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Breast Cancer Update: What Every Interested Person Should Know

Today we attended the 4th Annual Women’s Health Symposium at Clemenceau Medical Center (CMC), organized in partnership with Johns Hopkins Medicine International. Although the symposium was targeted mostly towards doctors and medical professionals, we benefitted greatly from the community lecture “Breast Cancer Update: What Every Interested Person Should Know” by Dr. Nagi Khouri.

Nagi Khouri, M.D. – Director, Division of Breast Imaging at Johns Hopkins Medicine

The presentation started with a focus on the growing numbers of breast cancer cases around the world. Now although it may appear that there’s many more cases in Lebanon than other parts of the world, that’s in large part due to the smaller population ratio.

.. the percentage of breast cancer, even though by incidence is a lot lower, it appears to be that we actually see by percentages and by numbers a larger number of young women because there is so many more [by population]. It’s not that the risk is increasing.. That’s very important to understand.

The highest number of cases recorded were in North America, Western Europe and Australia. Numbers are however increasing in Africa, Asia and the Middle East. In 2010, 1.5 million cases were recorded worldwide – almost double what it was in 1990. It’s important to note though that the curve of survival has also changed in the past 20 years due to drastic improvements in treatment.

Worldwide Breast Cancer Incidence Rates

Turning then towards the risk factors leading to breast cancer, Dr. Khouri explained that:

One of the most important questions for any women is: Am I at risk for developing breast cancer? And who is at risk? Many women say “I’m not getting a mammogram.. We don’t have any predisposing factor”.. 75% of women who develop breast cancer [in fact] share two risk factors: Being a woman and increasing age – usually after the age of 40.. So basically, every woman is at risk for developing breast cancer.. When there’s a family history, it’s an added risk.

It’s recommended that all women as of the age of 40 do an annual mammography (and not every other year as other practices may advocate). Dr. Khouri stressed this point several times during the presentation. 60% (if not more, which is the goal) of breast cancers should be picked up without anyone actually feeling anything in the breast.

The density of breasts actually plays a major role in the detection process. Fat in the breast is actually “a blessing” that renders the breast transparent in the mammogram and revealing any abnormality more clearly than in denser tissues. Women with implants will need to take twice as many pictures and it’s also dependent on where the implant is placed with regards to the breast muscle (ie. in front or behind the muscle).

Mammography is not perfect and its sensitivity will differ by case but it’s the best thing we have so far.

How do we know that mammographies save lives? Remember, mammography is only for detection. If a woman detects breast cancer but doesn’t get treated, then we haven’t really achieved anything..

In the Arab world 80% of women diagnosed with breast cancer are not at the curable stages (stage 3 and 4) which was the case in the Western world 30 years ago. Why such a large discrepancy in the developing world? It’s due to a lack of awareness, education and early detection – and getting the full treatment of course.

Image Source: WebMD

Dr. Khouri also brought up a significant point regarding the importance of self-check exams for every woman:

A lot of the cancers are picked up by women in the shower.. I encourage women to be familiar with their breasts and start that education very early on, in their school [for example], so that a woman is not embarrassed to examine herself. I don’t like to say examine – I prefer to say “be familiar”. Get to know your breasts the same way you know about your nose.. It encourages a woman to be responsible and think about her breast health, including doing a clinical examination of the breast periodically.

If you spot a lump in your breast and you get it checked, never leave without knowing why. You need to get an explanation from your physician. Another cautionary point Dr. Khouri brought forward was that all biopsies should be done only with a needle and not through surgery. It actually harms the woman’s cancer treatment if the biopsy is done by surgery.

No surgical biopsies.. No – ZERO! All women should know that.

Patients-focussed breast care is key and should be accessible, timely, sophisticated, coordinated and comprehensive. Don’t be afraid to ask your doctor questions to better understand your condition. That’s where the right kind of awareness and education can also play a significant role in giving the patient options for their treatment.

Those were just a few of the many key points covered in Dr. Khouri’s presentation. All in all, the presentation was very informative but our only regret was that there weren’t enough women in the audience who could have benefitted from this wealth of knowledge. Hopefully the next symposium will attract even more public attention and further spread awareness from a medical perspective.

Interview | Rosemin Manji

Rosemin Manji, founder of RR&Co. Bespoke Luxury Management and the popular host of “Fashion Thursdays on Studio One” on Dubai One TV, is an influential advocate for breast cancer awareness in the Middle East. Rosemin was also recently involved with in the Bras for a Cause Middle East campaign as both a Jury member and a guest speaker at the Dubai fashion show event.

