With her immaculately coiffed curls, perfectly tied silk scarf and sharp tailored jacket, the woman behind the imposing desk could easily be mistaken for any of the powerhouses working in Dubai’s most glamorous industries. Look more closely though and it becomes apparent that the foot high pile of photographs partially obscuring her from sight does not contain camera images of the latest catwalk trends, but rather the images resulting from hundreds of MRI scans, CTs and mammograms.
We are in the office of Dr Houriya Kazim, the first female Emirati ever to qualify as a surgeon and to this day, the only one dedicating her life to the fight against breast cancer.
Her path to the specialism was a long and unexpected one. While medicine was always in her sights – “There are around 80 doctors in my family. It’s in the blood” – Dr Kazim had initially wanted to specialise in infectious diseases after finishing medical school in Ireland. But when she returned to her native Dubai for an internship at Rashid Hospital, the need for a female surgeon in the country quickly became apparent. “I was seeing patients with very advanced breast cancers. I’m talking about cases I’d never seen in training in Dublin, things that were in textbooks from my Dad’s generation,” admits Dr Kazim. “I realised that not only were people unaware, by the time they knew there was a problem they were too afraid to go to a male surgeon.”
Subsequently setting her sights on surgery, Dr Kazim admits that, while she never encountered too much resistance to her trailblazing, she did rattle a few local foundations. “We’d have male construction workers coming in and they didn’t want me putting my hands anywhere near them to examine them, so we came to a kind of agreement where my male colleagues and I would swap cases and they’d treat the guys and I’d treat the girls. Little things like that were an adjustment for everyone. There was this imaginary line down the middle of the canteen with men on one side and women on the other, so we surgeons would have to pick a table in the middle of the room and I’d sit on one side of it so as not to upset the balance!”
However, she faced no opposition to her chosen career at home, where generations had followed the same path. “When I look at women in fields that have been difficult to break into culturally as a woman, it’s only now I realise I realise how big a difference it makes who your parents are. If I had said to mine I didn’t want to get married or have kids, it wouldn’t have phased them, but if I’d stood up and said I didn’t want to go to school, it would have seemed like the end of the world. Education was everything in our house.”
After a period spent specialising in breast cancer surgery in London, Dr Kazim returned to the UAE in the early 1990s to put her expertise to use. But having set her sights on raising awareness to ensure a reduction in late stage cases, she was quickly frustrated by local restrictions. “I couldn’t even put the word breast on my medical license”, she laughs. “I couldn’t even have the word on a card that goes in my wallet that nobody else sees, that’s how weird it was here then. I couldn’t even design flyers.”
How times change. “Now, we have buses that drive around Dubai in October carrying posters about breast cancer awareness month. I hadn’t really realised how much things have changed until a couple of years ago, a surgeon from American Hospital stopped me to tell me that he no longer sees advanced breast cancer cases. And he’s right, neither do I! It’s changed so much.”
So much of that is about awareness, a drive that Dr Kazim has dedicated the last two decades to. Not content with her surgical work and extracurricular talks to local women, in 2006 she set up the Well Woman Clinic, which provides a full range of healthcare options with an entirely female staff, allowing her to focus solely on breast cancer patients. How many patients does she have? “Just over 8,000 now, I think,” she admits.
She also founded Brest Friends, an awareness raising, educational body which recently produced a multi-language video encouraging woman to check themselves for breast lumps, under which she also hosts the UAE’s only support group for breast cancer sufferers and survivors. With over 300 members, the group is making some serious headway, but Dr Kazim insists she still has a lot of work to do.
“I think the awareness is there in so many ways, but there are still some things that I’m trying to address and one of those things is the fear,” says Dr Kazim. “I think, historically, because people here presented so late, more than likely not, they died from their cancer. So in everybody’s mind, breast cancer equals death. As more people present early, survive and go on to live a normal life, that’s changing, but it’s an evolutionary thing and it will take time.
“So I think we need to keep some perspective. You’re eight times more likely as a woman to die of a heart attack than from breast cancer. Patients don’t have that same emotive connection with heart disease but we’re all more likely to have heart problems than breast cancer. We need to stop scaring people.”
