Breast cancer remains the most commonly diagnosed cancer among women globally. Due to a lack of early interventions, most women in low- and middle-income countries have advanced disease at the time of diagnosis, conferring a grim prognosis. Yehoda M. Martei, MD, of the Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, has done extensive research in areas of Sub-Saharan Africa to determine, among other things, ways to design effective educational and cancer control programs.
Yehoda M. Martei, MD
Dr. Martei was born and raised in Accra, the capital and largest city in Ghana. “After graduating from high school, I received a full scholarship to study at the United World College of the Atlantic in the United Kingdom, which expanded my educational opportunities,” explained Dr. Martei. “There I did my 2-year international baccalaureate work, before applying to universities. I applied to colleges in the United Kingdom and the United States. I didn’t know exactly what career I wanted, but, like a lot of African families, my parents wanted me to go into medicine.”
Seeking the Best Medical Education
Dr. Martei decided to go to the United States, where she began premed studies at Harvard University. Asked how her parents felt about her relocating to such a distant country, Dr. Martei said, “Like all parents, they wanted to be as close to their children as possible. But they also wanted me to have the best educational opportunity possible. So, they were very supportive of my move to the United States.”
She continued: “Even though I was doing premed work, I still wasn’t settled on becoming a doctor. So, I took 2 years off to work as a research assistant at Mass General Hospital, which was an eye-opening experience that sparked my interest in oncology. I found it extremely interesting to be around multidisciplinary oncology teams providing clinical care with state-of-the-art therapies. I saw exciting possibilities in a career in oncology—a field that was rapidly evolving, developing promising new therapeutics, and advancing the scientific knowledge of cancer genetics and biology.”
After Dr. Martei decided to become an oncologist, she entered Yale University to pursue a medical degree, which she attained in 2011. “Growing up in Ghana, I was always interested in global health issues that affect low-income countries, especially in sub-Saharan Africa. I thought about pursuing a career in infectious diseases such as human immunodeficiency virus (HIV)/AIDS. But I was really drawn to oncology, and then it also occurred to me that there were significant gaps in knowledge and access to high-quality cancer care, as well as opportunities to improve care in low-resource settings. So, after my first year of medical school, I decided to study various access and oncologic challenges women in resource-restricted countries like Ghana face,” said Dr. Martei.
“The fear of mastectomy [by Ghanaian women] was definitely the most shocking finding to me personally."— Yehoda M. Martei, MD
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Dr. Martei described her university experience in New England as transformative. “I went to schools in Ghana and the United Kingdom that attracted smart, motivated people, but studying at universities such as Harvard and Yale was different. It was actually humbling, but in a good way. I felt like I was part of a history of top education, and being part of that was a special experience that challenged me to always strive for excellence. It was a very rewarding time for me.”
Work in the Field
Dr. Martei noted the lack of substantive studies examining access-to-care issues and barriers to preventive services such as mammography and other screening modalities in low- to middle-income countries; this is one reason so many women in these areas present with advanced breast cancer at the time of diagnosis. She investigated this issue in a study designed to characterize the sociocultural factors associated with delayed presentation of breast cancer in women living in Ghana.
“We used interviews of patients with breast cancer seen at the Korle-Bu Teaching Hospital in Accra. We did the interviews in English and three local languages,” she shared. “We found several recurrent themes associated with delayed presentation of disease, such as not thinking a painless lump could be cancer, the societal stigma associated with breast cancer, and perhaps most compelling was a fear of mastectomy due largely to personal and societal stigma.”
Dr. Martei continued: “The fear of mastectomy was definitely the most shocking finding to me personally. In my mind, if a woman is diagnosed with nonmetastatic breast cancer and mastectomy is her best option for survival, that is the only clear choice I could understand. However, for some Ghanaian women, it was not as clear a choice because there are multiple factors in their decision such as loss of femininity and sexuality.”
She shared some discussions she had with Ghanaian women with breast cancer. “I spoke to an older woman who had a mastectomy, and she elucidated the underlying issues women face. She said it was socially less painful for an older woman to have a mastectomy, but a much more difficult decision for a younger woman, because it diminishes her desirability and chance for marriage. Another woman said that she would rather die with two breasts than live with one. A third woman who had initially consented to a mastectomy expressed regrets, stating that ‘my husband even wanted a divorce because he said I had been maimed.’”
As a woman from Ghana, Dr. Martei said she found these attitudes shocking. “These societal realities highlighted the need for an educational campaign to empower women about their breast health,” she explained.
Global Oncology Philosophy Needed
Dr. Martei reflected on global disparities in care. “In the United States, I work in an institution in which patients are receiving state-of-the-art cancer care. They are living longer with better quality of life than ever before. However, when I get on a plane and fly 16 hours to Botswana, where I’m currently working, the clinical reality is starkly different, and it emphasizes the vast gap in access to high-value cancer treatment that exists on a global scale. Unlike in the United States, in Botswana, there is a shared sense of fatality that comes with a cancer diagnosis.”
“We need to shift gears and begin thinking about how to implement sustainable programs for cancer control and continuums of care, within the framework of available resources.”— Yehoda M. Martei, MD
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Dr. Martei noted that over the past decade or so, there have been a number of publications and policy statements addressing the growing global cancer burden, but much more awareness and work are needed. “We need to shift gears and begin thinking about how to implement sustainable programs for cancer control and continuums of care, within the framework of available resources.”
Asked for a closing thought, Dr. Martei said, “I believe we need more global leaders involved in research and implementation of reality-based solutions that fit within the cultural context of each specific area. Moreover, if there were more emphasis in medical school training on global health, it would empower young doctors to engage in this vital and rewarding field. It teaches you to do the best with less, which is a valuable lesson for all of oncology.” ■
DISCLOSURE: Dr. Martei reported no conflicts of interest.