While the global pandemic has is still very much a reality, breast cancer awareness month should still be at the forefront of our minds this October. Breast surgeon Houriya Kazim explains why it’s still important to talk about cancer.
Each October, Breast Cancer Awareness Month helps thousands of women around the world to recognise a problem in their own body, or help breast cancer sufferers and survivors to get through the disease and fight on. Since its inception in the United States 1985, Breast Cancer Awareness month has raised awareness and encouraged women (and men) to talk about the disease and recognise how common it has become in our society as well as raising millions to help towards research and support of people who suffer from the disease. The harsh reality is that breast cancer affects one in eight women. So the chances are, even if you don’t get the disease yourself, you will know someone that does. But it’s not all negative. Between 2013 and 2017 the death rate of Breast cancer decreased by 1.3 per cent each year and this is mostly due to awareness and diagnosing the disease early, something that was previously far less common.
Someone who is an advocate for the awareness of breast cancer is Emirati Doctor and surgeon Houriya Kazim. Kazim was the UAE’s first female surgeon as well as being the first female breast surgeon. She has worked with thousands of women over her career and truly believes awareness and talking about the illness is the way to reduce the mortality rate, particularly in the Middle East where there is still a stigma connected with talking about cancer.
Aside from her work as a surgeon, Houriya Kazim felt there was even more she could do to help the women suffering from breast cancer, as well as their families. She set up a charity support group “Brest Friends” in 2002 to help support women with funding and highlight the symptoms and causes of breast cancer. Brest Friends partnered with the Al Jalila Foundation and the two have a joint mission to promote early detection of breast cancer, facilitate medical treatment and set up and fund locally-based research into the epidemiology of breast cancer in our region.
As we enter October and this year’s Breast Cancer Awareness Month, there is certainly a different feeling around the subject. The global pandemic has put COVID-19 at the forefront when it comes to disease and the worries about illness, however, as terrible as the global pandemic is, it is important not to forget that cancer is still one of the biggest killers we have today in the world. Breast cancer is still there and it should not be forgotten about. To talk more about why we should be aware of the disease and what we can be doing to support those who have it and ensure that any symptoms are eliminated at very early stages, we talk to Houriya Kazim.
Take us back to the beginning of your career as a breast cancer surgeon – why was it something you wanted to be involved in?
As a surgical intern at Rashid Hospital in Dubai, I saw women with very advanced cases of breast cancer – the likes of which I had never seen before, not even in my surgery textbooks. It was truly horrifying that someone could leave her disease to such an advanced stage, which would clearly be so obvious to the patient. What kind of mindset would allow a woman to see and feel this cancer, for a considerable period, and not do anything about it? This was over 30 years ago when women were reluctant to show their breasts to a male surgeon. These women, and their ultimate demise, were what pushed me to pursue specialising in this field.
What was the biggest challenge you had at the beginning?
Apart from working as a surgeon, it was clear that I needed to raise the collective national conscience about breast cancer. I formulated an educational program but there was resistance to my visual aids which showed a breast – from having my educational videos confiscated to not being allowed to hand out flyers with a stick- figures showing the breast! Seeing pink with the word “breast” throughout October, both in the media and in advertising, even on the side of buses, makes me so happy.
Why is it important to talk about breast cancer?
Breast cancer is the most frequent cancer among women, accounting for over 2 million cases globally. It also causes the greatest number of cancer deaths among women. In the MENA region and Indian subcontinent, breast cancer occurs at a much younger age. The average age for women getting breast cancer in the West is 62 years. In the MENA region, it is 45-47 years. This means that when a woman in this region is diagnosed with breast cancer, she will be in the prime of her life, at the peak of her career and/or looking after a young family.
What message would you give to women who are afraid or worried to share their symptoms?
Firstly, most breast symptoms are not cancer. And if it is cancer, then the earlier it is picked up, the easier it is to treat and the more likely you will survive.
How important is it to get checked sooner rather than later?
Most breast cancers, contained within the breast, has a 5-year survival rate of 99%. If it has spread to the lymph nodes under the arm, the survival rate drops to 86%. If the cancer has spread to other parts of the body, the 5-year survival rate is 27%. So, it’s very important to pick up breast cancer early.
What age should women start thinking about Breast Cancer?
I don’t think we should “think” about breast cancer per se, instead think about their health, and their bodies as a whole, from the time they are in their late teens. I encourage full body awareness, not just breast awareness. Knowing what your body looks like and recognising where your moles and lumpy areas are so that if there is a change, you’ll be the first to know. Breast awareness is part of body awareness. Once a woman is sexually active, she should be seeing a GP or Gynaecologist for regular checks, including a breast examination, and once she is over the age of 40, she should start having screening mammograms. If a woman has a strong family history of breast cancer, we may start mammograms earlier.
Of course, COVID-19 is a huge health crisis, but we cannot forget that people are still dying of cancer – what message would you like to share with people at this time to remind them to be aware?
It certainly has been an interesting time and yes, breast cancer is still there despite COVID- 19. The hospitals and clinics in the UAE are now safe to visit so if you have symptoms, please see a specialist. If you have no symptoms and are over 40, please have a screening mammogram.
How do you think breast cancer Awareness month has helped to raise that awareness over the years?
