Breast cancer is rising in poor countries

International cancer experts are meeting this week to plan an attack on the worrying rise of breast cancer in developing countries, where nearly two thirds of women are diagnosed only after the cancer has spread.

On top of that, some worrying data suggest that breast cancer strikes women in poor countries at an average age 10 years younger than in the United States, and no one knows why.

"Today in most developing countries you see many young, premenopausal women with breast cancer," said Felicia Knaul of the Harvard School of Public Health, who was diagnosed with breast cancer at 41 while living in Mexico. "We have to help them know what they have, and fight for their treatment."

From Mexico to Malawi, Knaul says, she has seen stigma as well as poverty. Nurses training rural women in Mexico to examine themselves for breast cancer hear fears such as: if a woman loses her breast, her husband will leave her.

Dr Lawrence Shulman of the Dana-Farber Cancer Institute, part of a team starting cancer care in parts of Africa where "women are often seen as being for childbearing or for sex", agrees this is not trivial. "But some success in treating HIV and tuberculosis in those regions gives us hope that we can make a difference. I don't think it's a pipe dream."

Knaul and Shulman met on Tuesday with an international task force of leading health specialists and charities to start planning a two-part approach.

First, training midwives and other rural health workers to do regular breast examinations by pressing and feeling, in places where mammograms (breast X-ray machines) are simply too expensive. That won't find very small tumours, but specialists agree it could greatly improve diagnosis in some areas.

Second, the task force will start negotiating lower prices for generic chemotherapy for poor countries, following the same model that helped transform AIDS care in parts of Africa. "You don't need cancer specialists to give chemotherapy," Shulman says. "Just a network of oncologists who can advise local health workers by email or phone, as I do for colleagues in Malawi."

Breast cancer has been seen as a disease of rich countries: 192,000 new cases are expected in the US this year, with good chances of survival thanks to modern equipment. The true spread of the disease in most developing countries is unknown because of poor diagnosis and record-keeping, but new Harvard research estimates that they will account for 55% of the 450,000 breast cancer deaths expected this year, and that the poorest countries will see a 36% jump in breast cancer by 2020.

One problem, Shulman says, is that in rich countries early diagnosis can lead to breast-saving surgery instead of removing the breast. Even in countries such as Rwanda and Malawi, clinics can remove breasts if patients can travel to the capital, but few have radiotherapy, which helps save the breast. Mexico is a mixed case, with radiotherapy, mammograms and other treatments available in some places: that is how Knaul, whose husband is a former Mexican health minister, was diagnosed early and given good odds with chemotherapy.

But she says that while poor and rural Mexican women often have a vaginal smear to check for cervical cancer, "no one even suggests they check their breasts" at the same visit. She founded the group Cáncer de Mama to help, noting that Mexico's insurance programme for the poor covers breast cancer care, but women need a diagnosis first.