Harvard researchers have noticed an unusual increase in the number of women with breast cancer in developing countries. So they have spearheaded an international drive to expand research and gather relevant statistics to begin to address the problem.
In the U.S., people race to raise money for breast cancer research. Celebrities endorse fundraisers. And women with breast cancer talk about it openly, including two former First Ladies who spoke publicly about their cancers, Betty Ford in 1972 and Nancy Reagan more than a decade later.
"The common thought until very recently was that this is a disease only of wealthy women and wealthy countries," said Harvard University's Felicia Knaul.
She heads a program at Harvard University which aims to find a way to provide cancer care, including breast cancer, to more people in developing countries.
Harvard research shows that more than half of the 450,000 people who died from breast cancer last year lived in developing countries.
"If a woman gets breast cancer in the developing world, they [she] has a much higher probability of dying than a woman who gets breast cancer in the developed world," added Knaul.
Dr. Elmer Huerta at Washington Hospital Center sees many Hispanic patients. He says part of the problem with breast cancer is the disease itself.
"Breast cancer is a silent condition. It doesn't hurt when it's growing," said Dr. Huerta.
Dr. Huerta says many Latin and South American communities do not have mammography machines, and there is a general lack of knowledge about the disease.
"So if you have a combination of a silent condition, a combination of lack of access to early detection methods, then what you get, when women find they have something, usually the tumor has grown, has metastasized," added Dr. Huerta. "And then they seek medical care and it is too late."
Dr. Shawna Willey has seen the same thing in Nigeria.
"Economics is the biggest barrier. This is a base population that is very poor," noted Willey.
And it is a cash society.
"It's all pay as you go," added Willey. "So if they wanted to have a biopsy done, they had to arrive at the hospital with cash in their hand. The same would be true if they were to have a mammogram done."
Knaul would like to reduce costs by training local examiners.
"To do a good breast clinical exam, you do not require an oncologist," said Felicia Knaul. "You need someone who's been properly trained, and it's not that difficult to get this training."
Barriers to treatment differ from country to country. In some countries, the disease is stigmatized. Doctors might not even discuss it with a woman who has breast cancer.
Harvard is working with officials and medical experts in many parts of the world to identify the barriers and help countries eliminate them so women can be screened and diagnosed in the early stages when breast cancer can still be treated.