18 October 2018
This Breast Cancer Awareness Month, a group of UK specialists is travelling to the West Bank with Medical Aid for Palestinians (MAP) to support the development of breast cancer care. We spoke to Jane Macaskill, Consultant Oncoplastic Breast Surgeon at Ninewells Hospital in Dundee, to find out what her and her team will be up to, following their first visit in May:
In May I travelled to the West Bank to take part in a MAP-supported breast cancer mission. As a group of UK based breast cancer specialists, we were helping to determine the major obstacles for Palestinian women trying to access breast cancer care and to see where simple changes could be made in order to help that.
It was a very useful week for observing how breast cancer services can be improved. The health workers there are very busy, so it’s very important to try and simplify the treatment pathway for patients and relieve the pressure on an already extremely busy healthcare system.
One thing we will be discussing on our mission this month will be streamlining the breast cancer clinics. At the moment anyone from anywhere can turn up having had investigations or procedures somewhere else. We would like to discuss reorganising this and developing a specific breast clinic with recommendations for what investigations should be done rather than have breast cancer patients springing up at various points in the system.
At the moment, Palestinian patients are the ones having to coordinate their diagnosis and treatment. If, for example, they find a lump they will go to a primary health clinic and there they may have certain investigations done. They might have another investigation at a hospital and then have to go to a surgery clinic, but they might be told there that they have missed a key step so they have to go back and get that done. So patients are managing their whole pathway which is quite different to in the UK where everything is co-ordinated through referral pathways within hospital cancer centres.
On our mission this month we will be setting up workshops to look at specific cases and techniques with local health workers. In May we had hoped to teach Palestinian surgeons a technique to allow assessment of cancer spread to lymph glands through a limited axillary (armpit) operation. It involves a blue dye directed sample and it’s a really useful technique as it limits the amount of operating you have to do and it means less complications for the patient in the long run. So this is something we will be teaching the surgeons this time, as there were no suitable patients on our last trip. The radiologists will also be running workshops to show local medics how to do biopsies under ultrasound guidance because this facility is not available at the moment in the West Bank and it is quite a simple thing to do once trained.
One of the key areas we will work on with the whole team will be the concept of “multi-disciplinary” team (MDT) working, a strong principle of cancer care in the UK. Regular meetings of the teams involved in caring for patients with breast cancer allows discussion of cases, sharing of expertise and decision-making, and streamlining of treatment pathways. We will be demonstrating these concepts by running MDT meetings with the local teams during this trip.
Sadly, in the West Bank there is not a perception among women that cancer is treatable, despite breast cancer being potentially curable if caught early. There is a governmental screening programme, which in Scotland has around 85-90% attendance figures, whereas in the West Bank I think it is at best 20%. I think a lot of women don’t know about the screening programme, they are not invited into the programme and there is a stigma around presenting for breast cancer symptoms.
I look forward to seeing the activities organised by the Dunya Women Cancer Centre for Breast Cancer Awareness Month, helping to spread the message that if you get diagnosed early breast cancer can be treated.
Please donate today, to help MAP ensure Palestinian women receive the care and support they need when diagnosed with breast cancer.