Working out why some women are more prone to breast cancer than others is also particularly problematic here as there is no government-mandated, national cancer register for professionals to draw information from, as there are in the USA and across Europe. “I’ve been trying for 12 years now to get that going but, frankly, it doesn’t sound as sexy as building the world’s tallest structure – I need to figure out a way to make it more exciting!” sighs Dr Kazim. Joking aside, the lack of a national registry is a serious concern for Dr Kazim and her colleagues, particularly as women here seem to be getting cancer at a younger and younger age. “In the UK and the US, it’s mostly a disease of post-menopausal women. Around 80 per cent are over 50. But here, the curve is about 10 years younger – and we do all the right things. If you look at studies of breast cancer over the years, they say have children, have them young, breastfeed and don’t take HRT. But we do all those things here. It’s Islamic to breastfeed for two years and a lot of women do that and more. We have our children young, we’re not big on taking hormones and yet we still get breast cancer, we get it young, and we get it in aggressive forms. So these are the things we need to look at to see if we’re more genetically prone in some way or if we get a different disease than in the West.”
This trend is a genuine worry across the region, not least because it makes screening for the illness far more difficult than it is when patients are older. “In the West, they’ve decreased the death rate by getting mammograms done preventatively in women over 40, but if we’re seeing breast cancer in women in their 20s and 30s, what do we do? We can’t mammogram them at birth! And the breast tissue is so dense when you’re young, you can’t even get the information you want from a mammogram. So at the moment, we don’t know how to screen these women and we don’t know why they’re more at risk.”
Carry on fighting
Breast cancer remains the most common form of cancer for women worldwide and rates are rising, with nearly 1.5 million women diagnosed in 2010. The World Health organisation says the upward trend is common to both developed and developing countries, though the challenge there is to implement screening programmes when money for healthcare is hard to come by. In Western countries meanwhile, survival rates have reached around 89 per cent.
Here in the UAE, health facilities are world class and, unlike when Dr Kazim started working here, there is very little in terms of detection, testing or treatment which now has to be outsourced to other countries.
However, Dr Kazim warns that having world class hospitals and clinics is not enough if their doors remain closed to some due to a lack of insurance coverage. “If the women are from India or the Philippines, it’s cheaper for them to be treated there so we send them home. But sometimes we just can’t help and it’s horrible.
What I’m trying to do is speak to companies, especially companies which hire significant numbers of women, and ask them to please read carefully what their insurance policies cover. Because most local insurance companies – in fact all bar one – do not cover screening mammograms. If you have a problem and you want to have a mammogram, they’ll cover it, but if you just want to check, they won’t cover it. Many won’t do a pap smear either. And that’s not right. We encourage women to check so, if they want to, that should be covered,” urges Dr Kazim, adding, “In other parts of the world, they’ve actually had to pass laws that force insurance companies to cover those things because, of their own free will, they’re not going to."
With such a challenging environment, it would be understandable if she had days where she simply wanted to give up or pass the baton. But that’s not an option, thanks to one key motivator – the women she helps. “To watch how some women go through it with a strength even they don’t know they have is amazing. A lot of the women I meet come from quite traditional backgrounds, where they defer to their husbands for everything. But their husband can’t go through the chemo for them, he can’t get the surgery. And when they get through it, it’s amazing to see their strength. The same women that came into my office cowering behind their husbands come marching in and greet me full of confidence. And that for me is the wow moment. That’s the moment that makes it all worthwhile.”
Beating Breast Cancer
With so much information out there, it’s understandable that women can get confused over what they should be doing to protect themselves. But, depending on age, Dr Kazim says there are a number of steps you can take to minimise your risk...
No-one knows your body better than you. In the same way as we keep an eye on moles, we should keep an eye on our breasts so we know if there are any changes. If there are, consult your GP, but remember there are many potential causes, not all of them serious. Visit www.brestfriends.org for more advice on self-examination.
Know if you’re at risk
Women with a family history of breast cancer or a personal history of cysts or fibrous lumps may benefit from more regular screening. Seek advice from your GP if you think you may be in the at-risk category.
While self-examination is key, from the age of around 20, we should also be having yearly check-ups which involve a clinical breast examination. Otherwise healthy women should begin to have screening mammograms at least once every two years from the age of 40, while from the age of 50, we should be screened annually.
Take care of your health
Experts give the same advice for preventing cancer as for protecting our basic health. A healthy diet, regular exercise, avoiding tobacco and limiting our alcohol intake can go a long way.
“We go for a dental check-up, we go for pap smears and it’s just the same with breast checks,” says Dr Kazim. With early detection, breast cancer has a very high survival rate so if you’re in doubt, go for a check-up.
Bing Moore, 33, from the Philippines, was diagnosed with stage three breast cancer in August 2011, just months after her wedding. She then underwent chemotherapy, surgery and radiotherapy and, while still receiving treatment, is now in recovery.
