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NICE Campaign Aims to Eradicate Cancer in Developing Countries
"The rich amongst us are the weakest in my eyes until they have secured the rights of others. And the poor amongst us are the strongest in my eyes until I have secured their rights for them." This is the motto that guided Aymen Elfiky, MD, MA, and founder of Yale International Action Group, in his development of the National Initiative for Cancer Eradication (NICE) campaign.
The NICE campaign is a non-profit organization focused on eradicating cancer in developing countries. It represents a unique multilateral collaboration between Yale University, the Centers for Disease Control (CDC), the WHO Cancer Control Program, International Union against Cancer (UICC), the Middle East Cancer Consortium, and the Fulbright Program. The idea for NICE came from Dr. Elfiky's strong feeling that an unnecessary disparity exists between cancer statistics in developed versus developing countries. "The United States has so many new advancements for the early detection and treatment of certain cancers, but they are not being carried over on an international level. In the United States screening is a basic institutionalized part of health care, but this is not so in developing countries. It is my belief that everyone should have the access to the screening and prevention that we have," Dr. Elfiky said.
NICE is focused on the screening and prevention of breast and cervical cancers. The main goal is to raise awareness in developing countries about risk factors associated with these cancers and screening practices which can help to decrease their incidences. The pilot project was instituted in Egypt where breast cancer is the leading cancer diagnosis in females, accounting for as high as 37.6% of all reported cancers in Egyptian females. 80% of cervical cancer deaths occur in developing countries because there is limited access to screening and treatment services; 95% of women have never had a Pap smear or other cervical screening exam. The Breast Screening Program, developed by NICE, consists of two centers in Cairo where women aged 45 to 70 can receive free breast screening. A mammography van is being incorporated into future projects. The Cervical Screening Program, also developed by NICE, regularly screens women at different intervals depending on age. This means that women are provided with a more targeted and effective screening program.
In order to reach women in developing countries, like Egypt, NICE begins with reaching the general population through media outlets, the government, and education initiatives. In Egypt, USAID-Egypt, a cooperative development program between Egypt and the United States formed in 1975, played a critical role. Through USAID-Egypt, the NICE campaign increased both public and leadership awareness, communicated the breast awareness/prevention goals/activities through various media outlets, public events, and seminars, and developed relationships with hospitals in Egypt that have taken on the responsibility of cancer planning, prevention, and ultimately eradication. “One of the important factors of the initiative is not so much vaccinating the people, but also instilling within them a sense of what ‘health’ and ‘self-health’ means in an effort to empower them. The last aspect is continuity and follow-up on the long-term outcomes of these women,” Dr. Elfiky said.
Aware of the religious and cultural sensitivity present in Egypt, recommendations were sought from religious officials on how to proceed without offending the women and their families. At the same time, involving their husbands in the process helped to lessen the impacts of social and cultural misconceptions and pressures. Dr. Elfiky commented, "It is humbling to visit these countries. It makes you aware of the privileges we have here that we sometimes take for granted. You quickly realize that it's not going to be as easy as you had envisioned and it puts your willpower to the test, but in the end it was the desire to turn my dream into a truth that kept me going.”
Since the successful pilot project in Egypt, NICE is developing new strategies based on the data collected and hopes to establish a comprehensive cancer registry so they can monitor incidence and prevalence. Dr. Elfiky is now looking to bring NICE to South American and Southeast Asian countries where the incidences of breast and cervical cancers are high. He feels that it is the responsibility of those in positions of power to help decrease the burden of cancer in developing countries. “These inequalities in cancer care must be the focus of a collective action taken by those in positions to do so. We have the awesome responsibility to help those less fortunate. As advocates, physicians, health care providers, and educators, wherever we are, we need to support the efforts of decreasing the burden of cancer once and for all. Our humanity commands no less,” Dr. Elfiky said.