Stigma part of breast cancer's grip on poor

A woman touches an activist of the Costa Rican

WASHINGTON — International cancer specialists meet this week to plan an assault on a troubling increase of breast cancer in developing countries.

Nearly two-thirds of women with breast cancer in developing countries are not diagnosed until it has spread through their bodies.

Adding to the problem, some data suggests that on average, breast cancer strikes women approximately 10 years younger in poorer countries than it does in the US.

A reason for this is not known.

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

"We should help them to know what they have and to fight for their treatment."

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

Nurses were training women in rural Mexico to examine their breasts for cancer when one raised her hand to object.

Knaul recalls the woman saying: "My man would leave me" — and with him, the family's income.

"One of the trainers said, 'if he'd leave you for that, he's not worth having,'" says Knaul.

But she acknowledged that will be a hard message for some women's economic realities.

"It's not a trivial consideration," agrees Dr Lawrence Shulman of the Dana Farber Cancer Institute, who is part of a team working to begin cancer care in parts of Africa where he says, "the women are often seen as really either vessels for producing children or as sex slaves."

But some success in treating HIV and tuberculosis in those areas has him "hopeful we can make a difference. I don't think it's a pipe dream."

On Tuesday (local time), Knaul and Shulman will bring together an international task force of health specialists and prominent charities to begin planning a two-pronged approach.

First, train midwives and other rural health providers will perform regular breast exams, using the power of touch in places where mammography machines simply are too expensive.