Efficiency is a big issue in breast cancer management in Bangladesh: US specialist

It’s not lack of awareness or new technologies or tests, a former US cancer specialist says, but affordability, access, and quality of care are the challenges that women face in Bangladesh when they suffer from breast cancer.

“Quality of care is particularly with respect to efficiency. Too many tests are done, expertise in medical oncology is very limited, and hormonal therapies are way underused, to pick three examples,” Dr Richard Love, who has a nearly decade of experiences in Bangladesh, says.

He was speaking to bdnews24.com on Friday on the sidelines of a conference on breast cancer in Dhaka, marking the month of October which is globally observed as a breast-cancer awareness month.

Breast cancer tops the list among the types of cancer women suffer in Bangladesh. There is no national registry system to know the total number of cases.

But Paris-based the International Agency for Research on Cancer estimates every year at least 15,000 new breast cancer patients add up in Bangladesh.

Delayed marriage, tendency to take babies lately and not to breastfeed children are some of the factors believe to be responsible for more breast cancer cases.

Health Minister Mohammed Nasim, who inaugurated the conference, said free screening and tests for breast cancer would be offered in government facilities this December, marking the Victory Day.

Dr Richard Love

Dr Love believes most Bangladeshis with cancer die of this disease since “there are few places for them to get care, and often they cannot afford the care that is available; and the quality of the services is often not good".

He visits Bangladesh three times a year as a consultant at Amader Gram Cancer Care and Research Centre at Khulna’s Rampal upazilla.

Based on the Khulna experience, he said about 10,000 Khulna Division residents with cancer each year could benefit from radiation therapy treatment, but there is not a single radiation therapy treatment centre anywhere in Khulna division

“You have perhaps 30 functioning radiotherapy units here when you need 300,” he said.

He, however, found women “very aware when they develop a distinct breast change”.

“Bangladeshi women, rich and poor, are intelligent and rational when faced with this problem. The big problem is affordability,” he said, contrary to the common perception that women lack awareness of the disease.

A former professor at the University of Wisconsin, Dr Love, based on his Rampal experience, said, when they proceed with the diagnosis of breast cancer, the first thing they encounter is that patients cannot afford treatment.

“When they start finding the money to afford treatment, the next big thing is that medical establishments are expensive and do tests that are not needed.”

“There are treatments which are affordable. There are focused approaches that can keep costs down. But these are not happening (in Bangladesh).

“We need to pay attention to them. Efficiency means that you do something and you get a big return,” he said.

He said palliative care, which was much needed for relieving pains of the terminally ill, was also not happening mostly due to human resources limitation.

Also, when patients need palliation they do not have money to avail themselves of the facility.

“We developed a cell phone app and in Khulna region, gave it to the patients so that they can fill up questionnaires form home.

“They fill up and it comes to our server. The red flag means something bad started happening. Then we try to intervene to decrease the pain.

“It’s about Tk 1,000 a month. But the patients say they have no money because by this time they spent all the money for costly CT scans, PET scans, at least 20 blood tests and many more that they did not need.”

“Wise application of available therapies is what is lacking (in Bangladesh),” he said.

Dr Love suggested that the government contribute in cancer treatment much the same way it is contributing to BIRDEM and National Heart Foundation for diabetes and heart treatment.