1. Breast Cancer In Palestine Belal M. Abu Samha

2. Introduction Breast cancer is a cancer that starts in the cells of the breast in women and men. Worldwide, breast cancer is the second most common type of cancer after lung cancer, and the fifth most common cause of cancer death. multifactorial disease. Geographical variations in incidence and mortality rates suggest that environmental factors are of greater importance than genetic factors.

3. West Bank Rapid urbanization/ changing lifestyles/epidemiologic transition. Cause Specific Mortality Rates per 100,000 population, West Bank:

4. West Bank Cancer in the West Bank is a public health problem. Approx 73%  < 30 years old. Approx 4%  65 years & older. Before 30 years #1 killer were chronic dse and nutritional deficiencies. NOW: non-commonicuable dse &Cancer.

5. West Bank Breast cancer is the most common type in Palestinian women. Approx 30% of all cancers in these women. The % is similar to neighboring countries except Lebanon. High mortality rate among women, about 21.1%

6. Factors with high total fertility rate (4.6%) high rate of breast feeding (95.6%) with a mean duration of 10·9 months. young mean age at first birth (20 years). low alcohol consumption. “Protective against Breast Cancer”.

7. Factors against  obesity and null parity. About a third of Palestinian women of reproductive age are single and thus mostly childless. (There is some hope !)

8. If you are a Palestinian woman with breast cancer, your chances of survival are poor. Conservative estimates suggest 7 out of 10 Palestinian women with breast cancer will die. MOH reports show that about 60% of women diagnosed with breast cancer in the Gaza Strip were diagnosed after the disease had already spread to other parts of the body. 42.2% showed that cancer had spread to the lymph nodes at the time of diagnosis. 17% of cases the cancer had reached other areas of the body.

9. COPE What is ? Goals?

10. Breast Cancer services between Palestine Vs Israel Diagnostic Services. Surgery and Post-surgery Services. Support Services.

11. Diagnostic service  Israel: 1991, ICA start mammogram national project. Women >50  bi-annually Women >40  annually Free, cost 50$ for NOT covered. 70 screening unit throughout Israel, and some mobile units.  Palestine: Screening units in governmental hospitals, FREE. Private & NGOs sectors, 30 $ Nablus (Family Planning Clinic), Jerusalem (Patient's Friends Society), Bethlehem (Patient's Friends Society), Beit Sahour (Greek Orthodox Clinic), and Hebron (Patient's Friends Society). No mobile units? Roads, heavy equipment, barriers.

12. Surgery and Post-surgery Services  Israel: full range of surgery and postsurgery services with FREE for covered. Mastectomy, HRT, physiotherapy… The ICA has trained 40 physiotherapists to treat lymphedema.  Palestine: For covered …surgery, chemotherapy, and radiotherapy. Surgery and chemotherapy are available and depend on political situation. Radiotherapy NOT available… abroad or Israel. There is no specialized physiotherapy or occupational therapy available in the West Bank or Gaza. Jerusalem.. Al-Makased & Agusta Victoria, NOT for breast cancer.

13. Support Services  Israel: The ICA runs support and information hotlines in Hebrew, Arabic, and Russian for patients and the public. Yad Lahachlama.? One in Nine, Ma’agan, Beit Natan, private hospitals.  Palestine: PFS

14. Both Yasser Arafat and Ben Gurion agreed: “The main weapon in the arm conflict is not bullets or bombs, but a secret one (The Womb)”

15. MOH strategy Vision: Increase the quality of life through reduction of cancer distribution. Message: Decrease number of cases through the preventive methods, early diagnosis, health care..etc

16. Procedures: 1.Control the risk factors(obesity, smoking, physical inactivity, stress & anxiety, HRT, alcohol). 2.Early diagnosis ( mammogram+ awareness). 3.Medical care. 4.Information systems(committees, forums, assemblies, meetings, research).

18. References Health Directorate – Tulkarem. World Health Organization. Fact Sheet No. 297: Cancer. Available from the net: http://www.who.int/mediacentre/factsheets/fs297/en/index.htm l. http://www.who.int/mediacentre/factsheets/fs297/en/index.htm l Potter JD. (1997) Food, nutrition and the prevention of cancer: a global perspective. www.cancer.gov/cancertopics/pdq/treatment/breast/.../page3.www.cancer.gov/cancertopics/pdq/treatment/breast/.../page3 www.bcpartnership.com http://www.euphix.org/object_document/o5648n29949.html.http://www.euphix.org/object_document/o5648n29949.html CDC mammogram brochure. Risk Factors of Breast Cancer among Palestinian Women in North West Bank/ Alaa Darweesh.