Unveiling Breast Cancer

Dr. Salwa Boulos is training physicians devoted to women's breast health.

Dr. Salwa Boulos is leading a grassroots effort to educate the women of Cairo about breast health. Since 2000, Boulos, the sole breast radiologist at the Italian Hospital in Cairo qualified to read mammography film, has been sending teams of social health educators into areas of the city in a door-to-door campaign to improve women’s chances of detecting and surviving breast cancer. In the first year of the pilot project, more than 4,000 women between the ages of 35 and 65 were invited to participate in the study, designed to evaluate the role of clinical breast examination as a primary screening modality. Under the auspices of the Ministry of Health and Population in Cairo, the study confirms that breast screening detects a high rate of breast cancer—about 8 per 1,000 at the first examination and 2 per 1,000 among those who appeared for re-screening. The second phase of the study is now underway, bringing to 15,000 the number of women contacted.

Dr. Boulos studied medicine at the University of Cairo and did post-graduate work in mammography in Milan. When her cousin was misdiagnosed and died of breast cancer at age 44, Dr. Boulos was determined to focus her energy on a disease little regarded in a male-dominated culture. As a female physician, Dr. Boulos was able to gain the trust of her patients, teaching them to perform self-examinations and, if indicated, to undergo mammography and treatment.

Her clinic has the financial support of the wife of the former Italian Ambassador to Egypt, Vittoria Aloisi de Larderel, who was impressed that Dr. Boulos was pioneering breast cancer detection and treatment in that country.

“She wanted to do something for Egypt,” Dr. Boulos says, “so we developed this project that trains social health workers and young doctors to screen women for breast cancer.” If the woman has a lump or a family history of breast cancer, she is referred to Dr. Boulos’s clinic for further evaluation and treatment. The program operates under the umbrella of Challenge, an organization established by the European School of Oncology (ESO) with whom INCTR is establishing a collaborative program, and Mrs. Aloisi who, together with ESO, covers the entire cost of screening, diagnosis and treatment.

“We are beginning to see higher levels of cooperation among our target population, with respect to annual visits and taking tamoxifen, an important part of the follow-up care regimen, and we are starting to get some support from local businesses,” says Dr. Boulos, who is helping to transfer this program to Yemen, Sudan and soon, to Lebanon, by training doctors and social workers from those countries in breast examination, needle and core biopsy, and the proper use of instrumentation.

“One of the fruitful things is the Euro-Arab School of Oncology, established last year in Cairo in collaboration with ESO,” she says. “Because we share language and culture, we can more easily train the next generation of doctors and technicians to work with the resources we have.”

Scarcity of resources and rampant illiteracy are on her list of challenges, but her biggest obstacle, she says, is a male-dominated society that hinders diagnosis and treatment for its women.

“I lost a wonderful patient because her husband wouldn’t let her be treated,” Dr. Boulos recalls. “When she was finally brought to me and she took off her veil, I could see the cancer had metastasized up to her neck. It was too late to save her. She died.”

Dr. Boulos also struggles to explain complicated medical procedures to the illiterate. “Many don’t understand the difference between biopsy and surgery. One young patient couldn’t quite grasp how she woke up with a reconstructed breast.”

Still, she fights the good fight and dreams of a not-too-distant day when her clinic works hand-in-hand with the Egyptian government, the Minister of Health and the National Cancer Institute to enhance women’s health.

Marcia Landskroener for INCTR