KAMPALA, Uganda — Mary Namata unbuttoned her dress in an examining room at Mulago Hospital, revealing a breast taut and swollen with grape-size tumors that looked as if they might burst through the skin.
"How long have you had this?" a doctor asked gently. Ms. Namata, 48, an elegant woman with stylishly braided hair and a flowing, traditional Ugandan dress, looked away, shamefaced.
"About a year," she murmured. The truth, she admitted later, was closer to four years.
Such enormous tumors, rare in developed countries, are typical here. Women in Uganda, trapped by stigma, poverty and misinformation, often do not see help for breast cancer until it is too late.
For Ms. Namata, though, there was still hope that the cancer had not yet spread beyond the breast, her doctors said. Treatment could prolong her life, maybe even cure her — if it started soon.
But would she be treated in time? Women in Africa often face perilous delays in treatment as a result of scarce resources, incompetence and corruption. Would Ms. Namata wind up like so many women here, with disease so far gone that doctors can offer nothing but surgery to remove rotting flesh, morphine for pain and antibacterial powder to kill the smell of festering tumors that break through the skin?
Cancer has long been neglected in developing countries, overshadowed by the struggle against more acute threats like malaria and AIDS. But as nations across the continent have made remarkable progress against infectious diseases once thought too daunting to tackle, more people are living long enough to develop cancer, and the disease is coming to the forefront. Given the strides poor countries have made against other health problems, they should also be able to improve the treatment of cancer, public health experts increasingly say.
Two years ago, the United Nations began a global campaign against noncommunicable diseases — cancer, diabetes, heart and lung disease — noting that they hit the poor especially hard. Worldwide, at least 7.6 million people a year die from cancer, and 70 percent of those deaths occur in poor and moderate-income countries, according to the World Health Organization.
Breast cancer takes a particularly harsh toll. It is the world's most common cancer in women and their leading cause of cancer death, with 1.6 million cases a year and more than 450,000 deaths.
Survival rates vary considerably from country to country and even within countries. In the United States, about 20 percent of women who have breast cancer die from it, compared with 40 to 60 percent in poorer countries. The differences depend heavily on the status of women, their awareness of symptoms and the availability of timely care. At the same time, scientists' deepening insights into the genetic basis of cancer have introduced a complicated new dimension into the care of women globally.
Uganda is trying to improve the treatment of all types of cancer in ways that make sense in a place with limited resources. A new hospital and clinic, paid for by the Ugandan government, have been added to the Uganda Cancer Institute in Kampala, though they have not yet opened, for lack of equipment. A research center is being built.
But women like Ms. Namata, with breast cancer so advanced that there is just a tiny window of time, if any, in which to save their lives, will be among the toughest challenges here.
"The terrible part about breast cancer is that if we just did what we already know how do in other places, we could make major shifts in survival," said Dr. Benjamin O. Anderson, who heads the Breast Health Global Initiative, based at the Fred Hutchinson Cancer Research Center in Seattle.
There is a pressing need for action because breast cancer is "escalating," the initiative says, predicting that incidence and death rates in developing countries will increase by more than 50 percent in the next 20 years.
The breast cancer rate in Africa seems to be increasing, though cervical cancer kills more women in the sub-Saharan regions. It is not clear whether breast cancer is actually becoming more common, or is just being detected and reported more often, but physicians consider it a looming threat. Compared with breast cancer patients in developed countries, those in Africa tend to be younger, and they are more likely to die, in large part because of late diagnosis and inadequate treatment.
Doctors also suspect that more aggressive types of tumors may be more common in young African women, as they appear to be in young black women in the United States, though there is not enough pathology data from Africa to know for sure. Among women who die young (ages 15 to 49) from breast cancer, 72 percent are in developing countries, and many leave small children.
"The story of breast cancer here is a miserable one," said Dr. Fred Okuku, an oncologist at the Uganda Cancer Institute in Kampala, which treats about 200 women a year for breast cancer. "There is little information for the people who need to be helped. Only a few know how to read and write. Many don't have TV or radio. There is no word for cancer in most Ugandan languages. A woman finds a lump in her breast, and cancer doesn't cross her mind. It's not in her vocabulary."
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