Dr Iman Eweis, a radiologist specialising in breast imaging at a women and foetal imaging clinic in Cairo, has observed that many women at a younger age are prone to breast cancer and that Egypt has a lower age threshold compared to other countries in the world.
“Breast cancer is a public health problem in Egypt,” she highlights. “October being Breast Cancer Awareness Month, I want to request the government to work hard towards this issue and design solutions and better pathways for women for breast cancer.”
A speaker at Omnia Health Live Africa, Dr Eweis is part of the national women's health outreach programme in Egypt and has graduated from Mansoura University Medical School in 2009. The doctor shares that during her first year of service in primary healthcare, she received many women with breast complaints who didn't know where to go or what examination was suitable for them.
“I didn't have any directory of where to refer them to and noticed the huge gap women had to face to access breast healthcare. So, I decided to address this problem, and continued my postgraduate studies in radiology and breast imaging to be a part of better breast healthcare in Egypt and give the women the care they deserve,” she says.
Enhanced breast care
The doctor emphasises that the role of imaging is based on detecting and diagnosing different breast diseases not only cancer. But when it comes to breast cancer, more sensitive modalities in the pre-operative assessment are needed especially when a multi-focal disease or bilateral disease is suspected. “We need imaging for patient follow up in neu-adjuvant therapy, and for patients follow up after surgery. And we need it again when patients survive and are back to their routine annual screening,” she adds.
When asked about how to ensure consistency in image interpretation, she advises and follows BI-RADS, which stands for Breast Imaging Reporting and Database System. It is a scoring system like tool for the abnormalities found in the breast in daily practice. It is a helpful and evidence-based method that helps monitor performance and improve the quality of reporting and communication with clinicians. It is a tool provided by the American College of Radiology and is being used worldwide.
Moreover, technology has also enhanced the field of imaging and is improving the quality of examinations such as breast density. In breast imaging, she explains, every woman has her own breast texture and many women present with dense breasts, which lowers the 2D mammography sensitivity and hides small masses. But digital breast tomosynthesis, which is performed through the same mammography machine, helps a lot more in detecting invasive disease in the dense breast at an earlier stage, as this could have been missed out with conventional 2D images.
Dealing with radiation exposure
Dr Eweis says that she often receives questions from patients about radiation exposure. “We need to agree on something here – mammography saves lives,” she stresses. “The radiation dose that women get exposed to in a full examination is quite low, even lower than the natural radiation that we get exposed to in our daily life. It is almost equal to radiation received in a four-hour round-trip flight. Till today, there is no scientific evidence of breast cancer-associated risk with mammography radiation following the guidelines of annual screening even in high-risk women. We need to end the confusion around this issue and help women get screened annually starting at the age of 40 because saving a woman's life is what really matters!”
When it comes to other examinations besides mammography, the doctor highlights that guidelines are in place and all examinations are not requested in one go and distance is maintained between keeping each course into consideration.
She concludes: “I wish one day women in the Arab countries would have access to breast care that addresses their need, and that they can receive an annual screening without worrying about the cost or the distance. I wish we could all work together for better healthcare for all women in our region.”
Omnia Health Live Africa
Dr Eweis will be a panellist at ‘The impact of COVID-19 on breast cancer management’ on Wednesday, October 14, 14:00 CAT at Omnia Health Live Africa.
The presentation will feature members from The Egyptian Society of Radiology and Nuclear Medicine and The Egyptian Society of Breast Imaging on how the pandemic has affected breast imaging practice and the management of breast cancer patients.
“It is a very important topic, as breast cancer radiology services were held back during the pandemic outbreak in Egypt,” says Dr Eweis. “We experienced fewer working hours and limited personnel at the clinic. We could only deal with one case at a time. Also, the patients didn’t want to leave the house due to the fear of contracting the virus. This reflected in some of the patients' results when they came in later for their routine screening. In some cases, this delayed intervention for a palpable abnormality, and we found many patients with a later stage of the disease at presentation, so COVID-19 has had a significant impact on our practice and patient outcomes.”