Breast cancer on rise in poorer countries

WASHINGTON — Nurses were training women in rural Mexico to examine their breasts for cancer when one raised her hand to object. If she lost her breast, Harvard public-health specialist Felicia Knaul recalls her saying, "My man would leave me" — and with him, the family's income.

International cancer specialists meet this week to plan an assault on a troubling increase of breast cancer in developing countries, where nearly two-thirds of women aren't diagnosed until it has spread through their bodies.

Adding to the problem, some worrisome data suggest breast cancer seems to strike women, on average, about 10 years younger in poor countries than it does in the U.S. No one knows why.

"Today in most developing countries you see a huge bulge of young, premenopausal women with breast cancer," says Knaul, who heads Harvard's Global Equity Initiative and was herself diagnosed at 41 while living in Mexico.

But from Mexico to Malawi, stigma like Knaul witnessed a few weeks ago may prove as big a barrier as poverty.

"One of the trainers said, 'If he'd leave you for that, he's not worth having,' " Knaul says. But she acknowledged that will be a hard message for some women's economic realities.

Breast cancer long has been considered a cancer mostly of wealthier countries. About 192,000 new cases are expected in the U.S. this year, where long-term survival is high, thanks in part to good screening.

The true prevalence in most developing countries is unknown, because of poor diagnosis and bad record-keeping. But new Harvard research estimates those countries will be home to 55 percent of the world's 450,000 expected breast-cancer deaths this year.

The report predicts the poorest countries will see a 36 percent jump in breast cancer by 2020.

One problem: In wealthy countries, earlier diagnosis can lead to breast-saving surgery instead of breast removal.

Even countries like Rwanda and Malawi have clinics that perform mastectomies if patients can travel to the capitals, says Dr. Lawrence Shulman of the Dana Farber Cancer Institute. But few have radiation equipment, making breast-conserving surgery there not an option yet. (He is hunting down a radiation unit for Rwanda.)

Mexico is a mixed situation, with radiation, other treatments and diagnostic mammography available in some places. Knaul founded an advocacy group — Cancer de Mama — to help, noting that Mexico's insurance program for the poor covers breast-cancer care but women must get diagnosed first.