“I was only 32 when I was diagnosed. Too young. I’d celebrated my birthday on August 3rd and then my husband Mike and I went on holiday to his home country, England. But while we were there, I started feeling a real pain in the right side of my breast. I thought it might be because of the cold but when we came home it continued and, one morning, I told Mike it felt like there was a needle in there. The pain was so sharp and it just wasn’t stopping. So he took me to the hospital to be checked and that’s where it all began with the scans.
I never suspected cancer at that point. There was no family history and I was too young anyway. They always say it’s a disease to look out for after 40. And besides, I don’t smoke, I don’t drink. There was no reason to suspect cancer.
So I went for an ultrasound and a mammogram and the doctor said it’s unlikely to be cancer because the tumour is so big. So we breathed a sigh of relief then went home to wait for the biopsy results. A couple of days later, when we went back, the doctor almost didn’t know what to say, how to tell me I had stage three, locally advanced cancer, I just broke down and cried. I couldn’t believe it. I kept thinking, I don’t have kids, I just got married, I’m too young for this to be happening. I just felt like tomorrow had been taken away.
In some cases, you get surgery immediately, but in my case, I had to have the chemotherapy first to shrink the tumour. It was six centimetres by four centimetres so if they’d done the surgery, they probably wouldn’t have saved my breast. So I had the chemotherapy and it shrunk to two by one, then we were able to operate. Next came radiation and now I’m in remission, though I still have four or five Herceptin infusions to go to ensure the cancer cells don’t come back. When I was told I was in remission, I wanted to be sure I was really and truly in the clear, so my oncologist ordered every scan I could have and everything was totally fine. So I know I’m ok, even though I’m really only in remission. After five years, I’ll hopefully get the final all clear.
I know it’s looking good but I’m only human and sometimes, when I’m not busy, I do worry. One time, when I got a bit sick, I couldn’t stop thinking it was something serious. But when you really think about it, I have oncologists and doctors who are doing their best to monitor me and make sure it doesn’t come back so most of the time I try to remember that and not worry too much.
We had been married less than a year when I was diagnosed and at that time, I wasn’t really even thinking about having children. I just wanted to enjoy life with my husband for a time. Then, suddenly, I was diagnosed. Now, I’m having tamoxifen treatment for five years which means I’m not allowed to conceive. My oncologist did ask me if I wanted to freeze eggs before I started my treatment but, at the time, I was so scared all I could think about was that I wanted to live. So I told them just to start the treatment as soon as possible. Now, I have an injection once a month to suppress my ovaries so I’ll be able to have a baby when my treatment is all over.
I guess maybe after five years I might have a baby or, as Mike says, maybe we can adopt. But right now, all I can think about is that I want to live my life.
I’m so blessed to have Mike because from day one, he’s been there for me 24/7. To think that he’s working and has still managed to be there to make sure I’m fine and to come to all my hospital appointments, I really am blessed. He was actually quite funny after my surgery – he wanted to hire a nurse to take care of me. I had to tell him I didn’t want a nanny!
Before my treatment, my hair was so long I kept complaining it needed cut! My husband liked it really long and I would moan about it. But I never cried as hard as I did the day I started to lose my hair. I felt like my confidence went into negative. Before, it was just my hair, but when I started to fall out, I realised the impact it had on how I felt about myself. Suddenly, I didn’t have long hair, I was wearing a scarf and everywhere I went I was sure people were staring at me.
I didn’t want to go to work, I didn’t want to go out at all. Mike kept telling me that people weren’t actually staring, that I just felt like they were, but I was certain. Then one night, I just cried and cried, and once I’d let it all out, I was fine. My hair started growing back and I tried not to wear the scarf anymore even though I felt my hair was so thin. Then people started complementing me on my hair, saying how funky it was and I thought, ok, this is now my summer look. I’m used to it now and people say it suits me so it’s fine. But I do still miss my long hair, I will grow it back and I definitely won’t complain about it this time!
When I was diagnosed, my outlook on life changed. I used to complain so much – I was Mrs Whiner! I was never satisfied – if I had work, I wanted time off, and when I wasn’t working I wanted a job. I was never just contented and happy. But since I was diagnosed, I’ve realised the value in taking it a day at a time and just focussing on being happy. I’m still alive and that’s all that matters now.”
Lisa Tarr, 37, was diagnosed with stage one breast cancer in October 2011. The Zimbabwean mother of two underwent surgery and chemotherapy and is now in recovery.