Rosemin guest speaking at the recent Bras for a Cause event in Dubai

As a wonderful role model for women of all ages, we thought, who better to talk about this important cause? We took a few minutes out of Rosemin’s busy schedule to get her take on this topic and what it means to her:

1. As we’ve come to learn, your mother is a breast cancer survivor and no doubt an inspiration for your active involvement in supporting awareness campaigns for this cause. How has what she’s gone through affected you? Please describe with us your experience as the daughter of a survivor.

My mom was diagnosed over 25 years ago, a time when no one really talked about it and there wasn’t as many options except than to remove the breasts and go through extensive chemo. I was only 4 when she was doing the hospital visits and chemo treatment yet those memories are still feel very vivid. I remember being very scared at the thought of losing her.

We were very lucky that a young doctor from Florida flew into a small town in Canada to perform the reconstrution for her. I am so blessed that she is still alive and well, and that medicine and technology have advanced so that we now have better early detection methods.

Check out a clip of Rosemin’s speech at the event below:

2. What advice would you give to a family member or friend of someone diagnosed with breast cancer?

Be supportive, be a friend and be a good listener. Sometimes while going through something this traumatic, you need someone to laugh with and a shoulder to cry on – all at the same time.

3. A drawing concern for women who have been touched by breast cancer within their family is “Am I at risk too?” Has this question ever come to mind and have you ever gotten a mammography scan to eliminate any doubt?

Knowing that I have breast cancer in my family now, I do annual phyicals with my doctor and mammography scans every other year. My doctor taught me how to properly do a self-exam so I do this VERY regularly. It’s important to know your body.

4. What are your thoughts on the growing rate of breast cancer in the Middle East and what would encourage more women to get checked early-on? 

Over the past three years, I have seen a growth in education and more emphasis on breast cancer awareness in the region. We need to change the myth that only women who are 40 and above can get breast cancer. This misconception tends to make women who are in their 20s and 30s more passive about getting scanned.  Two years ago, a close friend of mine in Dubai was diagnosed at the young age of 31 so it’s really never too early to start getting checked.

5. Breast cancer is often referred to as “that disease” and people in our part of the world shy away from talking about it as it’s still very-much regarded as taboo. Survivors oftentimes suffer in silence for fear of being rejected by society. Do you think that the public’s perception is changing and what, in your opinion, can be done to remove that “taboo” that comes along with breast cancer in the Middle East?

It’s all about education. We as a society need to learn about all types of cancer (prostate cancer, breast cancer etc.) for both our own good and to help educate others. It will take time but campaigns, like Bras for a Cause Middle East, are the first steps toward creating this kind of awareness.

Rosemin taking the K-Lynn Pledge in support of early detection. She's wearing the stylish "Pink Outside the Box" custom-designed t-shirt by Customnation for the "Look Good, Feel Good" Collection.

6. It was an honor having you involved in Bras for a Cause Middle East for the past few months as not only a Jury member but as an active supporter of the campaign. What initially drew you to take part in the campaign and do you think it was successful in raising awareness? What were the key highlights of the campaign for you?

It was a real honour to be a part of Bras for a Cause Middle East and I enjoyed the fashion element of the campaign. Women often feel less feminine or attractive after surgery, so the bra design competition was something that I thought was appropriate yet fun at the same time.

7. If you could leave one closing message about breast cancer to all the young women reading this interview, what would it be?

I am begging women, regardless of how old you are, PLEASE get a mammogram scan done. Take your girlfriends, mothers and sisters with you! Also learn to do a self-exam so you can detect any changes in your body.

Lastly, buy one of the cool t-shirts or bras from the “Look Good, Feel Good” Collection as full proceeds will be donated to breast cancer groups across the region making a difference.

Grab your own "Pink Outside the Box" t-shirt and other fab items from the collection at the following stores: Galeries Lafayette, K-Lynn Lingerie, Cream, Maison Bo-M, Amuse Concept Store, Pink Dust, Sotra, La T-Shirterie and online at Aura-b: http://www.aura-b.com

Rosemin Manji proves that “pink” truly never goes out of style. Thank you very much for taking the time to do this interview with us and we hope you’re important message of awareness leaves an impact on anyone reading this.

Lara’s Story

We had a chance to meet Lara Safar at the Bras for a Cause ME  fashion show in Dubai where she openly shared her inspirational story of overcoming the disease to all our guests, starting with the following simple yet very powerful introduction:

Two years ago, this is probably how I would have introduced myself: “Hi everyone, my name is Lara. I’m Lebanese. I’m 25-years-old and I work in advertising”. Today I say: “Hi everyone, my name is Lara. I’m a twenty-seven year-old breast cancer survivor.”

