THE EVER-PRESENT CHALLENGES OF BREAST CANCER DETECTION AND TREATMENT: HOW DO WE COMBAT THEM?

By: Neha Mani

In 2013, I remember seeing a photograph in The New York Times. A Ugandan girl, Edith Kemigisha, sobbed as she saw the inside of a wooden coffin lined with printed flowers and white lace—no matter how pretty the encasing, the sight brought to terribly vivid detail how metastatic breast cancer had taken the life of her mother (Grady, 2013). She was my age. The eerie tone of the article lingered in my mind: all of the stories in the article seemed to imply that if only her mother had been diagnosed sooner, treated sooner, then maybe she’d still be alive. 

​Breast cancer disproportionately impacts women of color from impoverished backgrounds. Every year, there are more than two million cases of breast cancer per year, accounting for 24.2% of cancer cases in women—the highest incidence of all varieties of cancer with a global mortality rate of 6.6% (Barrios, 2022). Lower and middle-income countries (LMIC) bear 60% of new breast cancer cases and 70% of breast cancer-related deaths worldwide (Barrios, 2022). Most notably, LMIC has worse five-year survival rates for breast cancer than high-income countries (HIC) by at least 25% (Rivera-Franco & Leon-Rodriguez, 2018). Perhaps we should more specifically ask the question of why early detection is lacking in LMIC before we begin to understand how to address the resulting healthcare inequity.

Naturally, these grim statistics simply stem from poorly developed women’s medical infrastructure, particularly with regard to early detection and treatment of cancer, in countries with already underfunded healthcare systems (Rivera-Franco & Leon-Rodriguez, 2018). For example, in India, there is a lack of routine breast cancer screenings and diagnostics which, compounded with a cultural reluctance to improve women’s healthcare, culminate in poor outcomes (Rivera-Franco & Leon-Rodriguez, 2018). A lack of cultural awareness and stigma fuels an already growing vacancy in women’s healthcare (Cousins, 2018). While it is difficult to change a culture in a short period of time, it is easier to address the more tangible need for easily accessible mammographic scans with advancements in technology. 

One new development is a more user-friendly, accessible, technologically integrated breast exam device produced by UE LifeSciences (Cousins, 2018). This hand-held device, iBreastExam, employs ceramic sensors to accurately detect variations in breast tissue texture in only five minutes with all of the results uploaded to a smartphone app (Cousins, 2018). Additionally, this technology is both pain and radiation-free as well as $16-19 cheaper than a mammogram, all facets encouraging more patients to follow-up on this crucial check-up (Cousins, 2018). Mihir Shah, a co-founder and CEO of the company, has brought iBreastExam to state-assisted screening campaigns, most notably one in Maharashtra for 250,000 women (Cousins, 2018). In just a few hours, someone could be trained to administer exams using this device, thereby saving thousands of women precious time, money, and heartache (Cousins, 2018). 

Early detection is one half of the battle; treatment is the other. One of the most important advances in breast cancer treatment has been the development of anti-HER2 therapies—drugs like trastuzumab target the human epidermal growth factor receptor 2 (HER2) on the surface of cancerous cells (Vu & Claret, 2012). A notable barrier to universal treatment access is cost, the newest breast cancer treatments being especially expensive. For example, in India, trastuzumab costs anywhere between $173,825 and $275,523 rupees ($2,486 to $3,940) for annual treatment—this cost far exceeds what many can afford and thus prevents people from seeking out medical care (Gupta, et al. 2020). Yet, if physicians focused on crafting more universally applicable regimens of chemotherapy, radiation, and surgery in a cost-effective, remissive (or, potentially “curable”) way, then maybe we’d see lower mortality rates in LMIC.

So, the question remains—if these kinds of revolutionary devices and treatments exist in the market today, how come the statistics seem reluctant to budge? Where is the impact of advancements in early oncological detection on a global scale (i.e., not simply from a one-off clinical interaction or campaigns, but rather systemic changes in early detection)? Now with technology like iBreastExam infiltrating the commercial healthcare system, there is a demand for such tools to find their way into more public hospitals and clinics—those sectors of healthcare are where the statistics lie. The first step to more equitable healthcare is technology that adapts medicine to varying environments but the next one is even more crucial—access. It seems counterintuitive, but the push for the latest treatments may actually be harming treatment access in LMIC to begin with, as we’ve seen with the economic barriers posed by trastuzumab (Barrios, 2022). Hopefully, as we begin to recognize the fallacies in global healthcare, we’d see more women lining up outside clinics for screenings and physicians addressing their issues effectively, presenting them with viable options for their social circumstances. It is a haunting reminder that, perhaps, one of those women would have been Jolly Komurembe, Edith Kemigisha’s mother. 

References
https://www.sciencedirect.com/science/article/pii/S0960977622000303 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5802601/ 
https://www.uelifesciences.com/ibreastexam 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3376449/ 
​https://www.nytimes.com/2018/08/28/opinion/detect-breast-cancer-developing-countries-asia.html 
https://www.cancer.gov/types/breast/research#:~:text=Approved%20drugs%20include%3A,advanced%20or%20metastatic%20breast%20cancer.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7051799/ 
https://www.nytimes.com/2013/10/16/health/uganda-fights-stigma-and-poverty-to-take-on-breast-cancer.html