Mena cancer inequalities present a life-or-death situation for patients
▶ Chances of surviving disease differ greatly throughout the Middle East and North Africa, writes Himaya Quasem
Late diagnosis for cancer patients, a lack of public awareness and the huge cost of treatment have created a chasm in survival rates between developing and richer nations in the Middle East and North Africa.
Figures from last year released by World Health Organisation lay bare a life-or-death issue for the region.
Israel – ranked 19th out of 189 countries in the UN’s Human Development Index last year – had the highest rate of new cancer cases in the region in 2020, but only the fifth-highest cancer mortality rate among Mena countries.
In stark contrast, Egypt – placed 116th on the same UN table – had the highest cancer mortality rate in the region, even though its rate of new cases was much lower than Israel’s.
Lockdowns brought about by the Covid-19 pandemic may have also exacerbated the problem, with many cancers going undiagnosed and untreated, one senior doctor said.
Conflict has also taken its toll, as in the case of Syria.
Meanwhile, a stigma surrounding the disease has deadly consequences for many, said Prof Michael Silbermann, head of the Middle East Cancer Consortium, a regional initiative for cancer research and treatment.
“If you have cancer in the family, it has a big stigma for the entire family,” he said.
He told the story of a woman aged 38 who was terminally ill with cancer in Jordan.
Asked why she delayed seeking treatment, she confided that she feared that her daughters’ chances of getting married would suffer if her condition was known.
In richer Mena countries, health outcomes are more promising. Saudi Arabia had the lowest rate of cancerrelated deaths, at 51 fatalities per 100,000 people last year.
This was followed by the UAE, which registered about 56 cancer-related deaths per 100,000 of the population in 2020.
There is a cancer divide in the Middle East and North Africa region, as developing nations suffer high mortality rates, while richer countries are often able to detect and treat the disease before it becomes terminal.
Israel had the highest rate of new cases in the region last year.
But despite recording 240.7 cases for every 100,000 people, it had only the fifth-highest cancer mortality rate among Mena countries.
About 90 people died from cancer in Israel for every 100,000 of the population last year, according to the World Health Organisation.
By contrast, Egypt had the highest cancer mortality rate in the region, 108 people for every 100,000, even though its rate of new cases was much lower than Israel’s.
Lack of early detection, poor public awareness of cancer and high treatment costs are factors fuelling higher mortality rates in developing countries, experts said.
“The majority of patients are being diagnosed in advanced stages,” said Dr Emad Shash, medical director of the Breast Cancer Comprehensive Centre at the National Cancer Institute at Cairo University.
Late diagnosis reduces survival chances. This is a common problem in developing countries, Dr Shash said.
Egypt ranked 116th out of 189 nations last year in the UN’s Human Development Index, which measures factors such as a country’s gross national income per capita and its citizens’ expected years of schooling.
Israel was ranked 19th. Liver cancer caused the most deaths out of all cancers in Egypt last year.
The Egyptian government launched a 100 Million Healthy Lives campaign in 2018 to increase screening and testing of hepatitis C, which can lead to liver cancer. It also aims to increase early screening for breast cancer.
Dr Shash called for caution when interpreting WHO figures, because they are estimates. Medics have long called for more accurate data on cancer in the Mena region.
“Only then will we be able to invest properly according to what we need,” said Dr Mohanad Diab, consultant medical oncologist at NMC Royal Hospital in Abu Dhabi.
Lockdowns in response to the coronavirus pandemic meant that fewer cancer cases may have been detected last year, Dr Diab said. That could lead to more advanced cases coming to light this year.
Meanwhile, stigma continues to claim lives, said Prof Michael Silbermann, head of the Middle East Cancer Consortium.
“If you have cancer in the family, it has a big stigma for the entire family,” he said.
He described meeting a 38-year-old woman in a cancer ward in Jordan. She was terminally ill with breast cancer.
“So, I asked her: ‘Why did you wait so long? Why didn’t you come earlier?’” he said.
“Her response was: ‘If my
neighbour knew that I had cancer, my daughters would not get the chance to marry.’”
People need to know that a cancer diagnosis does not mean “automatic death” and that the disease is not only hereditary, but environmental factors play a huge role too, Prof Silbermann said.
Gaza and the West Bank had the region’s second-highest cancer mortality rate last year, followed by Syria.
Conflict has worsened the situation.
In April, The National reported the plight of cancer patients in Gaza who faced delays to treatment because of the complex system of permits required to allow them to travel to hospitals.
More than a decade of conflict and economic sanctions in Syria have closed
institutions and limited the import of new equipment and technology, writes Dr Maha Manachi, haematologist and oncologist at Al Bairouni University Hospital in Damascus, in the book Cancer in the Arab World, which will be published later this year.
For residents of richer Mena countries, health outcomes appear more promising.
Saudi Arabia had the lowest rate of cancer-related deaths. An estimated 51 deaths for every 100,000 of the population were registered last year.
The kingdom was followed by the UAE, which recorded about 56 cancer-related deaths per 100,000 of the population last year.
But even in these countries cancer remains a pressing problem.
The cancer incidence rate
among young people in both countries was found to be very high in a study by Dr Humaid Al Shamsi, professor of oncology at the University of Sharjah.
In the UAE, the cancer incidence rate among those aged between 20 and 49 was more than 37 per cent. It was more than 39 per cent among this age group in Saudi Arabia.
This was extremely high when compared to countries such as the US, where the cancer rate among this age group was less than 9 per cent.
“The incidence is alarming and requires focused research to address potential risk factors,” wrote Dr Al Shamsi in the report, released this April.
Dr Al Shamsi, lead author and editor of Cancer in the Arab World, identified obesity and smoking as risk factors in the UAE.