Hungary's Cancer Rate Highlights ‘Health Gap’ Between Regions
BUDAPEST—Marta Haranth's grandmother died of lung cancer. A close cousin died of lung cancer. Her only son is a chain-smoker and she fears he may be at risk. Her brother-in-law was recently diagnosed with prostate cancer. And Haranth herself lost her right breast to cancer, in an operation whose complications lead her sometimes to wear an elastic bandage on her right arm for pain relief.
Statistically speaking, she can count herself among the fortunate. So
far, she has survived. In a region where cancer remains largely a
taboo subject, where screening programs and treatment are inadequate,
many women hide the disease from their families until it's too
There's a large number of women who don't want to
know if they have problems, Haranth said.
But they do have problems. Her family's medical history shows how Hungary, like much of Eastern Europe, seems stuck on the losing side of the war on cancer.
As Hungary and nine other countries prepare to join the European Union
next May, the bloc's leaders are paying much attention to closing
wealth gap between the low-income, former communist East
and the affluent West. But little has been said about the equally wide
health gap. Cancer may be its most dramatic indicator.
Hungary ranked first in the world for the rate of cancer deaths among men and women in 2000, according to the American Cancer Society. For men, other Eastern European countries held the second through seventh places.
Lung cancer is the most common cause of death among Hungarian men, while for women, breast cancer comes first followed closely by rectal cancer and lung cancer.
A person born in Hungary, the Czech Republic, Slovakia or Poland is likely to have a shorter life than someone born in Sweden, Italy, Spain or France. The probability of a Swedish man making it from birth to age 65 is about 84.8 percent, but for a Hungarian man, it is just 59 percent.
We can state that there is an epidemiological crisis in
Hungary, said Otto Szabolcs, deputy director of the National
Institute of Oncology in Hungary.
Breast cancer is something of an anomaly. Chances that a given woman
will contract it are about 60 percent higher in the West than in the
East. But deaths from that form of cancer are declining in the Western
thanks to improved diagnosis and services, said
Pisani Paola, an epidemiologist with the International Agency for
Research on Cancer in Lyon, France.
In the East, that hasn't
taken place yet. Mortality
is going up in most Eastern
European countries, Paola said.
Researchers say the reasons for Hungary's high rates of most kinds
of cancer include lifestyle and diet—
very tasty, but high in
fat and also poor in fruits and vegetables, Szabolcs said. And
there are environmental factors, such as chemicals, pesticides and
other pollutants that were poorly handled during the communist
era's efforts toward industrialization.
The country's communist officials also left behind a threadbare health care system with equipment that barely functions and doctors so poorly paid that most expect cash in an envelope from patients to top off their government salaries.
Today the Eastern countries remain poorer than the Western countries and spend a lower portion of their wealth on health care. Germany spends $2,422 per person on health care each year, according to the World Bank, while Hungary spends about $315 and Poland just $246.
After they join the EU in May, the 10 new countries—Cyprus, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Malta, Poland, Slovakia and Slovenia—will get money from the bloc to aid farmers, build infrastructure and reinforce porous borders. But next to no EU aid will directly target the health gap, because under the EU system, spending on health care remains the purview of national governments.
Under EU rules, licensed medical practitioners will have the right to work anywhere in the union—but that might lead to a drain of health care professionals, particularly nurses, from the East. Patients theoretically will also have the right to move anywhere within the EU for treatment and have their national insurance system pick up the cost, but that right is now generally limited to emergency cases, usually if someone becomes ill while traveling.
There will be a disparity, not because anyone in the ascension
countries is any less intelligent, but because their health care
systems are still in transition, said Nancy Brinker, the recently
departed U.S. ambassador to Hungary and a breast cancer
There's a finite amount of resources. The health care
in place is very spotty. There's little privatized care. And
physicians are not rewarded.
