Cancer In Saudi Arabia

Compared to several other places in the world as well as the Gulf region, Saudi Arabia is relatively low on the list of cancer occurrence. But there are a few things that are unique to Saudi Arabia when it comes to cancer. Not only are their unique issues with cancer occurrence itself but also the issue of Saudi vs Non Saudi treatments in the Kingdom, support and care of cancer patients, as well as cancer education.

One notable issue that relates to women is that of all the cancer reported in Saudi 20% of it is breast cancer cases. This is a rather high rate and is shared with most of other Arab states in the region as well. And like the history of breast cancer in the US majority of women are diagnosed in late stage cancer and the mortality rate is higher in this area than the other parts of the world. This is due to late detection and treatment which is influenced by a lack of education about breast cancer, cultural stigmas regarding cancer in general as well as womanhood being hung on the breasts of women (this is from both the male and female point of view). For the past several years the US has been working in cooperation with Saudi Arabia to tackle this problem. Women have been sent for education in order to learn how to promote breast cancer awareness in the Kingdom. This has had its affects, the numbers of earlier detection are increasing a bit.

One of the issues is that compared to the US where most breast cancer hits women in their fifties, for Saudi women it hits in their 30s. The idea that it is older women who have to be more aware of breast cancer is simply untrue to begin with, but more so in this country. You add in a social stigma of women and their breasts your running into major issues. Women here have a unique threat in that if they aren't woman enough for their husbands they may run the risk of either loosing him due to her 'defect' or sharing him with another wife. Granted men can be crude all over the world when it comes to women who have had a mastectomy, but I would venture to say it is more so in this culture.

Another unique issue related to cancer and women in this culture is that men are given the power to decide a womans medical treatment to some extent. He can simply deny her treatment and there is little power most women have in that. While the official rules may state that Saudi women have the power to determine their own surgery, in practically this simply isn't not the case for most women. Men withhold ID cards, prevent her by pressure not to go because they are ignorant about breast cancer themselves. In theory women here should be able to detect breast cancer early than other parts of the world simply because health care is free for them. But in reality culture issues do prevent this from happening in many cases.

This is not to say all Saudi men are huge bullies over their wives, but in some cases this does occur. What is more shocking to me is that many times doctors attitudes prevent good care when it comes to women. There is the overwhelming attitude that women in this culture are over dramatic (true as that may be) so should not be taken seriously even by their own doctors. I have a friend who had that happen to her, she went to her doctor for a couple of years telling him she feels something wrong in her breast. He noted her as 'over dramatic' and said she was fine and sent her on her way no matter how insistent she was. Until finally she was diagnosed with cancer, two years of telling her doctor. She knew her body, he simply felt as a doctor he knew best and women in this culture should be handled differently. (Do note she is now cancer free and did all of her treatments like a champ, far from an over dramatic woman)

Prostate cancer is low in Saudi compared to other parts of the world, as well as the US. However they do make up for a higher number of reported cases in the Kingdom. This doesn't mean that men are most likely to get cancer here, just simply they are most likely to seek treatment and I think that goes along with some of the issues I discussed above. Men are generally older in age when they are diagnosed with cancer although among the young children boys make up for the most cancer patients. Leukemia tends to be the most diagnosed cancer among men followed by liver cancer. Here is a male and female break down of cancers diagnosed among Saudis in both genders (does not include non Saudis)

Male
Leukemia 276 (9.6%) Liver 242 (8.4%) NHL 230 (8.0%) Colo-rectal 222 (7.7%) Lung 169 (5.9%) Prostate 156 (5.4%) Skin 143 (5.0%) Hodgkin Disease 137 (4.8%) Bladder 129 (4.5%) Nasopharynx 119 (4.1%) Total = 2875

Female
Breast 545 (19.9%) Thyroid 254 (9.3%) Colo-rectal 216 (7.9%) NHL 190 (6.9%) Leukemia 179 (6.5%) Ovary 101 (3.7%) Skin 100 (3.6%) Cervix uteri 92 (3.4%) Liver 81 (3.0%) Corpus uteri 78 (2.8%) Total = 2741

