Fighting the Stigma of Cancer: Regional Center Aims to Improve Historically Low Rates of Detection
When 46-year old Darejan Berishvili made a routine visit to the newly-opened cancer screening center in her home town of Zugdidi, she expected to receive a clean bill of health.
However, despite having experienced no discomfort, testing revealed she had a stage two malignant tumor in her breast.
“The fact that it was discovered at still a relatively early stage is what I suppose I owe my life and current health to,” Berishvili said. After diagnosis, she had successful surgery in Kutaisi.
Medical professionals in the Georgian region of Samegrelo-Upper Svaneti, which has historically reported high rates of cancer, say that local efforts to raise awareness of the importance of routine screening are paying off.
In general, cancer screening in Georgia remains low. For example, according to 2019 data, only 18% of Georgian women had undergone breast cancer screening, compared with 40% in Greece and 80% in Finland.
“The sizeable discrepancy of the cancer mortality rates between developed and developing countries are largely down to successful early stage detection,” said Ioseb Abesadze, Director of Tbilisi’s Cancer Prevention Center. “And in that, screening plays a pivotal role.
“The developed countries of the world made every effort to make screening a popular practice, to turn it into a routine healthcare procedure, while in countries such as Georgia, we still have to convince large parts of the population of the benefits of screening.”
He said that only between 12-15% of people access cancer screening services in Georgia, whereas around 40-60% of the target population needed to be screened to effectively reduce mortality.
A lack of information, fear, and the stigma around cancer mean that many people are reluctant to even take part in screening programs. Practitioners say that a more open discussion between healthcare providers and patients is needed to change these attitudes.
“A systemic change of the perception of the problem is needed to successfully overcome this obstacle,” Abesadze said. “Communication with the target audience should be bolstered so that the correct culture of taking care of one’s health is finally introduced at the grassroots level and not looked at as something only available to those who can afford it. You should take care of your health while you are healthy because it might prove too little too late if you only start doing it once your health falters.”
Detection rates have improved since a national cancer screening program was launched in Georgia in 2008. In the early days of the program, most identified cases were already at Stage IV and largely untreatable. By 2016, cases caught at Stage I and II had significantly increased.
But awareness raising is particularly important for rural populations who have less access to medical care.
The Zugdidi Screening Center, opened in October 2019 with financial support from the Czech Development Cooperation and Caritas Czech Republic in Georgia (CCRG), aims to improve early testing for a range of common cancers for the nearly half-a-million people living in Samegrelo-Upper Svaneti.
The region has reported relatively high rates of cancer in recent decades. Some experts attribute this to the consequences of the Chernobyl disaster 34 years ago; this western part of Georgia was believed to have been badly affected by the subsequent radioactive cloud.
There is also a large proportion of internally displaced people (IDPs) from previous rounds of conflict in Georgia.
“The Samegrelo region and particularly the city of Zugdidi are the most densely IDP populated areas in Georgia,” said Rema Ghvamichava, director of the Zugdidi screening center. “That’s why around 35-40% of those depending on the Zugdidi Screening Center are IDPs. Among this, around 10% are from Abkhazia.”
Tamuna Kurtanidze, project manager at CCRG, agreed that the center had been a game-changer for IDPs, refugees and residents of Abkhazia who had since gained access to facilities that were otherwise seriously lacking.
“Our story of establishing the screening center started almost a decade ago with an education campaign on the importance of cancer prevention and fighting cancer stigma. We continue this approach by reminding citizens to do regular check-ups even if they don’t have any symptoms. This education campaign is even more important in remote rural areas where accessibility to information is less available. To change this, we go door–to–door and from person-to person, sending the message that between 30-50% of all cancer cases are preventable if we lead a healthy lifestyle and do regular medical check-ups,” Kurtanidze said.
The center has so far provided services to more than 1,600 individuals from the Samegrelo-Upper Svaneti region. Numbers are growing, though there is still a large difference between men and women when it comes to screening. Staff note that men are more likely to attend the center after someone in their village is diagnosed and treated for cancer.
By Vazha Tavberidze
Ioseb Abesadze, the Director Tbilisi's Cancer Prevention Center. (Photo: Vazha Tavberidze)