Sharp rise in cancer deaths predicted

Mitya Underwood

• Last Updated: November 03. 2009 7:16PM UAE / November 3. 2009 3:16PM GMT

Abu Dhabi // Deaths from cancer in the region could almost triple over the next 10 years unless early detection and treatment measures are improved, according to the World Health Organisation.

Under current conditions, the number of deaths in the WHO’s Eastern Mediterranean Regional Office, which includes the UAE, is forecast to increase by between 100 and 180 per cent by 2020 – the biggest rise in any of the organisation’s regions.

A WHO report called for greater attention to be given to the disease noting,“because of rising incidence and mortality of cancer, unmatched by adequate measures to prevent, detect early and treat cancer, deaths from cancer in the Eastern Mediterranean Region could reach 760,000 per year by the year 2020.”

The WHO’s Eastern Mediterranean region includes, among other nations, Saudi Arabia, Jordan, Egypt, Pakistan, Iran, Iraq, Libya, Lebanon, Syria, Oman, Qatar and Kuwait.

The report, entitled Towards a Strategy for Cancer Prevention and Control in the Eastern Mediterranean Region, attributed much of the anticipated increase to an ageing population and fewer deaths from communicable diseases. The report also pointed to increased smoking and a change in social habits and diets as causes of the increased incidence.

While many UAE-based doctors accepted the report’s findings, they said some measures that were called for – such as increased screening and better case recording – could lead to the appearance of an increase in incidence and mortality.

The report said 40 per cent of cancers could be avoided, 40 per cent could be cured if detected early and the remaining 20 per cent should be given palliative care, which seeks to reduce the severity of the symptoms rather reverse the disease.

Unified approaches were needed whenever possible, be they regionwide or nationwide, it said.

The report called on member states to focus on five areas:

@Body-Bullets:Ÿ developing national cancer control programmes or updating existing ones, including the establishment a national cancer control committee;

Ÿ promoting research;

Ÿ encouraging non-governmental organisations to join the fight against the disease;

Ÿ setting up comprehensive cancer registries;

Ÿ developing palliative care.

“At present, resources for cancer control in the region as a whole are not only inadequate, but directed almost exclusively to treatment,” the report said.

In the UAE, breast cancer is the biggest killer of women, accounting for 22.8 per cent of all cancer cases, according to government figures. Only 30 per cent of cases are diagnosed in the early stages.

The figures are similar for cancers affecting men. Prostate cancer, for example, is diagnosed in the late stages in 60 per cent of cases.

Dr Waleed Hassen, head of the urology department at Tawam Hospital in Al Ain, the country’s largest cancer treatment centre, said the predicted increase could be accurate due to the ageing population and changes in lifestyles.

“We have a young population but, despite that, we see a fair amount of cancers presenting at late stages,” he said. “The biggest problem is we still have more of a reactive health system rather than proactive. We don’t really have a culture of primary care yet.”

Primary care focuses on prevention, and greater involvement in counselling by family doctors.

People in the UAE do not always receive the same sort of health maintenance and monitoring that existed elsewhere, said Dr Hassen.

That means risk factors, such as smoking and weight, were not linked with the disease and cancer is not prevented as often as it could be.

Dr Hassen, who previously worked in the US, said: “Cancer in general is a disease of the ageing.

“We need to expand the primary health care network, improve access to cancer care and, of course, raise awareness on a national level.

“A unified approach certainly has benefits, especially where the population is relatively small.”

According to the Central Cancer Registry at Tawam, the most common cancers in men are of the colon, rectum, lung and prostate, and lymphoma. Breast, cervical and thyroid cancer and leukaemia are most common in women.

Efforts have been made recently to increase access to primary care. Sheikh Khalifa Medical City in Abu Dhabi has set up a network of family medicine clinics, as have many of the government hospitals in Dubai.

However, screening programmes are limited to emirate-wide schemes and the same services are not available across the country.

Dr Mohammed Jaloudi, chief of medical oncology at Tawam, said the report should not create panic.

“Of course, if screening and capturing are increased, the recorded incidence will increase,” he said.

“I don’t agree fully that the number of deaths will increase so much, but if the incidence increases, then the death rates will too.”

Dr Jaloudi said not all cases of cancer were recorded or diagnosed, due to gaps in primary health care, the taboo surrounding the disease and a lack of awareness.

He called for more screening and better preventive measures, including increasing access to and educating of primary health care workers, and targeting specific problems, such as smoking, including shisha.

The UAE has developed its cancer facilities in recent years and more are due to open next year.

Mubadala, the government investment arm, is involved in the building of a molecular imaging centre on the grounds of Tawam that will detect and track cancer, and cardiovascular and neurological diseases. It will open next year.

Dr Shaheenah Dawood, the head of the Emirates Medical Association’s breast cancer awareness campaign, said the UAE should focus on creating programmes that targeted its own population rather than adopting western approaches.

“It is more than education and awareness, we need to know our population,” she said.

“We should learn what is needed in this community, not what works in the States or Europe.”

Last weekend, Dr Dawood hosted a conference in Dubai on breast cancer which was attended by more than 100 doctors from across the country.

“The health system has grown tremendously over the last decade,” she said.

“It is continuing to change and things will get better. Of course, we will see more cases as the population gets older and screening increases.

“It is now about what we do to control it, which is not always easy.”

munderwood@thenational.ae