x Abu Dhabi, UAEMonday 22 January 2018

Experts call for specialist breast license

Developing a licence scheme and building a registry of breast surgery specialists in the Emirates would help patients choose the proper doctor, experts say.

Experts in Dubai say patients facing surgery for breast cancer are at risk of being treated by non-specialist surgeons due to a gap in the country's medical licensing standards.

Doctors say the introduction of a specialist licence for breast surgeons would bring the country in line with the UK, where only doctors with specialised qualifications can operate on breast cancer patients.

Breast cancer is the second largest cause of death among women in the UAE.

As in most of the western world, doctors in the UAE who specialise in breast surgery are given a general surgeon licence. Experts, however, say this places breast cancer patients at risk of treatment by surgeons without the necessary expertise.

"The breast surgeon category falls under general surgery, irrespective of the qualifications," said Dr Richard Reyes, a breast and general surgeon at the American Academy of Cosmetic Surgery. "This leads to so many disasters in the treatment of women."

In the UK, a specialist licence requires certification from the Royal College of Surgeons and membership in the Association of Breast Surgery. Developing a licence scheme and building a registry of breast surgery specialists in the Emirates would help patients choose the proper doctor, Dr Reyes said.

"Breast surgery is a highly specialised field," said Dr Shaheenah Dawood, an oncologist and president of UAE Cancer Congress. "When treating a woman diagnosed with breast cancer, good breast surgery impacts the survival of these women. These surgical techniques are acquired with training and experience and are continuously evolving."

Doctors who want to specialise - performing only breast surgeries - must get approval from the Dubai Health Authority (DHA).

A spokesman for DHA said that a specialisation is granted only once the authority determines whether the doctor has the appropriate qualifications and experience.

Dr Hatem Al Ameri, the manager of Health Professional Licensing at Health Authority-Abu Dhabi (Haad), said licences were issued in the "primary field" - the main area of medicine studied, such as surgery.

"For example, endocrinology is a primary field but the doctor may be specialised in diabetes," he said.

"For the breast cancer surgeon, his credential is as a general surgeon," he said. The title of breast surgery specialist is "a privilege" bestowed by the hospital, he added.

Dr Sama Zibdeh, a breast surgeon at Emirates Hospital and CosmeSurge, is licensed as a general surgeon, but with a specialisation in breast surgery.

"Some still practice general surgery, others choose to specialise," she said. "It's a rare speciality that's not abundant everywhere. We can't prevent qualified general surgeons who know how to perform breast surgeries from operating on these patients and limit access to treatment."

She said part of the responsibility lies with patients. "They should be aware of the options available to them," she said. "Once they are aware, they will start to question."

Dr Reyes said the prevalence of the disease in the country substantiates the need for introducing a specialist breast surgeon licence.

"One of the challenges that the licensing authority will have is finding the personnel who will do the job," he said. "But things are changing, and now is the time to start looking at this option."

Meanwhile, experts in Abu Dhabi did not agree that a licence was necessary. "Breast surgery is performed by general surgeons with expertise in breast surgery," said Dr Mohamed Al Bashir, consultant surgeon at Tawam Hospital and director of the Breast Care Centre. "There is no special board for breast surgery in most of the world, including the US."

Officials in the capital emphasised the need for general expertise in the field of breast cancer. Particular attention was drawn to the area of screening.

"We need skilled mammographers and we need also highly qualified radiologists who read screening mammograms," said Dr Jalaa Taher, section head of cancer control and prevention at Haad. She added that although there is not a shortage of radiologists, "for screening you are looking for tiny things".

Dr Al Bashir also highlighted the gap in screening. "That's something that we have noticed here in Tawam, when we have patients referred from other centres ... we always pick up more stuff that wasn't picked up somewhere else. So I think that's one of the main issues."

In February, Haad introduced guidelines for the detection and treatment of breast cancer, but doctors said they have yet to see them implemented.