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Fighting breast cancer in the UAE

Cancer is one of the leading causes of premature death in the UAE, second only to heart diseases. According to a leading insurance company in the region, Zurich, between January 2013 and December 2015 - 32% of its life insurance customers who died, suffered from cancer and almost half (49%) of those who filed critical illness claims were battling cancer. According to Gulf news, approximately, 12 new cases of cancer are diagnosed in the UAE every day and out of this at least two or three are of breast cancer.

With breast cancer affecting one in every five people in the UAE (according to the Health Authority Abu Dhabi), it has become the most common and widespread type of cancer here and is also the second biggest cause of deaths among women. The major difference between the cases of breast cancer seen in western countries and in the UAE is that in the UAE late diagnosis of the disease is much more predominant and the age bracket of patients is much younger. Over 65% of women suffering from breast cancer in the UAE, get diagnosed only at an advanced stage of the disease and their average age is between 40 and 55 years as compared to 55- 65 years in western countries. The  emirates’ highest mortality rate of this disease is seen in the 45-59 age group.

Challenges faced by the UAE in fighting breast cancer

Delay in seeking medical attention: Breast cancer has improved prospects for survival if detected and treated early. The 5-year relative survival rate for women with stage 0 or stage I breast cancer is 98% to 100% whereas it drops to as low as 22% if the cancer is detected when in the metastatic, or IV stage. Despite it being a known fact that early intervention dramatically increases the chances of survival and cure, most women in the UAE still delay seeking medical help.

The key factors for this are the following: Awareness about self-examination, regular screening and early detection to fight breast cancer is still very low in the UAE.

Social stigma attached to the disease and cultural issues are also responsible for high rates of late stage prevalence in the women. According to a survey conducted by the UAE university, most of the women interviewed were afraid of what the community would say if they came to know that the interviewees had breast cancer. Some women were hiding their condition long after finding symptoms, fearing social prejudice or abandonment by their husbands.

There is a general lack of perception of risk and a false sense of security in young people as they believe that breast cancer happens to only much older women. However, statistics reveal lower age bracket of breast cancer patients, with 50% of the women diagnosed being below the age of 46.

Screening tests costs:Cost of basic screening tests can range from AED650 to AED1,200 depending on whether a mammogram or an ultrasound is required. Most health insurance companies do not cover these tests in their basic packages. For instance, Daman's basic Abu Dhabi plan, does not cover these tests. Hence unless a person has gone in for a top up or a premium plan, she will have to bear the expense of these tests on her own. Moreover, although women in the UAE are more predisposed to higher rates of inherited cancer due to prevalence of blood related marriages, no insurance company covers predictive genetic screening tests that can detect faulty genes such as BRCA1 and BRCA2.

Treatment Costs:The treatment cost for any kind of cancer in the UAE, especially in its advanced stages, will amount to at least AED 1 million per year and a breast cancer patient on average has to undergo treatment for a period of 5 years. Most women in Emirates like Dubai and Abu Dhabi, are covered solely by the basic mandatory health insurance plans provided by their employers, with coverage ranging from AED 150,000 to AED 250,000. This translates to out of pocket expenses of over AED 850,000 for a year's treatment which would be unaffordable for most middle and lower class families. Those who cannot afford it are therefore forced to forgo essential treatment. Even women who go in for specialized critical illness policies receive only 15% to 20 % of the full claim amount if diagnosed with an early-stage of the condition. Not many insurance plan options with comprehensive cancer specific coverage are available in the UAE.

Lack of trained resource: Inspite of breast cancer being the most common cancer in the country, most radiologists in the UAE lack the skill of detecting and understanding the nuances of the disease at its various stages. Breast cancer being a multifaceted disease, requires radiologists to be trained specifically in breast pathology, which is a very specialized subset within radiology. If breast images are read by general radiologists it is easy to miss malignant lesions in the early stages of cancer as well as confuse benign lesions with cancer. To address this issue, it has now become imperative for the UAE government to consider training more radiologists in breast pathology and setting up more specialized facilities that have all the tests and the technology needed for screening and diagnosis.

Summary: Keeping inline with the vision to bring down cancer fatalities by nearly 18% by 2021, the UAE National Health Agenda 2021 has included cancer as one of the Key Performance Indicators (KPIs) to assess the nation’s health-care goals being on track. Some of the ways to curb the spiraling rates of breast cancer mortalities could be as follows: Increasing awareness and educating the public using popular mediums like television advertisements, radio and newspaper campaigns. Creating well designed culturally sensitive programs and campaigns with the messages also targeting men, as men can play a vital role in influencing women to participate in screening programs. Creation of a national screening network for providing free/ subsidized screening and mammograms round the year through specialized camps

Mandating health insurance companies to include coverage for screening and cancer treatment in all plans. Introducing and promoting more comprehensive and specialized cancer specific insurance plans that can help women mitigate the risks



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