Treatment for Saudi cancer patients is free, as is other medical treatments, and there are some great oncology units in Saudi Particularly King Faisal Hospital in Riyadh, which many Saudis go to when they are diagnosed. There is a treatment center here in Khobar King Khalid hospital which is where my mother went. Their care was something that needed to be revamped, something which I'm told they had done. At the time my mother was there the Dr. saw five times the amount of patients than he should have been. The follow up care was slim to none, you received your meds, blood tests, and all of that in the hospital but the support was nil. If you felt terrible you waited until the one day that the Dr. was in the office, or you went to the ER. There are no support groups and everything is rather clinical lacking real compassion which is easy to do. The Dr once said to my mother "It is easy not to have to deal with the emotions of the women because of their distance with men, but with you it affects me". This would indicate oncology is a field that should employ more female Drs for women in Saudi Arabia.

Treatment for non Saudi patients is not free here. Although medical costs are very low considering much of the world, out of pocket expenses for a prolonged cancer battle can run into some serious money. It is very difficult to find a Saudi hospital to take you on under their care, which means you don't pay for it. It is doable but you have to use 'wasta' or someone else's, it is all about the connections. This isn't an inherently bad thing, but when certain services for cancer treatment are not available in private hospitals than it becomes an issue, at least for me.

Recently a friend was diagnosed with cancer, she may need radiation treatment. The only way to get the treatment in this area is A- go to government hospital which doesn't take non Saudis B- use Aramco services which are only for Aramco employees. Beyond that private hospitals in this area, to date, do not have radiation treatment available. You could go over to Bahrain, but according to the Drs. here that isn't a good choice. So for most expatriates having cancer means leaving and depending on themselves or others to help them during this time. If it isn't possible for the entire family to move, such as in this case mom has the cancer dad has a job here, than a split of the family doesn't make for a good support system for the cancer patient.

Not all cancer medications are available here in Saudi, which is why we had to send my mother to the US. Saudi uses its own screening process when it decides to allow a medication for use in the country or not. Some of that may take some time when it comes to new drugs that are placed on the American or European market. This also would be the same in some medications in the US compared to say Europe, so Saudi isn't unique in that at all. But the medications are EXTREMELY cheaper here than the US. When we compared prices for certain mediations for my mother most were 4x more than the cost here in Saudi. Insurance is a new thing in Saudi so perhaps that has kept the costs low. Perhaps other countries can learn from Saudi on how to keep drug costs so low.

My mother had wonderful doctors and other medical staff during her treatments here and Saudi. And she has had the same in the US so there isn't any major difference between the medical staff competence in one country or another. (Of course there are idiots in the field in any country) She did have more control over her choice in care here in Saudi because we paid out of pocket for most of her care here. But this didn't lead to any major problems since she has been in the US. The obvious difference however is the ability to find more support in the US from those outside and within the medical field. She has weekly meetings (she no longer has the energy to attend) with a cancer support group. Where those who have cancer or have a loved one with cancer gather, talk, and support each other in the battle. They compare notes, find out a lot of information that is helpful and give a means to just get problems off of their chest. This support makes for a better impact on the lives of the patients (victims as they refer to themselves) and is something Saudi should start to implement. Open group session will enable a patient to start talking and not be afraid of talking. Dealing with taboo issues in a frank and supportive manner without fear of being told to shut up about having cancer.

Of course there are steps that Saudi is taking when it comes to breast cancer but there are still so many social stigmas that are connected to cancer in general and even more so for women. The idea that such things should not be talked about openly, whispering about how Fatima is "miskeenah" while she isn't there is one thing, but directly dealing with such issues is another. And this isn't only about cancer this is a way many issues are handled in this culture. I believe more strives for the entire culture to become more open to discussing cancer and other medical issues would be beneficial to all. Including support for those going through cancer as well as their family is, which I believe, an important part of putting up a great fight. We had to find our way in all of this and not that I'm complaining because I think we did a very good job through it all even now. But for so many they want to know they aren't alone, they aren't loosing their mind to feel the way the do, what to expect from a person who has been there and done that. This goes for family members who should learn what is helpful and what isn't and now to be supportive to their loved one.

What I've learned along the way is not to speak of cancer like it is shameful. And this is something I think this country should adapt in order to become more aware of cancer, early diagnosing and treatment.