By Maya Bell
CORAL GABLES, Fla. (October 7, 2016)—Every minute of every day, three women receive the same devastating diagnosis that Felicia Knaul, the University of Miami’s first lady, received nine years ago while living in Mexico: You have breast cancer.
But if they are literate, documented, white, and happen to live in Florida, they’ll likely be diagnosed early, have access to institutions like Sylvester Comprehensive Cancer Center at the Miller School of Medicine, and survive. If, however, they live in a resource-poor country, like Bolivia or Guatemala, their chances of surviving even treatable breast cancer are slim. They’re even less likely to survive preventable cervical cancer.
“Hundreds of thousands globally and tens of thousands in our region die every year from preventable cervical cancer or treatable breast cancer,” Knaul, the director of the University of Miami Institute for the Americas, said as she opened a symposium last Wednesday on “Women’s Cancers in the Americas: Strategies for Synergies” with sobering statistics. “The majority of them are poor. The majority of them lack access to care. The majority of them are women in the prime of their lives with children who depend on them.”
Closing that gaping cancer divide brought about 200 clinicians, health systems experts, and women’s cancer and patient advocates from more than 10 countries in Latin America and the Caribbean to UM’s Braman Miller Center for Jewish Student Life to discuss synergies, strategies, and programs that can improve cancer care and outcomes in the region. Although planned for two days, the symposium was squeezed into one, thanks to Hurricane Matthew, which as an ominously fitting backdrop, had just left a trail of death in Haiti and was taking aim for Florida, a state far better equipped to survive such a disaster.
“Welcome to Hurricane Cancer,” Knaul, also a professor of public health sciences at the Miller School, said in thanking the people who had put aside personal preparations to address diseases that, like a hurricane, sweep into the lives of too many with deadly consequences.
Among them was one of the Frost School of Music’s most notable alumni, two-time Grammy-winning singer and songwriter Jon Secada. Known for his soulful pop songs, Secada pledged to lend his voice to educating women in the region to “take that first step” if they notice changes in their bodies, and not to fear the stigma of disease or disfigurement.
“This message has to come from many angles,” Secada said. “Maybe I can start by saying to all women, ‘You are beautiful. No matter what, you are beautiful.”’
Also joining Secada at the forum was Frost School Dean Shelton Berg, a pianist who, accompanied by Kate Reid, associate professor and program director of Jazz Vocal Performance, provided a healing musical interlude. The Frost School’s director of marketing and communications, Patricia San Pedro, also exhibited the Discover Your Doorway photos she created during her own journey with breast cancer.
Delivering the keynote address, UM President Julio Frenk noted that before Seguro Popular, the program he implemented as Mexico’s minister of health to expand health coverage to more than 55 million uninsured Mexicans, nearly a third of Mexican women diagnosed with breast cancer abandoned their treatment because they could not afford it. Afterward, that number fell to 1 percent.
But as Frenk learned, money alone cannot fix the inequities that perpetuate the cancer divide in the hemisphere. Accompanying his wife on her breast cancer journey, he said he saw health care barriers that are even greater than lack of access. Among them: women who refused to get mammograms for fear their partners would leave them if they were diagnosed with breast cancer.
“What that made me realize is that the fight against women’s cancers, breast and cervical cancer is, of course a pubic health and a medical crusade, but it is most importantly a fight for the dignity of women,” Frenk said. “The other big cancer we have in our society is the cancer of stigma, discrimination, machismo, and the absolute pervasive attempt to reduce women to parts of their body. So this is a fight for the dignity of women.”
It is a fight, Knaul noted, that is making progress on many fronts. Better prevention science, early detection, better treatment, and persistent advocacy from groups like symposium collaborator ULACCAM, (the Union Latinoamerica Contra el Cancer de la Mujer) have led to increased survival rates. The most recent report of the American Cancer Society, she said, showed a 36 percent drop in breast cancer mortality in the U.S. over the past 22 years.
“That translates into 249,000 women’s lives saved in the last 22 years. That means one woman per hour over the last two decades,” she said, noting that globally cervical cancer deaths are declining, too, and it is now overwhelming a disease of the poor. “The vast majority of women, however, continue to lack access to information, intervention and available treatments that could have saved their lives.”
The hope is that, one day, they will have access to institutions like Sylvester, a regional referral center for the most complicated cases which boasts among the best cancer survival rates and strives to provide care organized around the patient, not the provider.
For example, Steven Altschuler, CEO of UHealth—the University of Miami Health System and senior vice president for health affairs, told the audience breast cancer patients should see an oncologist, surgeon, plastic surgeon, social worker, and the person organizing clinical trials all on one visit, not multiple visits.
“It all has to be integrated in the form of one-stop shopping,” Altschuler said. “That is the methodology that is the care model that provides the best results at the most appropriate cost.”
Among the many other speakers were Erin Kobetz, Sylvester’s associate director for Disparities and Community Outreach and the Miler School’s senior associate dean for health disparities, who has implemented the kind of cervical cancer detection and prevention initiatives in South Florida’s immigrant communities that could be exported across the hemisphere.
In addition to Sylvester, the Miami Institute for the Americas, and ULACCAM, other symposium collaborators included the Harvard T.H. Chan School of Public Health’s Women and Health Initiative, and Tómatelo a Pecho, the organization Knaul founded in Mexico to address the inequities in care and treatment for breast cancer.