Partners Emphasize Early Detection of Breast Cancer

Although breast cancer mortality rates in the NIS and CEE are lower than elsewhere in Europe, cancer screening and education are also less prevalent. To help improve early detection and boost survival rates, partnership efforts have emphasized breast cancer prevention in a variety of ways. This winter, AIHA will launch a breast cancer prevention initiative in Ukraine, where deaths from breast cancer have risen 38 percent between 1981 and 1992.

In Russia, the partnership between Savior's Hospital in Moscow and Magee-Women's Hospital in Pittsburgh, Pennsylvania has focused on producing information about breast self-examination and other cancer prevention tips for its 25 women's health centers around the country. In addition, it provided to Semipalatinsk, Kazakhstan clinics plastic-coated cards for women to hang in the shower that demonstrate how to conduct self-examinations. The breast cancer mortality rate in Russia rose from 15 cases per 100,000 women to 22 in 1994; Kazakhstan has lower rates, but experienced a similar rise.

In Croatia, breast cancer rates doubled between 1968 and 1988 and have continued to slowly rise since then. Doctors at Sveti Duh General Hospital in Zagreb have lead the way internationally in using ultrasound technology to detect and diagnose lumps in the breast. Ultrasound eliminates the risk of radiation used in mammography and also can more accurately pinpoint cancerous lumps, according to Asim Kurjak, MD, chairman of the Department of Obstetrics and Gynecology at the hospital.

Kurjak and his associates expect to publish results of research on ultrasound use this fall. They have already extensively used ultrasound in detecting ovarian and endometrial cancers.

"They are true leaders in this field. Experts from around the world in the use of ultrasound in the detection of cancer have turned to them," said Jo Ann Kairys, director of marketing for Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, Sveti Duh's American partner hospital.

However, although Sveti Duh doctors have achieved accurate diagnoses using ultrasound, some researchers in America have not been able to replicate the Croatians' results, Kairys said. This may be because ob/gyn's specially trained in using the ultrasound equipment do the ultrasound in Croatia, whereas radiology technicians perform the test in the United States, Kairys said. Research in Germany, however, has shown ultrasound to be effective.

In Poland, an estimated 7,000 women are diagnosed with breast cancer every year. In 1991, Albany Medical College in Albany, New York, was paired with the Marie Sklodowska-Curie Cancer Institute in Warsaw, Poland, and the Copernicus Medical Academy in Krakow, Poland, as part of USAID's earlier CEE Partnerships in Health Care program. One of the primary goals of the three-year program was prevention of breast cancer - the leading morbidity among Polish women.

Early detection of breast cancer is hindered by a lack of advanced medical equipment and a lack of knowledge on early breast cancer detection, especially in more rural populations, according to Mira Lechowicz, program coordinator at the Community Health Plan in Albany, which is affiliated with the USAID partnership program.

The partnership focused its efforts on increasing early detection and screening programs for women in Krakow and Warsaw. Mammography screening is now available and targeted to over 5,000 women aged 50 and older. More than 50 potentially curable cases of breast cancer were detected and treated at early stages in Polish partnership hospitals, with an over 65 percent success rate for treatment.

Although government funding for this program ended in 1995, efforts between Albany and Poland still continue today, including branching out to more rural areas. Future partnership goals include the creation of a self-sustaining, regional women's health center in the town of Gdynia that emphasizes outpatient treatment and preventive medicine.