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Meike Feder is an editor at Siemens Healthineers and focuses on informative and inspiring stories around patient care. Here, Meike writes about how Siemens Healthineers is working to improve women's health through mobile mammography units travelling urban and rural communities in Egypt that offer free breast cancer screenings.

"Implementing breast cancer screening is always the right decision," says Siemens Healthineers.

"Despite many differences between Indonesia and Egypt, both countries have launched local breast cancer screening programs that tackle the challenge of delayed diagnosis and thereby higher mortality. In one country, the program is run by the government; in the other, by a healthcare provider. What are the crucial factors for success?" writes Meike.

Highlighting inequities between regions

In Egypt and Indonesia, breast cancer is the most common type of cancer affecting women. This is similar to many developed countries - but one major difference is the five-year survival rate in women who get the diagnosis. "And that is devastating," writes Meike.

Meike highlights breast cancer statistics that show huge inequities between different regions. In countries with a very high Human Development Index, 1 in 12 women will be diagnosed with breast cancer in their lifetime, while 1 in 71 women die of it. In contrast, in countries with a low Human Development Index, 1 in 27 women are diagnosed with breast cancer in their lifetime, but 1 in 48 women will die from it. 

Such disparities in incidence and mortality are most likely due to a delayed diagnosis. In Indonesia, around 73% of breast cancer patients come to medical centers in the late stages of the disease, which significantly decreases their chances of survival. The same is true for Egypt. Although the incidence rate is lower than the global figures, mortality is higher. This problem has been identified, and healthcare providers and governments have made it a priority to change the situation. Indonesia is a vast archipelago country with a population of more than 273 million. Many regions don’t have resident breast cancer specialists, and women aren’t yet sufficiently educated about the risks. Being aware of the burden of breast cancer in the country, Indonesia’s largest private cancer care provider, Siloam Hospitals Group, started a free-of-charge screening program in 2023.

“Breast cancer screening remains highly inaccessible due to limited hospital facilities and the lack of publicly funded, nationwide breast cancer screening programs. Through the program, we aim to provide free breast cancer screening to 50,000 women in Indonesia, especially those in rural areas, with no access to such screenings," explains Siloam Hospitals Group Sustainability Strategy & Program Department Head, Christina Renny.

Using an AI tool for reading mammograms

Meike writes that, besides individual risk factors, many studies have investigated and found geographical differences in breast cancer incidence, which are linked to urbanization, lifestyle, socioeconomic activities, welfare, and environmental exposure. Especially for private screening programs, it is crucial to identify areas with high cancer burdens in order to distribute resources to the right places. So far, eight Siloam screening centers spread across Indonesia have screened 32,000 women in 116 villages.

"The decision to address the shortfall in radiologists with modern technology was essential for the project. Siemens Healthineers offers an artificial intelligence (AI) tool specifically for reading mammograms. By checking the clinical images, the tool provides an important second opinion for the experts and reduces the workload for radiologists. If anything is detected, the doctors at Siloam Hospitals have the option to also use other systems from Siemens Healthineers for further evaluation, therapy planning, or control scans," writes Meike.

Half the world away, women are facing some similar challenges. In Egypt, breast cancer appears mostly in advanced stages - and at an uncommonly young age. The mortality rate of 11% is also much higher than in countries with a similar Human Development Index, such as China (6.3%). Like in Indonesia, Meike says that one crucial reason for the situation in Egypt is delayed diagnosis. Therefore, in 2019, the Egyptian government began setting up a nationwide screening program for 28 million women.

"Our goal is to target all women across Egypt, with clinical examination with imaging starting at the age of 35," says Chief Breast Radiologist and Deputy Executive Director of Presidential Initiative on Women’s Health, Ministry of Health & Populations, Norran H Said, MD FRCR.

Installing state-of-the-art systems

Meike highlights an interesting pattern that researchers found in Egyptian breast cancer cases was the mean age at diagnosis: only 50.4 years. While in societies with an older population pyramid, it is naturally higher, countries with similar age patterns to Egypt still have a higher mean age of diagnosis. In Egypt, 20% of breast cancer patients are younger than 40. This has implications regarding diagnosis, prognosis, and therapy - and regarding the setup of a screening program. While the American Cancer Society recommends annual mammography for moderate-risk women after the age of 45, this might be too late for Egyptian women, who on average seem to be affected earlier. Therefore, the Egyptian government offers screening for every woman from the age of 35.

"The method of choice for detecting breast cancer is a soft-tissue mammography. In younger women, the sensitivity of mammography is much lower because of higher glandular breast density. How to tackle this challenge?" asks Meike.

When the Egyptian government was looking for a partner for their mammography systems, they made the highest depth resolution a priority. The program will therefore be supported by 90 state-of-the-art mammography systems across the country. Installation is currently underway. To bring the fastest impact to the program, diagnostics started with mobile screening units, which are already screening women in Egypt today.

“As our trusted strategic partner, Siemens Healthineers has played a pivotal role in expanding access to care and cutting-edge technology,” says Consultant for Radiology Affairs to the Ministry of Health and Head of the National Liver Institute, Mohamed Fawzi, MD.

Meike explains how all this is only possible thanks to a holistic, tailored training approach for mammography technicians. Offering a newly developed vendor agnostic curriculum was a crucial deciding factor for the Egyptian government in choosing Siemens Healthineers as a partner. Already today, more than 300 technicians have been trained for this program in the Egyptian training academy. The academy is offering more than 200 courses, adapted to the regional needs - and thereby contributes significantly to the development of a skilled healthcare workforce.

"It feels like I’ve been given a second chance at life," comments breast cancer patient Endang.

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