In the U.S., we spend a lot of time talking about breasts, and not just Miley’s or Janet’s (Miss Jackson’s, if you’re nasty). We walk, march, and run for breast cancer awareness, we buy yogurts with pink foil tops, and every October we watch football players race around the field in pink gloves and pink cleats. We debate the merits of breast self-exams (starting when? how often?) and argue about whether women should have mammograms annually beginning in their 40s or their 50s, every other year, every three years, or some other option we haven’t considered yet. We’ve even begun to debate whether all this awareness and all this screening is doing more harm than good.
Contrast this to Uganda, where, according to a recent story in the New York Times, a woman who finds a lump in her breast is often either ashamed or unaware of the importance of early treatment in stopping the disease. For those who do seek treatment, there is one radiation machine available in the country—which is also in high demand among patients from Rwanda, South Sudan, and Kenya. According to the WHO, breast cancer is the most common cancer among all women, and its incidence in developing countries is increasing due to factors including longer life expectancies and better detection methods.
It’s a stark contrast between one health system that over-screens, over-treats, and offers too many options, and another that dramatically under-serves its patients, who often struggle to afford the limited treatments that are available. There are many resources in the American medical system that would benefit Ugandan women suffering from breast cancer, among them technology, training, and greater awareness and information around the disease. But are there lessons from Uganda that would benefit Americans? According to the Times, experts advise against transplanting the U.S. screening-mammography approach to breast cancer to Uganda: quoting Dr. Constance D. Lehman of the Fred Hutchison Cancer Research Center in Seattle, it “feels like we’re infecting them with our problems, rather than really sharing with them our triumphs.”
Instead, perhaps some strategies that American physicians are recommending to their Ugandan colleagues—such as using ultrasound rather than mammography to evaluate lumps that women have found themselves, which is both a more effective detection method in younger women and focuses limited resources on the most pressing needs—would be good moves for the American health system as well. Maybe we should think about following our own advice.
*With apologies to the former summer intern from whom I shamelessly stole this opening line.