Breast cancer is a looming destiny for 1 out of 8 women, and in some areas, such as Nassau County, for 1 out of every 4. It is an issue that unites all women, no matter what age, race, culture, or country. Greek women are not immune to the disease either.
Argy Avdoulos lost her mother after a protracted battle with breast cancer. She remembers her mother was first diagnosed with the illness when she was only 34 years old. She received a double mastectomy in order to save her life from and to stay alive long enough to raise her two young daughters. The mastectomy was a success and she lived another ten years cancer free. However, it came back as a melanoma on her hand and then as lung cancer she believes resulted from flying too often on Olympic airways flights back when Greeks smoked non-stop on them. Overall, Argy’s mom waged a mean battle against the disease for 18 years. “She was very strong,” Argy recounts, “that people who didn’t know her would never have known what she was going through.”
Argy and her sister grew up with the fear of losing their mother, but the terror escalated during the last year of her life when they witnessed their mother’s health deteriorate very rapidly. Argy spent as much time with her mother in her final year of life; “knowing how sick she was made each moment even more precious,” Argy remembers.
After her mother’s passing, the fear of getting the disease escalated. She was so terrified she almost gave up the chance to get screened for the disease because of the fear that it would exist in her as well. It was not until she reached 27 that she did get a genetic test. Luckily, her results showed she did not carry the genes that make breast cancer likely in pre-menopausal women. She practices vigilance by getting annual, if not bi-annual, mammographies. She has also had several core and needle biopsies. However, the relief that each new benign biopsy brings does not eradicate the fear that her family’s history of breast cancer has plagued her with. The emotional strain of living with a loved one lost to breast cancer or with the possibility of your own death can be overwhelming.
Still, Argy’s words of advice echo the health profession’s long-stated position, “Get screened early. Your chances of having a successful fight against cancer is to catch it early.”
In the absence of any long-term cure, early detection and prevention are vital. But how feasible is this for many Greek women?
One issue for women, especially our mother’s generation, in the Greek community with regard to this disease is lack of awareness, or rather lack of follow up. My mother, Athena, had ignored signs in her left breast for years. She had felt something like a “faki” a small lentil or a “bizeli” a chick pea, as she described, but had not made much of it to follow up. She let seven years go on before she realized that the “bizeli” was growing and that it had become a small golf ball. Her cancer had advanced to level 2 or 3. Had she been more vigilant, more informed about the disease, she would have caught it in time. As it turned out, after a painful battery of chemotherapy in conjunction with breast tissue and lymph node removal, she has been able to remain cancer-free. Had she responded earlier, the danger would not have been as grave.
Many women, like my mother, have never been taught how to perform a breast self-exam. They do not know the difference between “normal” and “suspect” breast tissue. There is a lack of breast health education for many women, especially those who did not grow up with the benefit of a required health class in high school or college. Additionally, while they might get a breast exam as part of an annual gyn exam, few medical practitioners have the time to teach them the protocols for a reliable self- breast examination. With breast tissue being so unique to an individual’s body, in many cases it is the woman herself who is the best detector if anything seems suspect.
This situation echoes much of the same scenario in Greece. According to an article published recently in cancerworld.net, the need for women’s proactive access to screening programs in Greece has led to a health policy proposal labeled “road map for treating breast cancer” made in collaboration with the Hellenic Society of Medical Oncology. The recommendations of this policy come on the basis of a study carried of out by the National School of Public Health together with the Hellenic Association of Women with Breast Cancer “Alma Zois” describing the “adventure” of women from the diagnosis of cancer until the recovery.
The health policy proposals are focused on three areas: prevention and early diagnosis; diagnosis, treatment and monitoring; and Research, evaluation of services and financing of care.
According to the study of the National School of Public Health, 49% of women in Greece had never done a breast self-examination and 35,7% had never had a mammogram. Women with high income and those with fixed doctor for breast control are more likely to make mammography. Three women out of ten reported obstacles to access to a doctor for an ultrasound and breast palpation, and more than four in ten barriers in accessing mammograms. The reasons were: “too busy”, “negligence”, or “high cost”. Only 30,7% of women surveyed identified the problem during screening. In Greece most women with breast cancer choose for the surgery a private hospital (57,4%). The private sector has also a high selection rate in the other stages of treatment (chemotherapy, radiotherapy). The treatment cost is covered mainly by the public insurance, but the patients also contribute out of pocket payments. In families hit by the illness, one in two households spend more than 20% of the family income for breast cancer management. About 10% of women surveyed were forced either to borrow money or to sell assets.(www.cancerworld.net).
Much of this lack of early detection in Greek women has to do with the fact that their role as the traditional nurturer and nurse is not easily switched on when it comes to themselves. While they will rush and fret over the health of other members of their family, they tend to brush aside their own needs. They wait too long to follow up with suspicions of problems. Greek culture distrusts the medical industry in general circles (remember the saying: “Kolos klasmenos, giatros chezmenos”). As a culture rife with herbal remedies and do-it-yourself treatments, one calls the doctor only as a last resort. This tendency poses a major problem as early detection of breast and other major cancers is the only real cure in some cases. Greek women wait too long to get the needed diagnostic tests that could be the difference between life and death.
Making Greek women, especially of the more traditional set, comfortable enough to give themselves a BSE (breast self exam) every month is another challenge. Can you imagine your yiayia or your very modest mother rolling her hand over her “vizya” every month in the shower? Cultural norms that dictate modesty make it difficult for women to get comfortable with the feel of their own bodies.
Given these cultural ramifications, it is even more important to educate and advocate for the cause of breast cancer awareness in the Hellenic community. Think white, light blue, and pink for this Breast Cancer Awareness month.