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In Bosnia, Breast Cancer Fight Gives Women a Unifying Voice

October 26, 2010 at 12:00 AM EST
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In a country still very much identified with its civil war that ended 15 years ago, the leading cause of death among Bosnian women is breast cancer. Special correspondent Kira Kay reports on efforts to stop the deadly disease.
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JIM LEHRER: Next tonight: a new killer in a country that has known a lot of war. From Bosnia, special correspondent Kira Kay reports on the fight against breast cancer.

(MUSIC)

KIRA KAY: To the sound of American rock star Melissa Etheridge, hundreds of women gathered for an event also becoming a recognizable American brand, the Susan G. Komen Race for the Cure, galvanizing the fight against breast cancer.

But this is Sarajevo, the capital of the Eastern European country of Bosnia and Herzegovina, a nation still more identified by its civil war that ended 15 years ago.

(SINGING)

KIRA KAY: The women arrived here in high spirits, but with a mission.

STANKA BORAS, Bosnia and Herzegovina (through translator): This is important to me because I am one of the sick women. I just had chemotherapy. And this is the second time that I have had cancer, first in my breast and now in my bones. Here, you feel alive, to not give up the fight for life, but there is some hope, and you can win against the disease.

KIRA KAY: This is the new frontier in the fight against breast cancer. Once seen predominantly as a disease of wealthy nations, the World Health Organization reports, 70 percent of global cancer deaths are now occurring in low- and middle-income countries.

NANCY MACGREGORL: You are not alone. You are with your sisters both in the United States and across the world.

KIRA KAY: Nancy Macgregor is here representing Komen.

NANCY MACGREGOR, vice president, Global Networks, Susan G. Komen for the Cure: What is different here is, this is newer for them. It is very similar to when the foundation was started 27 — 30 years ago, but when the race was new, people were a little timid.

But, yet, they come and you see them start to proudly wear their T-shirts, to begin to dance to the music. They are finding their voice and speaking for what needs to be done, because lives are being lost needlessly.

KIRA KAY: Breast cancer is the number-one killer of women in Bosnia. Local doctors estimate that 40 percent of women diagnosed with breast cancer here die from it, compared to 11 percent in the United States.

Race volunteer Azra Cajo has been fighting for five years to beat that grim statistic. At only 39, she noticed a lump and went to her doctor. After an ultrasound, she was sent away with a clean bill of health. Six months later, Azra’s husband urged her to get a second opinion. Then another month passed before she finally received a biopsy, and a stunning diagnosis.

AZRA CAJO, breast cancer patient (through translator): It wasn’t only one tumor. It was two tumors, and I was inoperable. So, first, I had to undergo chemotherapy. I received four chemotherapies. The tumors shrank, so I underwent surgery. And then I received another four chemotherapies and had one month of radiation.

KIRA KAY: Azra blames her doctor for his failure to identify her disease. She also blames herself.

AZRA CAJO (through translator): The disease isn’t talked about much here. It’s a taboo subject. If I knew more about it, when I suspected something, I wouldn’t have waited and I wouldn’t get into a situation where it was too late.

KIRA KAY: If breast cancer is caught in its first two stages, cure rates can be as high as 85 percent. But, in Bosnia, breast health is not routinely part of general care, and doctors lack knowledge and medical tools.

And, so, radiologist Vanessa Beslagic says late diagnoses like Azra’s are the tragic norm.

DR. VANESSA BESLAGIC, radiologist: We do not have national screening program. That is a big reason why we do have so many advanced cases. Then, our female population is not educated enough. Then, there is not enough radiologists specialized in breast disease, not enough diagnosticians.

KIRA KAY: The country of Bosnia used to be part of the former Socialist Republic of Yugoslavia, which actually had well-trained doctors and a solid health infrastructure. But, then, in 1992, war broke out here, and the medical system crumbled, along with the rest of the country.

Doctors fled. Hospitals were destroyed. Today, there are only about 30 mammogram machines to serve a country of almost two million women. Waiting times of seven months, even up to a year, are not uncommon. And bureaucratic hurdles further endanger women’s lives.

Take the case of Travnik, a city of 70,000 people, but not one mammogram machine. Travnik’s hospital does have a radiologist, Hasib Yareb, who is used to making do with what he has. He showed me his one diagnostic tool, an ultrasound.

Is this enough for you to save women’s lives?

DR. HASIB YAREB, radiologist, Travnik Hospital (through translator): With this machine, I can only try to reach the diagnosis as soon as I can. But the ultrasound checkup of the breast is not enough for early diagnosis of breast cancer.

KIRA KAY: The nearest functioning mammogram machine is an hour away over the hills, where there aren’t enough radiologists to run it full time. Nurse Mirsada Sakic says local women are being sent in circles.

MIRSADA SAKIC, nurse, Travnik Hospital (through translator): There are patients who come directly here, but the surgeon has to turn them back to do the mammography. And so women are wandering a lot before they get into this main hospital. And when they reach it here, it is often too late. The system has failed, to tell you the truth.

DR. HASIB YAREB (through translator): Lack of machines and a shortage of educated staff is a secondary problem. The main problem is that we don’t have a national program. Then we simply don’t know in which direction to drive our car.

KIRA KAY: What Dr. Yareb is longing for might be starting here at a conference that is bringing together Bosnia’s doctors, government ministers and breast cancer survivors.

It was organized by the Women’s Health Empowerment Program, WHEP, funded by Komen and the American Jewish Joint Distribution Committee.

Nela Hasic runs the program in Bosnia.

NELA HASIC, regional director, Women’s Health Empowerment Program/Jewish Joint Distribution Committee: If they are not working together, nothing will be improved. They need to work together. That is the only way. Governmental institutions, together with the expertise of medical professionals, and the experience of the patients can improve things.

KIRA KAY: Goals include increased training of health care practitioners, broadening screening and treatment, and strengthening the nation’s fledgling network of grassroots initiatives to reach women with information that could save their lives.

Bosnia is a patriarchal society and religious barriers still exist in traditional communities. But the biggest challenge is the widely held belief that cancer still means certain death. And so WHEP is trying to change this dangerous misperception, starting at a young age.

DR. AIDA TATAROVIC, oncologist, University Clinical Center of Sarajevo (through translator): We will talk about how to discover it as an early stage, because when the malignant disease is discovered early, then the percentage of successful cure is high.

KIRA KAY: This high school session is led by oncologist Aida Tatarovic. She walks students through a self-exam and the basics of breast health. And there’s a wider goal.

DR. AIDA TATAROVIC (through translator): I was listened to by someone’s children. Those children at home have mothers. They have grandmas. They have aunts. From that one family, if one person says, I listened to this very carefully and I will book a checkup, then I succeeded in my lecture.

KIRA KAY: It’s been three years since Azra Cajo underwent her last surgery. But every visit to the doctor is an anxious one. She has already had one recurrence of her cancer.

Today, Azra’s tests show no signs of the disease. But she still has two more years to wait before she is considered cured. The news wasn’t good for others visiting the same hospital. In the hour we spent here, two women were diagnosed with advanced breast cancer.

The struggle against breast cancer in Bosnia has a long way to go, but events like the Race for the Cure are bringing the cause out in the open.

AZRA CAJO (through translator): I will run this race for as long as I live.

KIRA KAY: And for Azra Cajo and other survivors here, this day capped another leg in their own race for recovery.