Brinker, founder of the Susan G. Komen Breast Cancer Foundation, named
after her sister who died of the disease, used her tenure as
ambassador here to try to raise public awareness of breast
cancer. Recalling the startled looks she got when she openly discussed
her own cancer in speeches, Brinker said that
breast cancer is not
a subject that is spoken of very widely.
In Western Europe, breast cancer screening is saving lives. Sweden, for example, has one of the most advanced programs. It was begun in the mid-1980s, and the country has recorded a slow and steady decline in breast cancer deaths for nearly 20 years, said Jonas Bergh, a professor at Sweden's Karolinska Institute.
In France, which has a high breast cancer rate, women beginning in their thirties can get a free mammogram every two years. Starting at age 50, women receive a letter inviting them in for a yearly breast cancer screening.
It was that letter, and that screening, that may have saved Sylvie
Noll's life, or at least her breast.
I received the letter and
said, ‘Why not?’ said Noll, 54, who lives in
Corbeil-Essones, just south of Paris. Medical workers found a very
small lump, only about a quarter inch across, and it was removed
I was very lucky, she said.
It was very, very
small. There were no complications.
But such screening is still rudimentary in the East, and even where it exists, participation is low. A new nationwide program is in place in Hungary, but it has only 65 centers for approximately 3 million women in the at-risk 45-65 group. Only about 45 percent of that group takes part; doctors said they will need a 70 percent participation rate if mortality rates are to fall.
Cervical cancer screening goes back decades in Hungary, but doctors said it has been mostly ineffectual and disorganized. A new cervical cancer screening process will begin in September, but colon and rectal screening will wait until next year. And a battle continues between the government and the national insurance fund over who will pay.
Marta Haranth underwent her mastectomy in April 1992. When she first noticed the lump in her breast, she knew it would be smart to go for a biopsy. But the lines at the public hospital were long, and the wait could take a full day—time she couldn't afford to take off from her job.
Instead, Haranth relied on a quick test from a private laboratory she saw advertised on television. Run by a television repairman-turned-healer, the lab claimed it could tell if a person had cancer simply by analyzing a drop of blood. After her test, she was told she was cancer-free.
But the lump didn't go away, and when Haranth finally went to a specialist, it had grown to about six-tenths of an inch, leaving no recourse but mastectomy.
Haranth has since become an advocate of regular cancer screening. But when it comes to bringing subjects once thought taboo into the open, Haranth is finding the toughest job is convincing her own family.
Her sister Eva, 68, refuses to go for regular screenings, insisting
it won't happen to her, Haranth said.
My sister says she
doesn't want to know. . . . She says, ‘Leave me
alone. Don't deal with this topic.’ I explained to her that
she's at risk, but she says, ‘Leave me alone.’
Eva's husband, Tibor, 70, a teacher in a music school, was diagnosed with prostate cancer but has refused to go for treatment. Her brother-in-law continues to delay treatment for the same disease because he is busy with the school term.
And Haranth's son, Gabor, 43, is a
a passionate smoker. But
he refuses his mother's entreaties to quit. Haranth said that when
she tells him he might get lung cancer, he replies,
You have to die
Changing the way of life is what can be effective, said Otto
Until the social acceptance changes—until smokers
feel they are not accepted in their circle of friends—until that
changes, there will not be any real effect.
The first time Anna Vaskor was diagnosed with breast cancer, she was
58. That was 17 years ago, and she recalls going into state of
I closed down, she said. But she survived and
afterward decided to try to help other women facing cancer, and to
become an advocate of early detection and prevention.
At 76, she travels around Hungary to attend workshops and take part in
fashion shows to demonstrate how mastectomy patients can still wear
evening gowns and swimsuits with the use of prosthetic devices. She
takes a prosthetic breast to meetings in rural areas, to teach women
how to check for lumps.
Vaskor still needs all her optimism. In January, doctors found a small
lump on her lung, and after four chemotherapy sessions, she has lost
most of her hair and wears a wig. She was slated to have six sessions,
but the doctors stopped when they saw that her cancer was gone.
I have now beaten cancer for the second time, she said.
will to win this.