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In Gulf, battling breast cancer stigma

Culture hinders early treatment

Laura Bush examined the head scarf Samia al-Amoudi, a gynecologist, presented her yesterday during a meeting of a cancer survivors group in Jiddah, Saudi Arabia. Laura Bush examined the head scarf Samia al-Amoudi, a gynecologist, presented her yesterday during a meeting of a cancer survivors group in Jiddah, Saudi Arabia. (Hasan Jamali/Pool/Reuters)

RIYADH, Saudi Arabia - One Saudi woman ignored the cancer growing in her breast for fear of seeing a male doctor. One was summarily divorced on the mere suspicion she had the disease, while a third was dragged away from a mammogram machine - the technicians were men.

Breast cancer is considered a taboo in the religiously conservative Arab countries of the Persian Gulf even as the disease claims more and more victims, but some women are pushing for greater openness about the illness.

Their efforts received a boost this week: a visit from Laura Bush to raise awareness about breast cancer.

Yesterday, on her second day in Saudi Arabia, Bush met with breast cancer survivors in the western seaport of Jiddah. As a token of appreciation, they presented her with a long black scarf, the kind Saudi women use to cover their hair in public, with pink ribbons symbolizing the disease attached to both ends.

They then helped her wrap it around her head, even though visiting female dignitaries are exempt from Saudi Arabia's strict Islamic dress codes for women.

"No campaigns, ads, or programs would have had the kind of impact that Laura Bush's trip has given to breast cancer awareness in the kingdom," said Samia al-Amoudi, a gynecologist who was diagnosed with the disease in 2006.

"Her trip will make people ask: 'Why is she here? For breast cancer? Is it that serious in this country?' " Amoudi added.

In Saudi Arabia, about 70 percent of breast cancer cases are not reported until they are at a very late stage, Amoudi said. In the United States, most breast cancers are diagnosed much sooner, when they are more easily cured.

Moudi also said 30 percent of Saudi patients are under age 40, compared with 5 percent in the United States.

Breast cancer is the number one killer of women in the United Arab Emirates, according to official statistics, with many dying because the stigma surrounding the disease prevents early detection and treatment.

Awareness campaigns are becoming more prevalent in the Arab world. In Lebanon, for example, a public service TV announcement shows two round, lit candles. One of them is extinguished as an announcer reads statistics about the disease and reminds women to have mammograms.

But in the more conservative Persian Gulf region, such campaigns are less aggressive, not as organized, and unlikely to use such bold imagery.

In Saudi Arabia, a campaign that began this month offers discounts on mammograms and on billboards urges women: "Do the test now, for peace of mind."

The problem is not a matter of resources. The kingdom has some of the world's best medical equipment and doctors, and even the poor have access to free medical care.

But many Saudis, like other Arabs, won't even refer to cancer by name, calling it "that disease" because of the fear surrounding the illness. Some families are afraid no one will marry their daughters if a mother's cancer becomes known.

For others, however, the greatest obstacle is the idea of women being examined by male doctors.

Amoudi recounted the story of a woman whose husband always pulls her out of the room because the technicians are male.

"The first thing women ask me when I tell them to get a mammogram is: 'Will the radiologist be male or female?' " she said.

Asma'a al-Dabag, a radiologist for 27 years, said some people feel that "if they talk about it, they become exposed."

Many gynecologists rarely talk to patients about breast self-examinations or routine mammograms, Dabag said.

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