In Tanzania, a woman might never be screened for breast cancer. If she is screened, it's because something seems to be wrong. There are no high-tech tools, it's a manual exam. And when cancer is found, it's likely well advanced.
Treatment is limited to surgical removal of the breast, something many of the women reject. So for all those reasons, women who could be successfully treated somewhere else may die simply because of geography. Tanzania offers little to a woman who has breast cancer.
But it's changing. And a pair of breast cancer experts from Intermountain Medical Center are at the heart of that change.
Dr. Brett Parkinson, a radiologist who is imaging director of IMC's breast care services, and Dianne Kane, nursing director for oncology services, are heading to the African nation late this week to establish Tanzania's first clinic to screen and treat women for breast cancer.
"Women in Africa get breast cancer at higher rates than women in this country. They don't screen," said Kane, "so it's found at a much later stage, and the women generally die."
It was one such death that summoned help from the Utahns and others. Parkinson's brother, James, an attorney, was in Tanzania and saw an editorial written by a young man who was trying to raise his many children alone after breast cancer killed his wife at 39. Why, he asked, do we not screen and find such cancers earlier?
The lawyer Parkinson asked the doctor Parkinson what he knew about breast cancer in Tanzania. Not much, at first. But Kane and Parkinson soon learned that in the entire country, there was only one mammography machine. And it was broken. There are 26 radiologists in the whole country and most have never seen a mammogram. James Parkinson had formed the East African Breast Care Project (he co-chairs it with Mississippi businessman and attorney Wil Colom) and they all set out to get equipment donated.
Hologic donated the mammography machines for Tanzania, including five that have already shipped and another half-dozen that will go later this summer. Alliance Imaging donated ultrasound machines. Film, casettes and other items have also been sent to Tanzania. Salt Lake-based Globus International Relief has coordinated the shipments.
In June, seven health providers from Tanzania came to Utah to learn how to set up a breast cancer program. During the 10-day training trip, Parkinson and Kane, along with Shannon McCarrel of Hologic, will hook up with those former students. Parkinson will teach radiologists how to read mammograms, while McCarrel helps technologists set up and operate the machines. Kane will explain the intricacies of setting up a practice that requires both patient flow and follow up. The training sessions will be in Dar es Salaam and Arusha, a large city near Mount Kilimanjaro.
But screening will only go so far, they acknowledge. Kane said that mastectomy is the only surgical option right now, but it shouldn't be. "Our plan over the long-term is this: We have surgeons interested in going over and teaching them to do lumpectomy and possible sentinel node biopsy. We're going to take it step by step."When you diagnose breast cancer at earlier stages, you have more options, Parkinson said. And that's exactly what they hope to give their Tanzanian counterparts.