, a social worker in a Buraida hospital.

The volunteers collected the names of 2,536 female shoppers who expressed an interest in being screened, she said, adding that the volunteers will call them to set up appointments. "They love the work," said Ms Akeel, who wore a dark business jacket and tie under her abaya. She had two pins in her lapel: one a button with the face of King Abdullah and the other a twisted pink ribbon, the international symbol of breast cancer awareness.

But the volunteers also labour under constraints. Since most are married with children, and already hold down day jobs, their volunteer work is usually done at night. "Sometimes her husband and her don't agree for her to work 'til 10 or 11pm," Ms Akeel said. And in a country where women cannot drive, transportation can be a problem if "we don't find any car to bring us", she said. "Sometimes Dr Atef supplies cars - because Princess Noura tells him to."

Ms Akeel said the educational campaign is tearing down taboos among women. "Before, they were very afraid to say 'breast cancer' or very afraid to come to the hospital," she said. "But now, after our awareness [campaign], they can say it, 'I want to examine myself. Can you teach me'?" Fatima al Qurzai, who chairs the volunteer committee, said that in the first six months after the awareness campaign began in November in the remote village of Uqlat Al Suqor, 276 women agreed to have a mammogram. They accounted for 16.7 per cent of the village's targeted group of 1,646 women.

Dr Abdelgader said the province's screening programme is unique in that "it's a female-to-female project", which is especially important "in this region with its [concerns for] privacy". At every stage - education, screening and surgery - patients are treated by women. But, out of necessity, the programme also includes men. Dr Surour said: "The support of the men is really necessary and I believe that if they understand what we are doing and we explain to them the feminine style of this project - since the ladies are serving the ladies - they are going to participate."

As an experiment, health officials gave imams and sheikhs in Uqlat Al Suqor the outline of a lecture on the importance of regular screening, and asked them to deliver it to their congregations during a break in Friday prayers. Afterwards, the number of women coming in for screening in the mobile unit "shot up", Dr Abdelgader said. "We were very surprised to find a large number of women brought in by their husbands. The imams of the mosques were very helpful."

Ms Akeel said the message to men is simple: making female relatives aware of the need for early detection "is your responsibility [because] you are the man, you are the father and you are the husband". As a result, "we don't, thanks be to God, have any problem with the men. Really, they support us."

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