Public health infrastructure in the Middle East and North African (MENA) region is greatly lacking; this is no surprise to any of its residents. These long-standing structural weaknesses and the overall inequalities in these nations were made even more clear by the COVID-19 pandemic.
Yet in recent years, the types of cancer awareness events popularised throughout the West have taken hold in the Arab region. In the United Arab Emirates, pharmaceutical giant Pfizer launched phase 2 of a campaign specific to the region, Take Action, to promote awareness and self-screening, including a round table with a breast cancer survivor.
Meanwhile, in the Gaza Strip, as part of the There’s No Shame In It campaign, health authorities, charities, religious leaders, and even bakers came together to encourage early detection and screening.
Despite greatly different economic and political conditions, breast cancer is the most common cancer in women in both Gaza and the UAE, and in both countries, the cancer is diagnosed in later stages, reducing treatment options and survivability.
Cancer is a group of diseases that can present when a group of cells begins growing out of control in body tissue, eventually invading other parts of the body. It is a leading cause of death in almost every country in the world, and it affects people across demographics and geographies. In 2020, there were approximately 19 million new cases diagnosed globally, most of which are breast, lung, or colorectal cancer, and 10 million deaths.
The WHO predicts that on current trajectories, cancer rates will increase by 60 percent over just the next 20 years. Cancer not only increases population mortality and disability but poses significant strain to health systems and health financing. Many cancers develop over the long term and there is no way to reverse population cancer rates overnight.
Unfortunately, many of the factors that contribute to cancer risks, like tobacco use, physical inactivity, environmental pollution, and occupational carcinogens, are present in the MENA, exacerbated by many fragile governments and countries in a conflict that are unable to meet even the most basic health needs of their populations.
Smoking is among the most pervasive behaviours that contribute to cancer in MENA, especially lung cancer. While smoking rates are decreasing around the world, up to half of the population of MENA smokes, and rates are estimated to increase to 62 percent by 2025. There remains high variation between nations, with Oman reporting the lowest rates.
Jordan reports the highest smoking rates in the world, with more than 80 percent of Jordanian men saying they have smoked or used nicotine products. This has contributed to “alarmingly high” cancer rates in Jordan, many diagnosed in patients younger than age 50.
In Lebanon, where cancer rates are among the highest in the MENA, smoking (cigarette and water pipe) led to most cancer diagnoses. About a third of the residents in Beirut report smoking, including 30 percent of doctors and 20 percent of pregnant women. The country, deep into a financial and political crisis, faces smoking-related health costs near $150 million dollars.
Aside from the health risks, the economic effects are undeniable; in just 2015, it is estimated that the region lost $30 billion due to mortality attributed to smoking.
While lung cancer is among the most common cancers in males in the MENA, women are less likely to smoke. In women from the region, as is the case worldwide, breast cancer is the most prevalent form of cancer and accounts for the majority of cancer cases throughout the region.
In 2016, 11 women per 100,000 died due to breast cancer in the Arab region. Reviews of the trajectory of breast cancer in recent decades show an increasing trend in MENA, yet part of that may be attributed to more widespread screening efforts. Unfortunately, few countries collect high-quality data consistently; only Kuwait, Oman, Jordan, and Tunisia had breast cancer registries before 1998.
Aside from smoking, the highest risk factors for many forms of cancer include a poor diet, low physical activity, and greater rates of obesity, and the MENA region is transitioning to greater rates of all these factors.
Egypt, Bahrain, Jordan, Kuwait, Saudi Arabia and the UAE report the highest rates of overweight and obesity, ranging from 74-86 percent of women and 69-77 percent of men, rates that are significantly higher than the global averages for overweight (39 percent) and obesity (13 percent). These factors are hypothesised to lead to higher cancer rates; for example, up to 30 percent of breast cancer cases are thought to be brought on by obesity and poor diet.
While the region has many concerns, separating rising cancer rates, or any health issue, from the other factors negatively impacting the region, is representative of a non-intersectional and depoliticised approach to health that, especially in light of the pandemic, is outdated and does not adhere to increasing evidence about social and political determinants of health. Thus, identifying steps that could improve population health, including reducing the cancer burden, goes hand-in-hand with mechanisms that can rebuild broken societies and realign public priorities.
The first priority for the MENA must be prevention. The reality is that a country cannot thrive politically, economically, or socially without a healthy populace. With a mix of health-forward regulations and public education, populations could be both incentivised to take certain cancer-preventing actions while dissuaded from engaging in actions that increase cancer risks.
For all forms of cancer, across demographics, early screening and treatment are key in preventing cancer from advancing and increasing survivability. Yet despite some improvement in accessibility in recent decades, cancer screening is still largely underdeveloped across the region. Aside from populations not being informed about the importance or availability of screening, many MENA countries lack the equipment or trained personnel to conduct screenings.
Neither of these initiatives – preventing cancer and ensuring sufficient capacity to treat it – is possible from a perspective that devalues human life at the expense of political and economic power.
The cancer trajectory of the region in the coming decades is unlikely to show a reversal of the increase in recent years without making needed changes today. While some countries are taking some steps, most are superficial or not at the necessary scale.
Like many of the other challenges facing the region in the 21st century, a long-term approach that is still not the norm in many Arab states is needed.
This article was originally published by the Arab Center Washington DC on November 18, 2021, and was republished with permission.
Dr Yara M. Asi is an Assistant Professor at the School of Global Health Management and Informatics, University of Central Florida
Follow her on @Yara_M_Asi