Inspired by her experiences, Knaul founded “Cáncer de Mama: Tómatelo a Pecho,” or “Breast Cancer: Take it to Heart” (literally, “take it to breast”). The non-profit organization promotes research, advocacy, awareness and early detection
initiatives for breast cancer throughout Latin America, whose poor women bear a great burden of this disease.
The conference was organized by the Fogarty International Center and NCI and attracted 500 attendees from diverse fields including public
health, engineering and private industry. It focused on low-cost diagnostic technologies that have the potential for narrowing global disparities
in treatable cancers.
“Harnessing technologies today, combined with communication and information,” said Knaul, “will give local physicians and professional health providers the ability to deal with cancer.”
Conference presenters discussed and demonstrated
a number of innovative, low-cost and portable technologies. These included a specially
fitted syringe that can biopsy and diagnose Kaposi’s sarcoma and small, paper-based tests that can be read accurately by iPhone. Such easy-to-use devices would be particularly useful in nations where cancer specialists, not to mention
doctors, are rare or non-existent.
“We can’t afford not to act,” Knaul exhorted her audience, emphasizing the total global economic costs of cancer death, which reach as high as $943 billion each year
Photos: Ernie Branson
Knaul emphasized that not only is cancer a major global health concern, but also many cancers
can be prevented or cured in a way that is cost-effective and compatible with other public health initiatives. For example, the mortality rate from cervical cancer in Mexico has plummeted
in the last 15 years due to campaigns to promote Pap smears and to educate women about the disease.
“No one would have believed this was possible,” said Knaul. She predicted that as the cervical cancer vaccine becomes more common, this preventable
malignancy will become “ghettoized” to poor women with little health care access.
“We can’t afford not to act,” Knaul exhorted her audience, emphasizing the total global economic
costs of cancer death, which reach as high as $943 billion each year.
Knaul told the story of a woman named Juanita, a victim of missed opportunities for cancer control.
Despite having an obvious breast tumor—and cancer treatment coverage through the Mexican
health care system—Juanita did not seek treatment until the cancer had grown so much that she could not use her arm properly.
Juanita inspired Tómatelo a Pecho to lobby for the addition of breast cancer education into the national women’s anti-poverty program. This is an example of a “diagonal strategy,” said Knaul, that grafts cancer awareness and education onto existing anti-poverty, social welfare programs
without additional cost. This strategy can improve cancer outcomes through simple interventions
that do not require major investment.
Tómatelo a Pecho is now also working with state health ministries in a project funded and led by Mexico’s national health care coverage program to train health promoters and primary
care providers in the basics of cancer prevention,
detection and care. The hope is that tumors like Juanita’s can be caught earlier and treated more successfully.
“In countries where so many women with breast cancer are being detected at such late stages, we have learned that community health workers can play a key role in ‘downstaging,’” or finding tumors sooner, “even before a woman seeks care from a doctor or a nurse,” said Knaul. “This is not rocket science. It is about sharing basic knowledge, battling cancer and machismo to encourage women to seek care earlier.”
Good surprises can come out of bad events, said Knaul, recalling how butterflies flocked to the brightly colored hats she wore during chemotherapy.
“What this is all about,” she concluded, “is being an optimist and an optimalist—making full use of all the different technologies, information and educational possibilities we have at hand” to improve cancer prevention, detection and treatment around the world.