Lifting the Veil From A Deadly Disease

Laura Bush listens to physician Huda Abdel Kareem, right, and another Saudi doctor during a visit to the Abdullatif Cancer Screening Center in Riyadh. Bush was promoting breast cancer awareness in a region where the disease is a major killer and still carries an intense stigma.
Laura Bush listens to physician Huda Abdel Kareem, right, and another Saudi doctor during a visit to the Abdullatif Cancer Screening Center in Riyadh. Bush was promoting breast cancer awareness in a region where the disease is a major killer and still carries an intense stigma. (By Hasan Jamali -- Associated Press)
By Faiza Saleh Ambah
Washington Post Foreign Service
Thursday, October 25, 2007

JIDDAH, Saudi Arabia, Oct. 24 -- When gynecologist Samia al-Amoudi was found last year to have breast cancer, a disease that still carries an intense stigma in this conservative country where women are forced to cover in public, she decided to share the details in her newspaper column, shocking many Saudis.

But the 50-year-old single mother insisted on telling her story in more than 30 television, magazine and newspaper interviews, trying to force a spotlight, she said, on a disease believed to be the leading cause of death among Middle Eastern women.

This week's visit to Saudi Arabia by first lady Laura Bush, who is on a regional tour to raise awareness about breast cancer, is a windfall to Amoudi's battle to bring the issue to the public, she said.

"The fact that there is a lot of media coverage of your visit, and people know you are here only for the purpose of spreading breast cancer awareness, that gives it importance and will really help our campaign," Amoudi told Bush at a "Break the Silence" coffee meeting Wednesday with other breast cancer survivors.

Bush is visiting the Persian Gulf region as part of the U.S.-Middle East Partnership for Breast Cancer Awareness and Research, launched in 2006 with Jordan and the United Arab Emirates, and this week in Saudi Arabia. She described the initiative at its launch last year as "the very best kind of public diplomacy."

The program is organized by the State Department and includes the Susan G. Komen Foundation and the MD Anderson Cancer Center in Texas.

Despite tense relations between the United States and the Arab world since the Sept. 11, 2001, attacks and the Iraq war, women in the region have been grateful for the breast cancer partnership, Amoudi said.

"This goes beyond political, cultural and religious differences," she said. "This binds women from all parts of the world."

Saudi women die of breast cancer because they seek treatment too late, said radiologist Asma al-Dabbagh, one of the first women to conduct mammograms in the country. "The breast is a sensitive part of a woman's body and they are shy to talk about it because our culture is very private and very conservative."

Women with breast cancer do not speak out, she said, for fear of losing their husbands and hurting their daughters' chances for marriage.

"We're at the stage now that American women were at 25 years ago; there's a lot of ignorance and shame surrounding breast cancer," Dabbagh said.

In her articles, and in the television and magazine interviews, Amoudi has made a point of repeating the word "cancer," considered a portent of bad luck in Saudi Arabia, where it is mainly referred to as "the bad disease."

"People here think, you have cancer, you die. They don't screen early, figuring, if I'm going to get it, that's God's will. But God told us to take care of ourselves," she said.

Seventy percent of breast cancer cases in Saudi Arabia are not reported until the late stages, compared with 30 percent or fewer in the United States. This denies Saudi women aggressive early treatment that could save their lives, Amoudi said.

In her first newspaper column, a month after she was diagnosed, Amoudi described finding a lump by chance while taking off her black abaya, or cloak. "My hand brushed my breast and I felt a lump. My doctor's instincts kicked in and in seconds I knew what I had. I circled the room, praying out loud, 'God give me strength.' "

Amoudi has used her column, which she has had since before her diagnosis, to urge women to go public with their breast cancer and to call on the health minister to provide free care for breast cancer patients.

There are signs that Amoudi's efforts are paying off. Dabbagh, the radiologist, said that recently women had started coming to her clinic asking for breast exams after seeing Amoudi on television.

As the group waited for Bush on Wednesday at the home of the U.S. consul, Somaia al-Thagafi, a 31-year-old journalist diagnosed in August, stretched out her arm and showed the other women bruises on the back of her hand from her chemotherapy treatment this week. Amoudi undid her abaya, pushed down the front of her dress and pointed to a slight bulge in her breast where doctors had implanted a catheter through which she takes her medication.

"You should try the catheter," she urged. "It's much easier and less painful."

Bush, who also visited Kuwait on Wednesday and planned a stop in Jordan on Thursday, then met with the seven breast cancer survivors and listened as each briefly told her story. "My mother and grandmother also had breast cancer," she said.

Bush told the gathering that she had overcome her own stereotypes about Saudi women, mistakenly believing it would be difficult to communicate with them. "I've found they're like women everywhere, very strong," she said.

"Thank you for caring not just about the American people but about us as well," Umm Abdul-Rahman, 45, in a black cloak and face veil revealing only her eyes, told Bush.

At the end of the meeting, Amoudi presented Bush with a gift from the group -- a black head scarf adorned with two pink ribbons stitched on the sides. Bush draped it over her hair briefly as the women beamed and moved in closer for photos.

© 2007 The Washington Post Company