It certainly has raised awareness. In comparison to 30 years ago, I now rarely see the advanced cases I saw as an intern, and many patients that come to the clinic now are asymptomatic and just want to be checked.
Do you think the stigma of talking about breast cancer is still there and do you think it’s something that still needs to be tackled particularly in the Middle East?
The stigma is certainly still there in this region. We don’t like to talk about any cancer because, in the past, women sought help late in their disease, so the mindset was that cancer equals death. This understandable fear has kept women from having breast checks. I’ve had women say to me that if they have a check, we will find something! Having said that, as more and more women have breast cancer and are seen to survive their illness, I think this fear will lessen.
How do you think we can be educating young girls to be aware and talk about breast cancer?
Especially with young girls, we should be talking about body awareness rather than just an awareness of the breast. Young girls have inhibitions when it comes to their bodies, so encouraging, and not scaring them, is the way forward.
What about men what is the role they should be playing in terms of support and awareness?
I think teaching men and boys to support family members and partners is a good thing and not just in the face of breast cancer.
Male Breast cancer is also a little spoken about topic – could you share a few words on that?
Reports from the West show that 1% of breast cancer patients are male. In my practice, it is much less – more like 0.1% but that could be because male patients prefer seeing a male surgeon rather than see me. I don’t have the figures for the UAE on this. Men have a small amount of breast tissue and like women, any breast tissue can become cancer. Most of the male patients I’ve seen have a family history of breast cancer, so perhaps in men, there is a genetic predisposition. Male breast cancers are treated in the same way as cancer in a female breast.
Can you share with us a little about the recent charity work you have been doing?
I set up Brest Friends in 2002, which is a charity and breast cancer support group, that is now in partnership with the Al Jalila Foundation. Our mission is three-fold – education, treatment and research. We have produced educational aids in the various regional languages for free distribution. We raise money to financially help patients, who have no insurance, or inadequate insurance, with their treatment costs. And, we’ve started some locally based research on breast cancer in the region.
What inspires you or keeps you motivated?
Definitely my patients! The World Health Organisation figures study for cancer s that one in two of us will develop some kind of cancer at some point in our lives. Some get it as an infant or child, others in adulthood and if we’re lucky, we get it in old age. There are, of course, good and bad cancers. Breast cancer is one of the good ones, particularly if caught in the early stages. My patients’ strength and grace in dealing with their disease inspires me every day to keep doing what I do.
What would you say is your greatest achievement so far?
Professionally, I would say it’s being the UAE’s first female surgeon. Getting a double fellowship in Surgery, from both the Royal College of Surgeons in Ireland and England, is quite an achievement as well.
What is the biggest lesson you’ve learnt in life?
That you can make a difference! Seeing less advanced cancers and having patients come into my office and say they are fine but want to be checked, indicate that the awareness message is being heard.
Can you remember a turning point or moment in your career that stands out in your mind?
I initially trained as a General Surgeon in the UK and before coming home to Dubai. I thought I should get some experience in Surgical Oncology as I knew my training would end when I came home. I applied for a mid-level job at the Royal Marsden Hospital in London, which was a difficult place to get a job as it’s the UK’s main cancer hospital and a tertiary referral centre. When I was training in the UK, only 10% of surgical consultants were women. Plus, I was not British. At surgical job interviews, I would scan the room of shortlisted applicants and knew that I had to go in there and be better than the British guys, better than the Foreign guys, and better than the British girls. I had to be the best interviewee if I wanted the job. After my interview at the Marsden, I was the first person they called back into the room. In my mind, I thought it was to give their regrets but no – it was to say I had a job and ask me which job I wanted. At this point, they tossed an A4 sheet of paper across the table at me. On this sheet was listed, in alphabetical order, the various jobs on offer according to the various specialities – pulmonary (lung), paediatric (kids) etc. I was so thrown by this sheet of paper, that I just read the first line, which said “Breast Unit”. And that is how I started on my path of becoming a Breast Surgeon!
In this issue we are talking about success – what does success mean to you?
I think true success is a personal thing. When we’re young, we want to succeed in order to please our parents or our teachers. But true success is pleasing yourself. I didn’t start my professional life wanting to be the UAE’s first female surgeon. I just wanted to help people and, coming from a large family of doctors, Medicine seemed to be the obvious path. I went to medical school wanting to specialise in Infectious Diseases and Public Health. This evolved into my love for surgery when halfway through medical school, someone put a scalpel in my hand. I then specialised in breast cancer surgery partially by interest and partially by pure fluke. Finally, I started a breast cancer charity and support group to address some important local issues.
I’ve lost track of how many people, along the way, said to me that I couldn’t do it – couldn’t do medicine because I wasn’t smart enough or couldn’t be a surgeon as it’s a man’s job or that it would be almost impossible to have kids in my 40s or that it would be difficult to start a charity. Each time I achieved what I truly wanted – that was success for me.
With all successes come failures and setbacks – how do you deal with this and stay motivated?
I’ve always been a “glass is half-full” kind of person. I do a lot of crossword puzzles and Sudoku. I like working things out. When things are really bad, I remind myself that every obstacle and setback I’ve had in the past were resolved, in one way or another, and usually for the better. This keeps me plodding along.
What is the motto that you live your life by?
As our Prophet (SWS) said; “Think positive and positive things will happen”