SYDNEY, Australia, Oct 24 (IPS) – The burden of breast cancer, the most common cancer among women, is global, and the projected increase in cases in the coming decades will affect women in high- and low-income countries in all regions.
That includes the Pacific Islands, where it is the leading cause of female mortality from cancer. Now, during Breast Cancer Awareness Month, Islanders are talking about addressing the disparities they face and reversing the trend.
“Breast cancer is a major health problem in Madang province,” Tabitha Waka of the Rural Women’s Association of Madang province, on the northeast coast of Papua New Guinea, told IPS. “Most of our women who live in urban centers have access to sufficient information and data about cancer, but at least those who live in rural areas do not.”
Current global trends indicate that new cases of breast cancer could reach 3.2 million each year by 2050, reports the World Health Organization (WHO). In the Pacific Islands, which comprise 22 island nations and territories and 14 million people, more than 15,500 overall cancer cases and 9,000 related deaths were recorded in 2022. But experts warned that the actual numbers are unknown.
“It is currently not possible to accurately estimate the true burden of breast cancer in the Pacific Islands due to significant challenges in collecting cancer data and incomplete coverage of population-based cancer registries,” Dr. Berlin Kafoa, director of the Public Health Division of the Pacific Community in Noumea, New Caledonia, told IPS, adding that it was an issue that countries were working to address. rectify.
The lack of cancer data is a sign of the funding and resource constraints experienced by national health services. And women are being affected, especially in rural communities where they have less access to knowledge about breast cancer and live far from urban health clinics and hospitals. These are important factors in global disparities, and while 83 percent of women in high-income countries are likely to survive after a breast cancer diagnosis, the chance of survival drops to 50 percent in low-income countries.
Breast cancer occurs when cells in the breast change, multiply, and form tumors. Symptoms may include unusual lumps or physical changes in the breasts. If cancer is detected early, the chances of successful surgery and treatment are high. In a more advanced stage, it can spread to other parts of the body. The risk of breast cancer increases after age 40 and with a family history of the disease, as well as lifestyle factors, such as tobacco and alcohol consumption and lack of physical exercise. However, this is not prescriptive and approximately half of all breast cancers are diagnosed in women without significant risk criteria other than age.
It is important to note that today receiving a diagnosis of breast cancer is not fatal and many women can enjoy a long and productive life. The key to this outcome is early detection, but one of the barriers for women in the Pacific is that specialist services are centralized in major cities. In Papua New Guinea (PNG), women can have mammograms, the main method of breast screening, at hospitals in the capital Port Moresby and the cities of Lae and Kimbe on the continent’s northeast coast. But most of the 5.6 million women, representing 47 percent of the population, live in rural areas, whether densely forested mountains or remote islands. And for many it could mean a long and expensive trip by road, plane or boat to get to a hospital with a mammography machine.
But it is also not uncommon for women to refrain from seeking medical advice or treatment due to cultural and community taboos.
“There is evidence to suggest that cultural and community taboos, personal inhibitions and fears around medical examinations are important factors contributing to low levels of early diagnosis and treatment of breast cancer among women in Pacific Island societies,” Kafoa said.
Modesty and privacy are important to many women in traditional Melanesian societies. In Palau, for example, a study published by Australia’s Griffith University in 2021 found that “low screening rates were explained, at least in part, by women feeling uncomfortable during examinations due to their personal nature.”
There may also be pressure from families who may encourage or discourage women from continuing treatment. “If the family does not agree with the treatment, women may comply due to cultural norms,” and concerns about mastectomy and how it changes women’s bodies “can cause resistance to surgical procedures,” reports a study on breast cancer in Fiji published last year.
It is imperative to take action now to save the lives of women across the region and, globally, achieve Sustainable Development Goal 3 of good health and well-being. The International Agency for Research on Cancer (IARC) predicts that breast cancer cases could increase globally by 38 percent and mortality by 68 percent by 2050. Experts project that cancer incidence in Pacific Islands could increase by 84 percent between 2018 and 2040. Kafoa says that “Pacific island governments are not yet sufficiently prepared to deal with the increase.” projected risk of breast cancer by mid-century.
The PNG government’s national health plan includes strengthening health services to reduce cancer morbidity and mortality, but a population-wide breast screening program has not yet been implemented. Waka says there is a need to invest more in breast cancer services. “One or two centers are not enough to care for the large number of women living with breast cancer,” she stressed.
But efforts have begun to transform the quality and reach of healthcare in the country, through the ‘glocal’ approach of combining global technology and local avenues of action. “This process is already underway,” Dr. Grant R. Muddle, ML, a global healthcare expert who has worked to help transform healthcare systems in Australia, the Pacific and other regions, told IPS. He now works with health services in PNG.
Two years ago, a collaborative project was created with an Australian health agency that “is providing PNG with proven cancer registry software and technical support, while local officials adapt it to the PNG context. The result is a win-win: PNG quickly gets a modern data system and trained staff, rather than building from scratch,” Muddle explained.
Mobile technology could also be used to help expand cancer registration. “Village health workers or clinical nurses, even in isolated areas, could be trained to enter basic patient and tumor details into tablets or smartphones,” he continued.
A major step in improving rural health services was taken this year when a new public hospital opened in the remote Highland province of Enga. It is expected to have an operational mammography unit by the end of this year. But there is also a need to “bring screening technology to women, rather than expecting women to travel to the technology,” Muddle emphasized. “Mobile mammography clinics have been used globally in vans or portable units to bring breast cancer screening to underserved communities…they could be truck-mounted clinics or portable equipment that can be transported by small plane or boat to regions without road access.”
And telemedicine, another proven strategy, can connect isolated clinics with specialist doctors in provincial hospitals through video consultations.
As PNG celebrates 50 yearsth Independence Day this year, these initiatives support better outcomes for women’s breast cancer survival and the long road ahead to achieve the country’s health care goals.
“What needs to be done, we must do. Let us not compromise on basic health care, but at the same time provide specialist care. Together, let us ensure a health system that works for PNG’s 10 million people,” Prime Minister James Marape advocated to the PNG Medical Society in September.
IPS UN Office Report
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