Impacts & Insights

Producing evidence to advance mammography screening in Palestine

Cancer is ranked as the second cause of death in Palestine. Among cancer deaths, breast cancer ranked first in women at both West Bank and Gaza Strip, where 22% and 27% of cancer deaths were respectively the result of breast cancer.

A cornerstone of breast cancer control is early detection. While diagnostic mammograms are used to check for breast cancer after identifying symptoms, screening mammograms are used to check for the disease in women who have no signs or symptoms. The latter is used to detect breast cancer in the preclinical stage, thereby reducing disease-associated morbidity and mortality.

In 2008-2009, MoH started providing free mammogram screening for breast cancer in the West Bank for women at the age of 40 and above and younger women at risk. In 2010, the project started in Gaza with one mammography machine.

In 2013, the Palestinian National Institute of Public Health (PNIPH) was assigned to assess the ministry’s national breast cancer screening program. Accordingly, a retrospective cohort study was conducted based on the 2011 data of the mammography registry records in 12 districts. The main goals of the study were to examine cancer detection rates; false-positive rates; challenges faced by mammography technicians and physicians who read mammogram films; timeliness of responses to abnormal screening and diagnostic follow-up; and quality and completeness of cancer records in Palestine.

Following the results and recommendations of the research, MoH is currently developing guidelines for mammography screening and referrals of suspected cancer cases. It has already improved infrastructure by raising quantity and quality of available mammography machines, and re-locating mammography facilities.

In close cooperation and supervision of PNIPH, the ministry has been successfully able to develop the national registry of mammogram, and currently upgrading the national cancer registry. Furthermore, more female physicians are being trained on reading mammography films in all districts, which has significantly increased the effectiveness of the program. Breast images have later been turned into digital, which makes results easily accessible by radiologists and overcomes the issue of limited film availability.

MoH has also updated its breast cancer screening protocol to start mammography screening every year for women at the age of 40-50, and every two years for women at the age of 50 – 60. The protocol has been amended according to the National Cancer Registry data and hospital breast-cancer reports, which show that the number of breast cancer cases has significantly increased among women at the age of 40-50.

Away from technical benefits of the research, new development and fundraising opportunities have become available for MoH. It is the first of its kind research that is undertaken by a non-governmental, independent, and trustworthy source of information. PNIPH, currently managed by World Health Organization, is further planning to re-asses the national breast cancer screening program in 2020, and examine the impact of MoH’s intervention.

Global Overview:

Breast cancer is the second most common cancer in the world and, by far, the most frequent cancer among women with an estimated 1.67 million new cancer cases in 2012 (25% of all cancer cases). Incidence has been increasing in most regions of the world; between 2008 and 2012, breast cancer incidence increased by more than 20%, while mortality rate rose 14%. Although incidence rates remain the highest in more developed regions, mortality is relatively much higher in less developed countries due to lack of early detection and access to treatment facilities.