Erin Walsh, Samia Al-Amoudi, Suad Bin Amer

(WOMENSENEWS)–Samia Al-Amoudi, 49, diagnosed herself with breast cancer on April 7. Four days later, biopsy results would confirm that the mass she had discovered was malignant.

As she undergoes treatment, Al-Amoudi–a gynecologist and former vice dean of the College of Medicine and Allied Science at King Abdul Aziz University in Jeddah, Saudi Arabia–is rejecting her kingdom’s traditional culture of silence about breast cancer, by writing about her battle with the disease in the Saudi press.

In speaking out about her treatment, she has contributed to rising public awareness in Saudi Arabia of what, according to the U.S. Department of State, is the No. 1 killer of Middle Eastern women.

“When I myself was first diagnosed, my family and my friends advised me, ‘Don’t tell anyone,'” Al-Amoudi told Women’s eNews. “In closed and conservative societies like ours, breast cancer is a unique problem. It involves a sensitive part of the female body, and this is why these topics are not discussed openly and are considered very sensitive issues.”

To raise awareness about the disease in the region, the U.S. State Department’s Middle East Partnership Initiative will this month launch programs in partnership with U.S. institutions and local groups.

In addition to Saudi Arabia, the partnership will also start programs in the United Arab Emirates. In 2007 the program will expand into Morocco and Jordan.

The initiative will provide logistical coordination for programs funded by its partners, hoping to replicate U.S. success in increasing early detection of the disease. Erin Walsh, a senior U.S. State Department advisor, declined to reveal funding amounts for those support efforts.

Partners ‘Reached Out’

Walsh said countries in the program reached out to the State Department to form partnerships and already have community efforts underway to raise awareness about the disease.

In Jordan the partnership is working with the King Hussein Cancer Center and the country’s health ministry on a campaign that will receive monetary and technical assistance from the U.S. Agency for International Development.

The shape of the partnership in Morocco has not yet been determined.

The partnership struck for the United Arab Emirates includes information-sharing between Johns Hopkins Medicine in Baltimore and Tawam Hospital in Abu Dhabi and sessions to educate working women about breast cancer, through local chambers of commerce and at Citigroup workplaces in the United Arab Emirates.

The MD Anderson Cancer Center, based in Houston, will share information on the disease with King Faisal Specialist Hospital in Riyadh, Saudi Arabia.

The initiative will also include outreach through Saudi chambers of commerce and women’s associations to raise public awareness about the disease and the importance of screening for early detection.

The U.S. Middle East Partnership Initiative focuses on politics, the economy, education and women’s empowerment in countries including Algeria, Bahrain, Egypt, Israel, Jordan, Kuwait, Lebanon, Morocco, Oman, Qatar, Saudi Arabia, Tunisia, the West Bank and Gaza, Yemen and the United Arab Emirates.

Further details about the partnership will be announced when Karen Hughes, U.S. undersecretary of state for public diplomacy and public affairs, visits the region later this month.

Some ‘Pushback’ Possible

Participants will likely contend with some distrust of the United States in the Middle East, said Julia Sweig, a senior fellow at the Council on Foreign Relations, a think tank based in New York and Washington. “This program is taking place in a very hostile, anti-American environment, where even when the U.S. government tries to appeal to basic issues such as women’s health there is pushback. But my sense is (that) there is a need for the program, and they have obviously found partners who are willing to work with them.”

Al-Amoudi said low public awareness of the importance of early detection means that 70 percent of breast cancer cases in Saudi Arabia are detected in advanced stages, with late diagnoses especially occurring in Saudi villages. The problems, Al-Amoudi said, are “social, psychological and organizational.”

Older women in particular, Al-Amoudi said, don’t believe that early diagnosis can save lives and “generally doubt the whole fuss over cancer is worthwhile. They prefer to finish their days with both breasts intact with or without cancer.” As a result, many refuse treatment and turn to non-medical alternatives, including healers who claim to better cure the disease.

“The Middle East is where the U.S. was 25 years ago (on this issue),” said Walsh, the State Department advisor. “Twenty years ago, 80 percent of women in the U.S. were diagnosed with breast cancer in stages 3-4, and 15 percent were diagnosed in stages 0-2. Today, 80 percent are diagnosed in stages 0-2, and 15-20 percent in stages 3-4.”

A 2005 study funded by the U.S. Department of State and conducted by the Washington-based Freedom House found that the Saudi government offers free, modern medical care to all citizens, but that women’s access is limited by factors such as the requirement that a male, non-marriageable family member (such as a father, brother or son) provide approval for surgery.

Women Often Share Consent

“In male-dominated societies like some areas in Saudi Arabia, women’s decisions are controlled sometimes by men, and men may be unaware of or disapprove of screening,” Al-Amoudi said. She added that Islamic and health ministry rules do allow women to consent to their own surgery, except in certain cases such as tubal ligation. However, some women leave it to a male family member to authorize surgery “out of respect or because they believe that the male member should agree.”

The partnership came about after a Saudi women’s association identified fighting breast cancer as a core objective during a meeting with a State Department official. The Middle East Partnership Initiative then contacted Sheikha Fatima bint Mubarak, head of the Women’s Association in the United Arab Emirates.

Diana Rowden, international director at the Dallas-based Susan G. Komen Breast Cancer Foundation, said the research and outreach organization is working on “train the trainer” programs in the United Arab Emirates to prepare Emirati women to educate others about the disease. The foundation has not yet determined how much funding it will commit to the project.

Some believe research and public outreach–the core focus of U.S. efforts to fight the disease–miss the root causes of breast cancer.

A faction of U.S. health activists wish that breast cancer educational programs placed greater emphasis on preventing the disease by changing environmental conditions.

Judy Brady, an environmental justice advocate who lives in San Francisco, believes that up to 95 percent of cancer cases worldwide are caused by multiple exposures to human-produced carcinogens. “There’s only one way to prevent cancer, and that is to prevent exposure,” Brady said. “The one way to prevent exposure is to stop producing carcinogens. And that’s not in the picture at all.”

In the United States, Brady believes Komen’s corporate partners–such as automobile companies–prevent the foundation from addressing environmental issues that are the core causes of breast cancer.

“The debate has been wrested away from us,” she said. “And now it is framed in terms of research and pink ribbons.”

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