SYDNEY, Australia, Oct 24 (IPS) – The burden of breast cancer, the most common cancer among women, is global, and the projected increase in cases over the coming decades will affect women in high- and low-income countries in every region.
This includes the Pacific Islands, where it is the leading cause of death among women cancer mortality. Now, during Breast Cancer Awareness Monthislanders talk about tackling the inequalities they face and reversing the trend.
“Breast cancer is a major health problem in Madang Province,” says Tabitha Waka of the Country Women’s Association in Madang Province, on the northeast coast of Papua New Guinea. “Most of our women living in urban centers have access to sufficient information and facts about cancer, but at least half of women in rural areas do not.”
Current global trends indicate that new cases of breast cancer may emerge 3.2 million every year by 2050, reports the World Health Organization (WHO). In the Pacific IslandsComprised of 22 island states and territories and 14 million people, more than 15,500 cases of general cancer and 9,000 related deaths were recorded in 2022. But experts warn that the actual figures 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 cancer data collection and the incomplete coverage of population-based cancer registries,” said Dr. Berlin Kafoa, director of the Pacific Community Public Health Division in Noumea, New Caledonia, told the IPS. He adds that it is a problem that countries are trying to solve.
The lack of cancer data is a sign of the funding and resource constraints facing national health services. And women are affected, especially in rural communities where they have less access to knowledge about breast cancer and are far from urban health clinics and hospitals. These are important factors global differencesAnd while 83 percent of women in high-income countries are likely to survive after a breast cancer diagnosis, the survival rate 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 the cancer is detected early, the chances of successful surgery and treatment are high. In more advanced stages 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 use and lack of exercise. However, this is not prescribed and about half of all breast cancers are diagnosed in women with no significant risk criteria other than their age.
Importantly, a diagnosis of breast cancer today is not fatal and many women can live long and productive lives. The key to this outcome is early detectionbut 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 examination, at hospitals in the capital Port Moresby and in the towns of Lae and Kimbe on the northeast coast of the mainland. But most of the 5.6 million women, who make up 47 percent of the population, live in rural areas, whether on densely forested mountains or remote islands. And for many, reaching a hospital with a mammography machine can involve a long and expensive journey by road, air or boat.
But it is also not uncommon for women to be prevented from seeking medical advice or starting treatment due to cultural and social taboos.
“Evidence suggests that cultural and community taboos, personal inhibitions and fears around medical examinations are important factors contributing to the low levels of early diagnosis and treatment of breast cancer among women in Pacific Islander societies,” Kafoa said.
Modesty and privacy are important to many women in traditional Melanesian societies. In Palau for example, a study published by Australia Griffith University in 2021 found that ‘low screening rates were explained, at least in part, as a result of women feeling uncomfortable during examinations due to their personal nature.’
There may also be pressure from families that can encourage or discourage women from undergoing treatment. “If family members disagree with treatment, women may comply due to cultural norms,” and concerns about mastectomy and the way it changes women’s bodies “may cause resistance to surgical intervention,” reports a breast cancer study in Fiji published last year.
Taking action now is imperative to save the lives of women across the region and achieve this globally Sustainable Development Goal No. 3 of good health and well-being. The International Agency for Research on Cancer (IARC) predicts that by 2050, breast cancer rates could increase globally by 38 percent and mortality by 68 percent. Experts predict that the incidence of cancer in the Pacific Islands could increase by 84 percent between 2018 and 2040. Kafoa says that “Pacific Island governments are not yet adequately prepared to deal with the projected increase in 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 yet to be rolled out. Waka says there is a need for more investment in breast cancer services. “One or two facilities are not enough to cater to the large numbers of women living with breast cancer,” she emphasizes.
But efforts have been made to transform the quality and reach of healthcare in the country, through the ‘glocal’ approach of combining global technology and local pathways to action. “This process is already underway” Dr. Grant R. MuddleML, a global healthcare expert who has worked to transform the healthcare system in Australia, the Pacific and other regions, tells IPS. He now works with healthcare in PNG.
Two years ago, a partnership project was set up with an Australian health agency that “provides PNG with proven cancer registry software and technical support, while local officials adapt it to the PNG context. The result is a win-win situation: PNG quickly gets a modern data system and trained workforce, rather than building from scratch,” Muddle explains.
Mobile technology can also be used to expand cancer registration. “Village health workers or clinic nurses, even in remote areas, could be trained to enter basic patient and tumor data into tablets or smartphones,” he continued.
An important step in improving rural healthcare occurred this year when: new public hospital opened in the remote Highlands province of Enga. An operational mammography unit is expected to be available by the end of this year. But there is also a need to “bring the screening technology to women, rather than expecting women to travel to the technology,” Muddle emphasized. “Globally, mobile mammography clinics in vans or portable units have been used to bring breast cancer screening to underserved communities. These can be truck-mounted clinics or portable equipment that can be flown by small plane or transported by boat to areas without road access.”
And telemedicine, another proven strategy, can link isolated clinics to specialist doctors in provincial hospitals through video consultations.
As PNG celebrates its 50the On this year’s Independence Anniversary, these initiatives support better outcomes for women’s breast cancer survival and the long journey ahead to achieve the country’s healthcare goals.
“What needs to be done, we need to do. Let’s not compromise basic health care, but at the same time provide specialist care. Together, let’s secure a functioning health care system for PNG’s 10 million people,” Prime Minister James Marape advocated before the Medical Society of PNG in September.
IPS UN office report
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