Breast cancer in the Gaza Strip
Schwartz S. Tel-Aviv University, Israel
Introduction. Breast cancer is the most common
cancer among women in both Israel and the
Palestinian Authority, accounting for approximately
30% of all cancer in Israeli and Palestinian women.
However, while the 5-year survival rate among
Israeli women stands at 71%, among Palestinian
women in the Gaza Strip it is assessed to be 40% at
best.
Aim. The purpose of this paper is to examine and
analyze the different factors leading to this
significant survival rate disparity.
Method. Review of relevant literature,
Results. A wide array of factors have been implicated in this disparity; these can be divided into the
following groups.
* Genetic factors. Studies show that breast cancer
among Arab women is more violent, with a younger
age of onset and higher mortality rates than among
women of European origin (such as are many Israeli
women). This suggests a yet undescribed gene
mutation, a more aggressive type of breast cancer, or
a combination of the two.
* Lack of facilities in the Gaza Strip.
- Impaired diagnosis: Lack of screening programs
and units (only (only one histopathologic lab in
the Gaza Strip); impaired accessibility to existing
units; cost of screening units; lack of trained
oncologists,
- Impaired treatment: No radiotherapy in Gaza; no
hormone tests; no bone density scans.
* Lack of access to facilities in Israel and abroad.
Palestinian Authority reluctant to refer patients
abroad due to economic reasons; Israel reluctant to
accept Palestinian patients due to security reasons.
* Social and cultural factors. Ignorance; sense of
modesty that leads to reluctance to discuss breast
cancer openly; Fear for negative stigma which can
affect a woman's standing in the community and /or
her daughters' changes of marrying; fatalistic view
and lack of belief in health system.
* Economic factor. With over 50% of Palestinians
in Gaza living beneath the poverty line (defined as
$ 2.1/day/person) and unemployment rates close to
30%, many are unable to pay for adequate treatment.
Discussion. The disparity of survival rates is caused
by numerous factors. Consequently, combating breast
cancer in the Gaza Strip requires a broad approach
addressing these factors jointly: further genetic
studies of the Arab population are called for to
pinpoint the gene mutations, if indeed such exist;
efforts and money must be spent to upgrade the entire
medical infrastructure in the Gaza Strip - from
prophylactic measures to medical care facilities. No
less important, social programs are needed to educate
women concerning the disease and help them to
overcome cultural restraints. Finally, Israel must
examine how it can alleviate bureaucratic and
security procedures so as to allow more Palestinian
patients to receive treatment within it borders,
Further reading
* Elatar I, Cancer in the Arab World: Magnitude of
the Problem, UICC, March, 2005
* Cohen M, Azaiza F. Early Breast Cancer
Detection Practices, Health Beliefs, and Cancer
Worries in Jewish and Arab Women. Preventive
Medicine. 2005;41(5-6):852-8
* Nissan A, et al. Clinical Profile of Breast Cancer
in Arab and Jewish Women in the Jerusalem Area.
American J of Surgery, 2004;188(1)62-7
* Baron-Epel O, et al. Perceptions of breast cancer
among Arab Israeli Women. Women Health.
2004;40(2):101-16
Websites
* Israeli Ministry of Health. www.health.gov.il
Report on morbidity, 2004 / Report on mortality,
2004. / Bara Hana M. Report on Geographic
Distribution of Breast Cancer in Israel [between]
1984-1999.
* Palestinian Ministry of Health. www.moh.gov.ps/
* Patient's Friends Society. www.pfsjer.org
* Israeli Physicians for Human Rights Organization.
www.phr.org.il/
- Bendel M. et al., Breast Cancer in the Gaza
Strip: A Death Foretold, January 2005
- Ziv H, “The Disengagement Plan and its
Repercussions on the Right to Health in the
Gaza Strip”, January 2005
* http://brookdale-en1.pionet.com/ Website of
Myers-JDC-Brookdale Institute:
- Rockof Y. et al., “Coping with Breast Cancer
among Palestinian and Israeli Women
(Project COPE)”
- http://www.cancer.org - American Cancer
Society Breast Cancer Facts & Figures
Acknowledgements
I would very much like to thank Maskit Bendel,
Director of Projects in the Occupied Territories on
behalf of Physicians for Human Rights, Israel, for
introducing me to this subject and for her help in
writing this presentation. I also wish to thank the
Israeli Cancer Association for making possible my
participation in this Summer School.
Summer School Participant
Schragi Schwartz
Tel Aviv, Israel
schragi@gmail.com