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Breast cancer awareness up in younger women
First lady Wafaa Sleiman, center, attends the 12th annual national breast cancer awareness campaign at AUB in Beirut last week. (The Daily Star/Dalati Nohra, HO)
First lady Wafaa Sleiman, center, attends the 12th annual national breast cancer awareness campaign at AUB in Beirut last week. (The Daily Star/Dalati Nohra, HO)
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BEIRUT: Angelina Jolie’s breasts, all the way in Los Angeles, shook the way Lebanese women think about their own.

Jolie, whose mother died in her 50s from breast cancer, made the decision earlier this year to have both of her breasts removed after a test revealed she had the infamous BRCA1 gene mutation that gave her an 87 percent chance of getting the cancer, the American film star and humanitarian wrote in The New York Times.

“I think it helped a lot, what she did, because everybody was talking about it,” said Dr. Nagi Saghir, a professor of oncology at the American University of Beirut and director of the Breast Center of Excellence at AUB Medical Center. “It removed a taboo, now a lot of women want to do the test.”

The BRCA1 and BRCA2 gene mutations are associated with a higher risk of getting breast and ovarian cancer because they can inhibit the way the body fights against abnormal cell growth. Likely, the BRCA1 and BRCA2 gene mutations are no strangers to these parts, where younger women are becoming increasingly interested in genetic testing and preventive surgeries.

The gene mutations are also linked to breast cancers affecting women below the age of 50. In Lebanon, a whopping 50 percent of cancers occur in women under 50, compared to places like the United States, where women below 50 represent closer to 25 percent, Saghir said.

These days, Saghir and a team of researchers at AUB are trying to gather more information about the prevalence of cancer in younger women, as well as the prevalence of the BRCA mutations in Arab and Lebanese women.

Breast cancer in women under 50 usually results in more aggressive tumors that require complex treatment, Saghir said. In a society that places family at the center of daily life, breast cancer in younger women, in their 30s and early 40s, can also be hard for those with young children or who have yet to have any.

Research about the high rate of so-called premenopausal cancer specifically in Lebanon has been out for several years. Public awareness programs here and international news like Jolie’s double mastectomy have made local women well educated about the risk of the disease at early ages and has served to break down taboos, doctors and survivors said.

Aware of the genetic links, Saghir said, women with sisters or aunts with breast cancer are getting screened yearly and at younger ages. He recommends Lebanese women start annual mammograms at 40 years old, a full decade younger than the international standard.

Early detection has over time almost cut in half the percentage of women having of total mastectomies, Saghir said.

More Lebanese women have also shown interest in blood tests for the BRCA mutations, something unavailable in Lebanon.

The test is no simple blood sample, Saghir said. It’s more timely, and women must undergo counseling in anticipation for potentially life-changing news, he said.

“This is a very serious test,” Saghir said. “She needs to know if she really wants to know what might happen in 10 or 20 years. Is she ready to go down that road?”

Mirna Hoballah is one of the few Lebanese who have been tested for the BRCA mutations. Hoballah, a breast cancer survivor and vice president of the Lebanese Cancer Foundation, was diagnosed at 42, after watching her mother and cousins suffer from cancer.

“I knew I’d get it because I have a family history,” she said.

Long after Hoballah was proclaimed cancer free, a genetic test found she had a BRCA2 mutation, and her surgeon suggested she have her ovaries removed and a double mastectomy as preventive measures. She’s already removed her ovaries, and she’s weighing now whether to do the mastectomy as Jolie did.

“We will see now if we have a total mastectomy, (my doctor) recently took more blood for testing,” she said. “I’m not afraid at all. I prefer to do an operation than to get sick.”

Her ordeal has made her eldest daughter, in her 20s, consider her own options. She also checks regularly for early warning signs.

But while knowledge and openness about preventive surgery has risen sharply, that has not been paralleled with changes to Lebanon’s health care system, which still considers breast reconstruction a cosmetic surgery, said Bashara Attieh, a plastic surgeon and expert in breast reconstruction.

Preventive, potentially life-saving, surgeries would be all the more difficult to undergo knowing that reconstruction – which is not covered by Lebanese insurance companies – would cost upward of $5,000.

Lack of coverage also affects Lebanon’s young survivors, who are more likely to desire and ask for reconstruction. Just recently, Attieh had two patients who were unmarried breast cancer survivors still young enough to have children. While reconstruction will not allow a woman to breastfeed, it will give her back a sense of normalcy.

“It’s a mutilating and traumatic surgery, morally, physically and emotionally. It’s not something you can easily accept,” he said.

As preventive surgeries increase, so does pressure on Lebanon to designate reconstruction as a medical operation. That is up to the government. Once public hospitals cover the procedure, so will private insurance companies.

“It’s a government decision,” Attieh said, adding, however, that breast cancer was probably not very high on their agenda.

A version of this article appeared in the print edition of The Daily Star on October 15, 2013, on page 4.
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