Tbilisi resident Maya Sartania was already in the third stage of breast cancer when, some 14 years ago, she went to a doctor to see about a lump in her chest. An immediate mastectomy saved her life, but not all Georgian women are as lucky.
According to a study financed by the United States Agency for International Development, Georgian women diagnosed with breast cancer, the leading cause of death among women between the ages of 14 and 49, have only an 18 percent chance of surviving beyond five years.
Local doctors blame that low survival rate on a mix of limited options for early detection and effective treatment, as well as low public awareness about breast cancer. With Georgia’s healthcare system still in reform flux, those numbers may not improve soon. Some 613 women succumbed to the disease in 2011, according to the National Cancer Center; 9,139 are battling on.
Much of the problem has to do with timing. Most women diagnosed with breast cancer are already at stages of the disease when treatment is “absolutely unsuccessful,” commented Lela Sturua, head of the Non-Communicable Diseases Division at the government-run National Center for Disease Control and Public Health in Tbilisi. In 2010, 580 of the 1,057 newly diagnosed breast cancer cases registered were at the later, more severe stages three and four.
The government and United Nations Population Fund (UNFPA) now provide a free screening program nationwide to promote early detection of breast and cervical cancer among women from 40 to 70 years old. But access to other forms of detection often depends on a patient’s wallet. One Tbilisi oncologist said that the government pays for fine-needle aspiration biopsies and some ultrasounds, but noted that screening for a genetic predisposition to breast cancer is “too expensive for Georgia.”
Still, the screening program, which comes complete with a mammogram van for outlying towns and villages, has had some effect. Eighty-two percent of the Tbilisi women diagnosed with breast cancer via the program in 2011 were still at stages one and two of the disease, compared with 49 percent in 2008, according to UNFPA.
Raising public awareness about the importance of early detection is not just a matter of money. Breast cancer survivor Sartania, one of the first public advocates for mammograms, says that the disease is still “a taboo topic, just starting to open up.”
Georgian women who are diagnosed with breast cancer often have trouble obtaining adequate treatment. “There isn’t good access to quality treatment. There are healthcare problems, surgeons and nurses are undertrained, equipment is outdated or non-existent, there are insurance problems,” complained Giorgi Dzagnidze, the head of the Breast Unit at Tbilisi’s private Simon Khechinashvili University Hospital.
The Ministry of Health did not respond to repeated requests from EurasiaNet.org for comment about Georgia’s breast cancer treatment facilities.
President Mikheil Saakashvili, a doctor’s son, routinely promotes healthcare reform. Georgia saw per capita public healthcare expenditures more than triple between 2001 and 2008 – from 115 lari ($69.27) to 379 lari ($227.24), according to an NCDC report. But the country still has a long way to go before it can completely shed its Soviet healthcare legacy. Tbilisi oncologist Nino Kartvelishvili claims existing pathology labs are still “low standard.” The government reportedly plans to build a new laboratory, she added.
Choices for radiotherapy clinics in Georgia, meanwhile, are limited to an older, free-of-charge facility in Tbilisi, and a nearby private clinic where fees start at about $5,000 – roughly the average per capita annual income. Costs for chemotherapy vary. For the fortunate few who can afford it, foreign treatment is a preferred option. After a 2008 mastectomy, Nino Sekhniashvili, president of the breast-cancer awareness organization Europa Donna Georgia, traveled on her doctor’s advice to Istanbul -- a two-and-a-half-hour flight from Tbilisi. To cover the costs of treatment – a sum she estimates at about $30,000 – Sekhniashvili sold her Tbilisi apartment. “I was lucky. I had something to sell. Many women have nothing,” she said.
The Georgian government provides state-funded medical insurance to about a million low-income citizens, about 22 percent of the country’s overall population. But state coverage won’t pay for all forms of breast-cancer treatment and support. Reconstructive surgery and psychological counseling for breast cancer patients go uncovered, according to Dzagnidze.
As for the country’s 10 private insurers, coverage can also be spotty, claimed Dzagnidze, adding that the system placed a burden on patients, who must physically bring a document to the insurance company after each test and doctor’s visit to claim reimbursement. Georgia’s postal system is generally unreliable.
Lasha Bazaradze, general director of Alpha Insurance, one of Georgia’s largest private insurers, believes that insurance companies should focus on preventing breast cancer. “The Georgian insurance system is just beginning and oncology prevention is at a weak level. We know that a good prevention system brings good results and we’re just starting to work on that,” he said.
Kartvelishvili, the Tbilisi oncologist, said prevention and care should be seen as part of the same package. “Screening needs good treatment to go with it,” she said. “Otherwise, what good is it?”