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Ukraine: U.S. Specialists Seek To Improve Breast-Cancer Care

  • Bruce Keppel



Bellingham, 3 September 1998 (RFE/RL) -- Breast cancer can be cured if detected in the early stages of development. But early detection is rare in Ukraine, says Cary Kaufman a cancer specialist, or oncologist, who has worked with Ukrainian physicians in the Pacific Northwest state of Washington, and in Kiev.

Doctor Kaufman says the lack of early breast-cancer detection is particularly unfortunate in Ukraine, because the rate of breast cancers continues to rise 12 years after a nuclear reactor at Chornobyl exploded, generating a huge and poisonous radioactive cloud.

Kaufman is part of a team of doctors from Washington state who traveled to Ukraine last spring as part of a continuing, three-year project, financed by the U.S. government, to improve early detection of breast cancers in Ukraine. Last year, as part of the same program, 10 doctors from Ukraine came to Bellingham in Washington to observe breast-cancer diagnosis techniques and treatments.

The American team includes specialists from Washington state's renowned Fred Hutchinson Cancer Research Center in Seattle. The small university city of Bellingham where Kaufman practices -- it is home to about 60,000 people -- is about a 90-minute drive north of Seattle along the Pacific Coast. Bellingham is the center of government for surrounding Whatcom County, which extends to the Canadian border and today is home to a large number of immigrants from the former Soviet Union -- many of them from Ukraine.

So for Kaufman, Ukraine is not just another distant country with health problems. What he has learned in working with Ukraine doctors, Kaufman says, is that "the woman there comes in to see a doctor when her beast cancer is in a very late stage." He says there are at least two reasons for this often fatally late detection.

First, he says, mammogram screening is rare. Mammography, as this high-tech screening process is called, is a form of X-rays that can "see" tumors developing in breast tissue. Mammograms are the resulting "picture." In the United States, the American Cancer Society recommends mammography every year or two for women between the ages of 40 and 49, and each year from age 50 and older.

Thanks to mammography, cancer experts say, detection of breast cancer is coming earlier and earlier as measured by the smaller size of many tumors detected.

The second reason for late breast-cancer detection in Ukraine, Doctor Kaufman says, is that doctors there have in the past felt that telling patients that they have breast cancer would only make them distraught and could lead to suicide.

That's where another Bellingham cancer specialist who participates in the Ukraine program, psychotherapist Leslie Jacobson, urges women to become their own first line of defense against cancer. She says that "women need to be advocates on their own behalf.

They need to watch their breasts and their bodies." The American Cancer Society says this should include, from age 20, a monthly self-examination for lumps within the breast.

Jacobson runs breast-cancer "support groups" in Whatcom County under a program called "The Next Step." These groups are important, she says, because breast cancer differs from many other diseases -- and other types of cancer -- in also affecting a woman's feelings about herself, including her sense of femininity, sexuality and general body image. Participating in a group of similarly afflicted women drives home the point that they are not alone and that there is hope for recovery.

Jacobson likes to tell her group participants about her own mother, now 82 and a 42-year survivor of breast cancer. She calls her mother "a model for both myself and other women" because "she caught the cancer early and aggressively traveled the country looking for a good treatment."

The doctors from Ukraine who visited Bellingham came away impressed by the concept of these support groups, which showed them how knowledge of the disease -- far from making cancer patients distraught -- can help their patients cope with their condition.

Doctor Kaufman said the American team also stresses a variety of diagnostic techniques that are less invasive than surgery. These include using a needle to sample tissue to confirm or rule out cancer rather than cutting out a chunk of flesh.

At the same time, the Americans learned that their colleagues in Ukraine sometimes must work under conditions that are relatively primitive today -- such as having to resort to a nurse to put a hand beneath a patient's nose during surgery to feel for breaths, rather than being able to wire a surgical patient to an electrocardiograph machine that shows vital signs or to an oxygen-monitoring system.

Kaufman says his work with Ukraine has taught him that "it's really unfair" to say that his colleagues there "are behind and we are ahead." On the contrary, he says, he respects their work, but adds that "they have not had the opportunity to get the equipment we have, medical literature and the access to stay up with everybody else."

The American specialists, he adds, are determined to change all that.



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