Yemen’s most common cancers are treatable, doctors say [Archives:2006/980/Health]
Eleven-year-old Samia Naji has had brain cancer since she was 2 years old, experiencing pain, spasms, loss of consciousness and being near death many times. Traveling from her home in Dhamar to Sana'a, she had surgery at Al-Thawra Hospital to remove part of the tumor. Afterward, she rarely had spasms but her left hand was paralyzed. She now gets chemotherapy and radiation therapy in an attempt to remove the tumor completely
Hiding her bald head under a scarf, Samia couldn't hide her smile when asked what she wants to be in the future: “I want to be a doctor!”
No one can predict Samia's future. Her doctor, tumor specialist Ali Al-Ashwal, confirms that her recovery process is improving as her body receives the treatment well. However, he can't ensure her survival.
Samia is one of thousands of Yemenis eligible for free treatment from the nation's only anti-cancer center in Sana'a. “We receive patients from every Yemeni governorate,” the center's media coordinator Mohammed Al-Mahafdi said, confirming that despite large number of patients coming to the center daily, there remain huge numbers of patients who can't receive such therapy.
“According to World Health Organization (WHO) estimates, there are 1,000 cancer cases per 1 million people worldwide. That means in Yemen, whose population is more than 20 million, cancer cases supposedly amount to 20,000. However, since its 2004 establishment, the center has received only 5,000 cases, as not all patients seek treatment,” Al-Mahafdi explained.
If WHO's cancer estimates are correct (100 cases per 100,000 people for countries with more than half of the population below age 20), the number of new cases in Yemen should be around 20,000 annually. However, WHO stresses that where cancer awareness is low and health care access is limited, few actual cancer cases (perhaps only five to 10 percent) are reported to health services. As awareness increases, so will demand for care and thus the burden on health service resources.
According to National Cancer Center manager Dr. Nadeem Mohammed Sa'eed, lack of awareness, wrong diagnosis and poverty are the main reasons preventing cancer patients from receiving proper treatment in sufficient time. “For example, a person may ignore the painless lump on his tongue and continue chewing qat and using shammah (a type of tobacco placed under the tongue), unaware that the small mark may be the first sign of mouth cancer.
“In another case, a person experiencing coughing, chest pain, shortness of breath, hoarseness and bloody sputum may go to a doctor who diagnoses him with TB and gives him medication, ignorant of the fact that those are lung cancer symptoms.
“In some instances, patients may know early on that they have cancer, but because they're poor and can't meet the expense of traveling from their area to Sana'a, they prefer to face their fate,” he explained.
Indicators require further study
According to Sa'eed, the center registers a high number of breast cancer cases among Yemeni women; whereas “frightful numbers” of mouth, head and neck cancers are found among males coming to the center.
“I became confused about the breast cancer risk factors we study in medical books because they don't apply to Yemeni women. Studies suggest several categories of women at increased risk for breast cancer: those with a long menstrual history (beginning before age 12 and ending after age 50); those who never gave birth or waited until after age 30 to have children; those who didn't breastfeed their children and those who drink alcoholic beverages.
“However, most Yemeni women with breast cancer are age 19 or 20, married with two children who breastfeed from their mother who never drinks alcohol!” Sa'eed noted.
Pointing out that lymphoma and gastrointestinal cancers are very common among Yemenis, he called for further studies highlighting the true risk factors contributing to cancer in Yemenis.
“We should consider profound demographic, socioeconomic and behavioral changes when studying the causes for certain cancers spreading in Yemen. For example, we discovered that most patients suffering mouth and jaw cancers live in coastal areas like Hodeidah and Hadramout. They are used to using shammah and smoking tobacco, which are considered carcinogens,” Sa'eed remarked.
Early diagnosis, early treatment and medical awareness are contributing effectively to curing cancer patients. “However, increasing public awareness is considered the most difficult aspect because we need to establish a network to provide citizens information. The media isn't enough in this regard, as medical staff also must be involved. They must arrange field campaigns whereby they can increase public awareness about cancer, its various types and prevention,” Sa'eed proposed.
Al-Ashwal confirmed that Yemen's most common cancers also are the most treatable. “The lymphoma treatment rate is as high as 80 to 90 percent, particularly if the patient is treated within the first or second stage of infection. The same rate applies to breast cancer and gastrointestinal cancers,” he added.
However, Al-Ashwal noted that many patients arrive at the center when their cancer is in its last stages and when their survival rate is very low.
Treatment according to standards
Some governorate public hospitals have anti-cancer units, but they simply offer diagnosis and medication to patients, most of whom are transferred to the National Center in Sana'a to receive treatment.
“Cancer treatment has various processes and stages. After diagnosis, the patient has surgery to remove a sample of the tumor [called a biopsy]. The doctor then will determine the appropriate therapy based on the tumor, the patient's age and the type of cancer,” Al-Ashwal explained, stressing that cancer treatment is based on international standards approved by medical scientists and physicians at international medical conferences. “So in Yemen, we follow the same cancer treatment standards used worldwide,” he added.
Major cancer treatments currently available are radio therapy, chemotherapy, hormone therapy and surgery. Targeting cancerous tumors often requires the artful combination of more than one type of treatment method.
The latest Ministry of Health statistics reveal that 5,000 Yemeni cancer patients travel abroad annually.
“Depending on the type and stage of the tumor involved, cancer treatment differs from other types of therapy, as chemotherapy takes at least six months and two months for radio therapy,” Al-Ashwal noted, insisting on the impossibility of Yemeni patients receiving such treatment abroad for that long.
“Yemeni patients may travel abroad for treatment; however, they return to complete their treatment at the center because they can't cover the expense of remaining abroad for a long time,” Al-Ashwal remarked.
The government supports the center with an estimated YR 700 million cancer medication budget. “Ninety percent of cancer medicines are available at the center's pharmacy,” Sa'eed noted.
“However, the center sometimes experiences medicine shortages due to delay in receiving finances, but we try our best to get the medicine as soon as possible because we completely understand that delaying medication means killing patients indirectly,” he explained.
The center lacks a tumor surgical unit, as most surgeries take place at public or private hospitals and sometimes abroad. “We're looking forward to expanding the center and establishing surgical units where physicians and specialist surgeons can perform operations. If we can reach this goal, we'll help many patients,” Sa'eed indicated.
Then and now
Both Al-Ashwal and Sa'eed agree that there's clear change regarding the Yemeni public's understanding of cancer treatment. In the past, some doctors even thought cancer meant inevitable death, but citizens nowadays are requesting and seeking treatment, believing there's always the hope for a cure, the two doctors concluded.