“I had breast implants about three or four years ago so I’ve always kind of been aware of my breasts. I was doing a self examination last October when I felt a little lump. Really little, but weird. I went to the doctor and she wasn’t sure what it was, because it was moving, so I went to City Hospital. The lovely doctor there did an ultrasound and straight away, she said ‘this isn’t good’.
She couldn’t tell straight off what it was, obviously, but she said that, from her experience, she felt it was bad. So they did a biopsy there and then and three days later, I got the diagnosis. Stage one cancer. Thankfully it was very small, less than a centimetre, and it was unlikely to have spread by that point. So from day one, everything was working in my favour.
Doctor Kazim ordered a whole load of tests before they could operate. So I had a full MRI of my chest, then I had to have a CT scan, a PET scan, a bone scan and loads of blood tests to make sure the cancer hadn’t spread.
I had surgery in November and while they were removing the lump, they took a lymph node for testing. After that, we were in a very grey area over whether I’d need chemo or not. The first lymph node test came back negative so we thought everything was fine. But about a week later they got another result saying there was a tiny, tiny bit of cancer there. And my oncologist said basically, because I was so young, he’d give me the advice he’d give his own wife or mother – ‘you need chemo’.
It was a real shock. What’s funny is that from the moment I was told I had cancer, all I kept hoping was that I didn’t need to have chemo because I couldn’t bear to lose my hair. I had hair down to my waist, so that was my main concern.
My oncologist advised me to cut my hair in stages, getting shorter and shorter, but I cut it to my shoulders and that was as far as I could go. I bought a really nice wig and I thought, when it starts falling out, I’ll shave my head and put a wig on straight away and no one will even know. That never happened. My husband, Darryl, shaved my head, which was a really traumatic moment, and afterwards, I put the wig straight on and I felt like I was hiding. I felt uncomfortable, unnatural. I wore it that once, then moved straight on to scarves.
Apart from that though, chemo wasn’t as bad as I expected. I felt a bit yucky but it was nothing like the movies, where people are ill for weeks. My first chemo was six days before Christmas so I missed Christmas parties and sat in on New Year’s Eve. It was inconvenient – but that’s life.
It wasn’t a great experience, of course, but I never once thought I was going to die. I knew I would nail it. I was very positive from day one and everything looked so good. Even the specialist said I’d caught it so early, the survival rate was about 99 per cent, so I never worried it would be the end of me or that I’d leave my kids motherless.
And I was honest with them from day one. I didn’t want to spring it on them so I told them the truth at every stage. Bradley, being a boy, wasn’t really that concerned, but Savanna was very worried, so I made sure I explained everything to her all along, right from the scans and the biopsy. Unfortunately, about a month before I was diagnosed, I’d had to fly home to visit my aunt who had lung and liver cancer and she died while I was there, so I think that was probably at the back of the kids’ minds. But we sat them down when the results came back and told them that I had cancer but I wasn’t going to die. I’d tell them what machine I was going in that day and they’d look it up on the Internet so they knew what all the machines looked like and did. There was no lying or hiding things and I think that helped them a lot. And they were great.
Darryl was extremely supportive too and I think having the kids gives you a reason to get out of bed every day. Obviously, on the weeks when I was having chemo, I’d arrange for them to be picked up from school, I arranged lots of play dates for them and the other mums helped out. But on my good weeks I’d get up and take them to school as normal. I couldn’t just lie there and feel sorry for myself, I had to carry on. I remember the day my husband shaved my head, my friend was here and it was really traumatic and we were all upset. And then I went round to collect the kids from school. Normal life doesn’t stop just because you have cancer. You’re still a mum.
I think being here also helped, not least because we’re from Zimbabwe where healthcare is very poor. I’ve got a lot of friends here and they’d take me to chemo and we’d sit there and have a laugh during the treatment, whereas when your whole family is around you it’s a lot more serious. My mum actually came over after I had my operation and it was so emotional for everyone. I hated seeing her so sad, so being here with just my husband and kids and friends was the best thing for me.
I’m getting tests done just now as I reach the one year point and, in some aspects, I do still worry. The treatment’s over but it’s always there at the back of your mind that every six months there’s going to be a test and there could be a result that raises questions. So it is quite hard, but you have to push forward. You can’t live in the past. You just have to go with it, move on.
I’ve always been the sort of person who just takes life head-on, and that hasn’t changed. When I was diagnosed, I said to my husband ‘this is just an inconvenience’. He’s got the same attitude really. He just said ‘let’s get it in one go then move on, no looking in the rear view mirror’. So that’s what we did. My cancer was a speed bump – it slowed me down a bit for a while but now it’s full speed ahead.”