“Twenty-seven-year-old” and “survivor” in one sentence is not something you hear every day, but Lara has actively proven (and continues to do so) the importance of early detection – no matter how old you are. We took a few minutes to get to know this fascinating young woman a little bit better to spread her important message to all women across the Middle East:

1. How did you find out that you had breast cancer? 

I sensed a lump in one of my breasts but kind of ignored it at the beginning as I didn’t think it was anything abnormal. One day I could sense it, the next day I couldn’t. I thought it was in my head and that I was being paranoid until one day at the beach when a friend of mine felt it and encouraged me to get a doctor’s appointment (which I did). After that, I did some tests, including an ecography and a mammography before the doctor announced the news to me.

2. What was your first thought upon hearing the diagnosis and what was treatment like? 

I was shocked when I first found out because I was not expecting it. Given that I was only 25 years old at the time and that I didn’t have any family history, it came as a surprise for me.

My first reaction was that this is not possible; I didn’t believe it.

I thought the doctor was wrong until I did more tests and got checked by other doctors who also confirmed that I had attained stage 2 breast cancer.

The treatment varies case by case. Given my age and the stage of my cancer, I had to undergo chemotherapy for almost 1 year and 3 months. It was 1 session every 3 weeks. I also did a surgery whereby the tumor was removed from my breast, followed by daily radiotherapy treatment for almost 5 weeks.

3. Is breast cancer genetic in your family? If not, how were doctors able to explain why you were diagnosed with it at such a young age?  

No one from my family had been attained by breast cancer and it’s still a question mark as to how I was diagnosed with it at such a young age. No science so far has been able to determine the reasons behind breast cancer in general. It is said that the probability of breast cancer increases with age and if there’s a family history, but people tend to think that they can only be attained by it for those reasons – which is a total misconception. My case is the proof of that. It’s very important that people correct their conception with regards to this matter.

Stages of Recovery: Before, During and After (left-to-right) Photos courtesy of Lara

4. What helped you recover during and after treatment? 

Of course, what helped me was the support of my family, in spite of this being very hard on them. They never showed me that they were in pain and always kept a hopeful attitude with a smile on their faces. My friends were also always there for me and I was constantly surrounded by the people I love. Most and foremost, having an optimistic spirit was the key to surviving this episode.

5. Were you able to meet other survivors your age and how important is the support of others who’ve gone through the same thing? 

I haven’t met many people who were attained by breast cancer at quite the young age like I have – only 1 as a matter of fact and I met her at the hospital. She had discovered it after I had already started my treatment so my case was more advanced than hers at the time we met. She was still at the beginning of her treatment so I found myself helping her by telling her what to expect and the different stages she’d have to go through.

6. Did you wear a wig during treatment, and if so, why did you chose to do so? If not, what helped you to make such a bold decision? 

Before I started chemotherapy I had very long hair, which I loved. As soon as my hair started to fall, I went to a hair salon specialized in making wigs from your own hair. They cut my hair and used it to make the wig, but I never wore it. I felt as if I would be lying to myself as well as to others. It wasn’t right and it didn’t look nice or natural to me. So instead I resorted to wearing scarves which felt much more comfortable. I started matching them with my outfits and would constantly received compliments on them.

Given that I never wore my wig, my friends and family helped themselves to it instead. It was very funny seeing them in a new hairstyle – especially the boys!

Lara’s fabulous scarf style during treatment. Photos courtesy of Lara

7. How has breast cancer changed your outlook on life? 

Many people say that after rough experiences, their perception of life changes. To be very honest with you, that has not been the case with me. Like I mentioned at the Bras for a Cause event, I’m still the same person. I still like the same things and still have the same friends. Nothing has changed really except that maybe now I try to do more of the things I like to do (like eating out, traveling, etc…) and avoid doing the things that I don’t like doing (like exercising!). But that’s not because I think that life is too short; far from that! Rather it’s because I now feel that there’s no point in doing things that don’t matter to you.

8. What tips or advice would you like to give for other Middle Eastern breast cancer patients about to undergo the same thing? 

That there is no point in being sad or asking questions like “why me?” as this will not make the cancer go away. My advice would be to look at the bright side and look at all the good things that will come out of this experience as they’re countless.

