Breast and Cervical Cancer: The Not-So-Silent Killer of Bolivian Women
Maria, a 68-year-old professor in Potosi, first felt a breast mass last February. She knew little about breast cancer, and, when she finally presented to the private hospital 4 months later, the mass had doubled in size. The doctors and hospital were not equipped to evaluate or treat breast cancer, so she traveled 9 hours to seek care in the capital city. By the time she was diagnosed, the cancer had spread to lymph nodes in her arm and neck. She underwent surgery for advanced breast cancer and currently travels 9 hours by bus every 3 weeks for chemotherapy. With no local support system and her doctors so far away, she suffers from severe depression, anxiety, and debilitating lymphedema. Fortunately, she is in the minority of women who have private insurance and adequate financial resources to access cancer care.
Cancer is the 2nd leading cause of death in Bolivia with a significant effect on women:
- Bolivian women are 5 times more likely to develop cervical cancer and 7 times more likely to die of the disease compared to women in the US; they are 7 times more likely to die of the disease than their US counterparts.
- The incidence of breast cancer is predicted to increase by over 50% in the next 2 decades. Women in Bolivia with breast cancer are more than twice as likely to die of their cancer as women in the US.
- The high burden of breast and cervical cancer in Bolivia is the result of multiple barriers, including poor access to healthcare, lack of public education, and ineffective screening programs. The combination of these factors results in women presenting with cancer at later stages when the disease is more advanced and less treatable.
The majority of women in Bolivia are of indigenous origin, with health beliefs deeply ingrained in Andean tradition. The word “cancer” does not exist in many of the local indigenous languages, and cultural perceptions of disease causation and treatment often differ from Western perspectives. Despite this, current education and screening programs rely on a Western understanding of cancer and the value of early detection screening tests. This is just one of many reasons why prior attempts to improve cancer screening have failed, with current rates of Pap smear less than 12% nationally. Cancer prevention, early detection, and treatment approaches must be provided in a way that is understood and accepted by local women in order to reduce cancer rates and deaths.
To improve female cancer outcomes in Bolivia, we seek to increase access and utilization of existing resources.
Access: We are conducting a comprehensive evaluation of the existing health system infrastructure and resources available to diagnose and treat breast and cervical cancers. This situational analysis will provide a baseline understanding of the current system, allowing us to identify gaps in care and ways to strengthen the existing system.
Utilization: Two methods to improve the utilization of existing health resources are: (1) provision of culturally-appropriate education and screening and (2) improving patient-centered care throughout the diagnosis and treatment process. We are conducting qualitative studies using focus group discussions and individual interviews to evaluate:
- Indigenous women’s understanding of breast and cervical cancer, their health practices, and perspectives on screening and cancer care.
- Traditional healers’ concept of disease, cancer etiology, and approaches to diagnosis and care.
- Cancer survivor and their family’s experience of disease and care, from initial symptoms through diagnosis and treatment.
These projects together will provide an understanding of the barriers to accessing screening, diagnostic, and treatment resources for cancer care. The results will guide future research and development to provide cancer care that is culturally-sensitive and applicable to local women. Further, it will identify avenues of partnership with traditional healers to promote cancer prevention and screening programs.
We thank our partners at Northwestern University, Northwestern Lurie Cancer Center, the Panamerican Health Organization-Bolivia, the Spanish Centro Nacional de Investigaciones Oncológicos, the University San Francisco Xavier of Chuquisaca and its Center for Postgraduate Studies and Research, the Cupertino Arteaga Cancer Center of Sucre, and the non-profit PRODECO. We are grateful to be a part of BAMS and for their ongoing support to improve health and cancer care in Bolivia.
|Steven J. Schuetz, MD
General Surgery Resident
Feinberg School of Medicine