Breaking the Breast-Cancer Stigma in Saudi Arabia

In October of last year, more than 4,000 women in black abayas topped with pink ponchos gathered together in Riyadh, Saudi Arabia, to form a giant ribbon in support of breast cancer research–the largest human awareness ribbon to date. Breast cancer is the most common cancer in the country–nearly one-quarter of all cancers–so the campaign to make it a larger part of the national conversation is critical.

Because Saudi women don’t get screened for breast cancer early or often, a majority of those with the disease—as many as 70 percent–are diagnosed at an advanced stage by the time they finally visit a doctor, leading to a lower survival rate compared to countries where the disease is caught earlier. In addition, 30 percent of breast cancer cases in Saudi Arabia occur in women under the age of 40, compared with five percent in the U.S.

Thanks to increased screenings, more awareness programs and improved medical treatment in the U.S., breast cancer incidence rates decreased by about 2 percent a year between 1998 and 2007, although the U.S. still has the highest breast- cancer rate in the world. But death rates from breast cancer in the U.S. have been declining, especially in women under 50. Most American women over 40 consider their yearly mammogram as routine as a getting their teeth cleaned.

In Saudi Arabia, however, getting a mammogram is seen as taboo. Carol Fleming, an American expat blogger, learned first-hand the impact of Saudi cultural stigmas associated with breast cancer. While living in Riyadh in 2008, she discovered a lump in her breast during a self-exam. When she went to a doctor for a mammogram, she was told there was a six-month waiting list, no exceptions. However, her connections at the facility allowed her to jump the waiting list, and she was eventually diagnosed with breast cancer.

Fleming says a native Saudi woman might just as easily jump the line if she used her wasta (connections and influence), but even then she might forgo a mammogram because of the shame that exists in the country around women’s bodies. For poor women, who have little money and few connections, getting screened is next to impossible. Fleming explains in an email:

A Saudi woman who discovers a lump is naturally frightened, like any woman. Yet she is frightened not only for what that means to her … but also of the perception. Is she now viewed as deformed? Is she now viewed as ‘unmarriageable’ or, if married, will [she] no longer be wanted or seen as attractive to her spouse?

MSNBC reported on one Saudi woman who ignored her breast cancer because she was afraid of being seen by a male doctor. Another was divorced by her husband simply for thinking she may have the disease. A third was dragged away from the mammogram machine because the technicians were men. Even Fleming found that after her diagnosis she was discouraged from doing her own research about her diagnosis and treatment. Physicians assured her that “they knew what was best.”

Dr. Dalal Tamimi, an award-winning doctor who is working to build a breast cancer research center in Saudi Arabia, confirms the cultural stigma attached to the disease: “Once [women] know the diagnosis, they keep it as a secret. They don’t want anybody to know it, and they don’t want to talk about it.”

At least the Saudi government has shown a commitment to lowering breast-cancer mortality. In 2007, it piloted a public breast-cancer screening program, and is currently working with local NGOs to put together guidelines for a national program, which experts hope to see introduced in the next two years. The U.S. has also offered assistance: In 2006, the State Department created the U.S.-Middle East Partnership for Breast Cancer Awareness and Research, which brought more than $4 million in government and NGO money to the fight against breast cancer in the Middle East.

Much more work remains to be done. These campaigns are not enough to break the silence and shame that overwhelms Saudi women. Fleming suggests that men wear pink thobes (traditional Saudi robes) during Breast Cancer Awareness month, and that professional men’s teams play soccer with pink soccer balls–taking a cue from the widely popular pink movement in the U.S., which helped make breast cancer a mainstream issue.

Fleming also proposes that local papers print free ads of support listing the first name of those battling cancer in the area, in hopes of reducing the shame associated with being a cancer patient. Perhaps most importantly, she emphasized that Saudis should work to build a broader person-to-person support system–creating an ongoing dialogue around breast cancer.

Photo from Flickr user annrkiszt through Creative Commons.