Another important thing to bear in mind is to find the best doctors as they will give you the confidence you need and will provide you with the best treatment possible to increase your chances of surviving.

Lastly, dont spend too much time on the internet looking for answers. Most of the times they’re exaggerated and incorrect. Ask questions to the right people (i.e. doctors).

9. You’ve been very open about your experience, which isn’t very common in the region. What boosted you to do so and how has the public responded to your story? Do you find talking about your experience difficult? 

When I survived, I took a pledge to start raising awareness about early detection because I want other women to be able to survive this like I did – and early detection is key for that. More so, I believe there is no shame in being  a cancer survivor. On the contrary; after this experience, people have so much more admiration, respect and love towards me. So why to not talk about it, especially when it can help others and make a difference?

Lara sharing her story at the Bras for a Cause fashion show in Dubai (October 2011)

The public has been quite responsive to my story. I’ve done a lot of media interviews and have spoken at a couple of events. Following those experiences, I now get stopped by random people who applaud my courage and thank me for opening their eyes by sharing my story. I really hope that my message has resonated with others and that women will do regular check-ups religiously!

10. What did you think of the Bras for a Cause fashion show event [that you were also a guest speaker at]? What kind of campaigns would you like to see more of in the region? 

This is a brilliant event because although the core of it is breast cancer awareness, it was surrounded by other fun activities which encouraged people to attend and take part. If the event had been more focussed towards the cause and the medical side of it, then it probably wouldn’t have captured as much attention.

I really hope that more campaigns will take place in the region, and not just in October (breast cancer awareness month) but rather all year long.

Safe & Sound‘s activities, such as their walk-a-thon, annual survivor fashion show, book sale, and, most importantly, the 5,000 free mammography vouchers they give away to women who can’t afford to get checked are also good examples.

Lara celebrates reaching the “Finish Line” at the end of her treatment. Photo courtesy of Lara

Thank you Lara for taking the time to share your story with us. You’re a true inspiration and we applaud your commitment to spreading your message of breast cancer awareness. We wish you the best of luck in all you do!

UPDATE: Read the follow-up interview with Lara we conducted two years after this post here.

Attention: Pink Ribbons in Aisle One!

This past weekend, Spinneys promoted breast cancer awareness month across their shops in Lebanon through the distribution of informative flyers and ribbons to their shoppers with the main purpose of spreading the awareness message – to as many people as possible!

Thinking "Pink" at Spinneys, October 2011

It doesn’t get as simple as that yet it might serve just the right reminder needed to get checked. Shopping malls, hairdressers and grocery stores are the perfect hub for such awareness campaigns and we applaud Spinneys for launching this initiative.

We’d like to additionally thank Spinneys for helping us spread the word about sharing stories on One Wig Stand through their flyers. Sharing experiences of overcoming the disease will greatly benefit those going through it feel less alone and learn from each other how to cope better. We’re all ears! Send us an email at onewigstand@gmail.com for more information (all personal details are kept completely anonymous).

Don’t be the next target.

Increase your chances of beating breast cancer by detecting it early. There’s no shame in getting a mammography, especially as 1 in 8 women are “targeted” by this disease. It could be you, your sister, your mother, your best friend or your daughter.

It’s time to get checked ladies!

This campaign was launched by the Ministry of Public Health and Hoffmann-La Roche. I’m sure you’ve seen the ad on TV or the billboards.

Commenting on the campaign, Dr. Mohamad Jawad Khalifeh, Lebanese Minister of Public Health said: “Research has consistently demonstrated that early detection can greatly reduce complications, thereby giving women more treatment options and a greater chance at survival. The need to stress on continued and targeted education for future generations of women is highly essential to help save both lives and long term treatment costs.”

“The nation-wide awareness campaign is set to run for three months enabling women to gain access to discounted mammography exams which will remain available till end of December 2010. Participating private hospitals and medical centers across Lebanon will reduce their mammography fees to L.L. 40,000 whilst government hospitals will offer free mammograms during the entire phase of the campaign. A dedicated hotline on 01-511 722 will be open throughout the campaign to answer basic questions related to the campaign, and guide callers to the nearest mammography center.”

You are advised to get checked as early as your 40s. However, from the statistics of younger, and younger women being affected by breast cancer in this region, getting checked in your 30s is even better – with less frequency of course but just as important, especially if you notice abnormalities or have a family history.

For more information about this campaign and about getting checked early, visit the dedicated website: www.roche-arabia.com/fmfiles/re7192006/BCAC/

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References to the campaign and selected quotes derived from press release.

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